Isifo samathambo

I-rheumatoid arthritis (RA) yisifo esiholela ekuvukeleni kwamalunga nezicubu ezizungezile. Kuyisifo sesikhathi eside. Kungathinta nezinye izitho zomzimba.

Imbangela yeRA ayaziwa. Kuyisifo esizimele. Lokhu kusho ukuthi amasosha omzimba ahlasela ngephutha izicubu ezinempilo.

I-RA ingenzeka nganoma yisiphi isikhathi, kepha ivame kakhulu eminyakeni yobudala obuphakathi. Abesifazane bathola i-RA kaningi kunabesilisa.

Ukutheleleka, izakhi zofuzo, kanye nokushintsha kwamahomoni kungaxhunyaniswa nalesi sifo. Ukubhema nakho kungaxhunyaniswa neRA.

Akuvamile kakhulu kune-osteoarthritis (OA). I-OA okuyisimo esenzeka kubantu abaningi ngenxa yokugqoka nokudabuka emajoyintini njengoba ekhula.

Isikhathi esiningi, i-RA ithinta amalunga ezinhlangothini zombili zomzimba ngokulingana. Iminwe, izihlakala, amadolo, izinyawo, izindololwane, amaqakala, izinkalo namahlombe yizona ezithinteka kakhulu.

Lesi sifo sivame ukuqala kancane. Izimpawu zokuqala zingafaka:

• Ubuhlungu obuncane obuhlangene
• Ukuqina
• Ukukhathala

Izimpawu ezihlangene zingabandakanya:

• Ukuqina kwasekuseni okuhlala isikhathi esingaphezu kwehora elilodwa, kuvamile.
• Amalunga angazizwa efudumele, ethambile futhi eqinile uma engasetshenziswanga ihora.
• Ubuhlungu obuhlangene buvame ukuzwa ngokuhlanganyela okufanayo ezinhlangothini zombili zomzimba.
• Amalunga avame ukuvuvukala.
• Ngokuhamba kwesikhathi, amalunga angalahlekelwa ukuhamba kwawo futhi angakhubazeka.

Ezinye izimpawu zifaka:

• Ubuhlungu besifuba lapho uphefumula (pleurisy)
• Amehlo omile nomlomo (iSjögren syndrome)
• Ukushisa kwamehlo, ukulunywa nokukhipha
• Amaqhubu ngaphansi kwesikhumba (imvamisa uphawu lwesifo esibi kakhulu)
• Ukuba ndikindiki, ukushosheka, noma ukushisa ezandleni nasezinyaweni
• Ubunzima bokulala

Ukuxilongwa kwe-RA kwenziwa lapho:

• Unobuhlungu nokuvuvukala kumajoyinti ama-3 noma ngaphezulu.
• I-arthritis ibikhona isikhathi esingaphezu kwamasonto ayisithupha.
• Uhlolwa kahle i-rheumatoid factor noma i-anti CCP antibody.
• Unyuse i-ESR noma i-CRP.
• Ezinye izinhlobo ze-arthritis zikhishwe ngaphandle.

Kwesinye isikhathi ukuxilongwa kwe-RA kwenziwa ngaphandle kwazo zonke izimo eziboniswe ngenhla uma isifo samathambo singajwayelekile kuRA.

Akukho sivivinyo esinganquma ngokuqinisekile ukuthi unayo yini i-RA. Iningi labantu abane-RA lizoba nemiphumela yokuhlolwa engajwayelekile. Kodwa-ke, abanye abantu bazoba nemiphumela ejwayelekile kukho konke ukuhlolwa.

Ukuhlolwa okubili kwelebhu okuhle kubantu abaningi futhi okuvame ukusiza ekutholeni ukuxilongwa yile:

• Isici se-rheumatoid
• I-anti-CCP antibody

Lezi zivivinyo zihle ezigulini eziningi ezine-RA. Ukuhlolwa kwama-anti-CCP antibody kucaciselwe i-RA kakhulu.

Olunye uvivinyo olungenziwa lubandakanya:

• Qedela ukubalwa kwegazi
• Iphaneli leMetabolic kanye ne-uric acid
• Amaprotheni asebenza ngoku-C (CRP)
• Izinga le-sedimentation ye-Erythrocyte (ESR)
• I-antibody ye-Antinuclear
• Ukuhlolwa kwe-hepatitis
• Ama-x-ray ahlangene
• I-ultrasound ehlangene noma i-MRI
• Ukuhlaziywa oketshezi okuhlangene

I-RA imvamisa idinga ukwelashwa kwesikhathi eside ngungoti wesifo samathambo obizwa nge-rheumatologist. Ukwelashwa kufaka:

• Imithi
• Ukwelashwa ngokomzimba
• Ukuzivocavoca umzimba
• Imfundo ukukusiza uqonde uhlobo lwe-RA, izinketho zakho zokwelashwa, kanye nesidingo sokulandelwa okujwayelekile.
• Ukuhlinzwa, uma kudingeka

Ukwelashwa ngaphambi kwesikhathi kwe-RA ngemithi ebizwa ngokuthi yimishanguzo yokuguqula izifo (i-DMARDS) kufanele kusetshenziswe kuzo zonke iziguli. Lokhu kuzonciphisa ukubhujiswa ngokuhlanganyela futhi kuvimbele ukukhubazeka. Umsebenzi we-RA kufanele uhlolwe ekuvakasheni okuvamile ukuqinisekisa ukuthi lesi sifo siyalawulwa. Inhloso yokwelashwa ukumisa ukuqhubeka kwe-RA.

IMITHI

Imithi elwa nokuvuvukala: Lokhu kufaka phakathi i-aspirin kanye nemithi yokulwa nokuvuvukala (ama-NSAID), njenge-ibuprofen, naproxen ne-celecoxib.

• Le mithi isebenza kahle kakhulu ukunciphisa ukuvuvukala okuhlangene nokuvuvukala, kepha ingaba nemiphumela emibi yesikhathi eside. Ngakho-ke, kufanele zithathwe kuphela isikhathi esifushane nangamanani aphansi lapho kungenzeka.
• Njengoba zingavimbeli ukulimala okuhlangene uma zisetshenziswa zodwa, ama-DMARDS kufanele asetshenziswe nawo.

Izifo ezishintsha imishanguzo yokulwa nesifo sokuqaqamba kwamalunga omzimba (ama-DMARD): Ngokuvamile le yimithi evivinywa kuqala kubantu abane-RA. Banikezwa kanye nokuphumula, ukuqinisa ukuzivocavoca, kanye nemithi yokulwa nokuvuvukala.

• I-Methotrexate yi-DMARD esetshenziswa kakhulu kwi-rheumatoid arthritis. I-Leflunomide ne-hydroxychloroquine nayo ingasetshenziswa.
• I-Sulfasalazine yisidakamizwa esivame ukuhlanganiswa ne-methotrexate ne-hydroxychloroquine (ukwelashwa okuphindwe kathathu).
• Kungaba amasonto noma izinyanga ngaphambi kokuthi ubone noma iyiphi inzuzo kulezi zidakamizwa.
• Le mithi ingaba nemiphumela emibi kakhulu, ngakho-ke uzodinga ukuhlolwa kwegazi kaningi lapho uyithatha.
• Imithi elwa namagciwane - Leli qembu lemithi lifaka i-hydroxychloroquine (Plaquenil). Zivame ukusetshenziswa kanye ne-methotrexate. Kungaba amasonto noma izinyanga ngaphambi kokuthi ubone noma iyiphi inzuzo kulezi zidakamizwa.

ICorticosteroids - Le mithi isebenza kahle kakhulu ukunciphisa ukuvuvukala okuhlangene nokuvuvukala, kepha ingaba nemiphumela emibi yesikhathi eside. Ngakho-ke, kufanele zithathwe kuphela isikhathi esifushane nangamanani aphansi lapho kungenzeka.

Ama-biologic DMARD agents - Le mithi yenzelwe ukuthinta izingxenye zesistimu yomzimba ezibamba iqhaza enkambisweni yesifo se-RA.

• Zinganikezwa lapho eminye imithi, imethotrexate, ingasebenzi. Izidakamizwa ze-biologic zivame ukungezwa ku-methotrexate. Kodwa-ke, ngoba kubiza kakhulu, ukuvunywa komshuwalense ngokuvamile kuyadingeka.
• Iningi lazo linikezwa ngaphansi kwesikhumba noma emthanjeni. Manje kunezinhlobo eziningi ezahlukahlukene zama-biologic agents.

Ama-biologic kanye nama-synthetic agents angasiza kakhulu ekwelapheni i-RA. Kodwa-ke, abantu abathatha le mithi kufanele babhekwe ngeso elibukhali ngenxa yezenzo ezingavamile, kodwa ezimbi kakhulu:

• Ukutheleleka okuvela kubhaktheriya, amagciwane nesikhunta
• Umdlavuza wesikhumba, kepha hhayi i-melanoma
• Ukusabela kwesikhumba
• Ukusabela okweqile
• Ukwehluleka kwenhliziyo okubi
• Ukulimala kwemizwa
• Ukubalwa kwamaseli egazi amhlophe aphansi

UKUHLINZA

Kungadingeka ukuhlinzwa ukuze kulungiswe amalunga omzimba alimale kakhulu. Ukuhlinzwa kungafaka:

• Ukususwa kolwelwesi oluhlangene (i-synovectomy)
• Ukufakwa okuhlanganyelwe okuphelele, ezimweni ezimbi kakhulu, kungabandakanya ukushintshwa kwamadolo okuphelele (TKR) nokushintshwa kwe-hip.

INDLELA YOKWELAPHA EMZIMBENI

Ukuzivocavoca umzimba kanye nezinhlelo zokuzivocavoca ezinqunywe ngumelaphi womzimba kungabambezela ukulahleka kokusebenza ngokuhlanganyela futhi kusize ukugcina izicubu ziqinile.

Kwesinye isikhathi, abelaphi bazosebenzisa imishini ekhethekile ukufaka ukushisa okujulile noma ukugqugquzela ugesi ukunciphisa izinhlungu nokwenza ngcono ukuhamba ngokuhlanganyela.

Ezinye izindlela zokwelapha ezingasiza ekunciphiseni ubuhlungu obuhlangene zihlanganisa:

• Amasu okuvikela ngokuhlanganyela
• Izindlela zokushisa nokushisa
• Izipikili noma amadivayisi we-orthotic ukusekela nokuvumelanisa amalunga
• Izikhathi zokuphumula njalo phakathi kwemisebenzi, kanye namahora ayi-8 kuya kwayi-10 okulala ubusuku ngabunye

UKONDLEKA

Abanye abantu abane-RA bangaba nokungabekezelelani noma ukungezwani komzimba nokudla okuthile. Kunconywa ukudla okunomsoco okulinganiselayo. Kungaba usizo ukudla ukudla okunothile ngamafutha wezinhlanzi (omega-3 fatty acids). Ukubhema osikilidi kufanele kumiswe. Ukuphuza ngokweqile kufanele futhi kugwenywe.

Abanye abantu bangazuza ngokubamba iqhaza eqenjini lokusekela i-arthritis.

Ukuthi i-RA yakho iyaqhubeka noma cha kuya ngobukhulu bezimpawu zakho nempendulo yakho ekwelashweni. Kubalulekile ukuqala ukwelashwa ngokushesha okukhulu. Ukuvakashelwa njalo nge-rheumatologist kuyadingeka ukulungisa ukwelashwa.

Ukulimala okungapheli okuhlangene kungenzeka ngaphandle kokwelashwa okufanele. Ukwelashwa kusenesikhathi ngenhlanganisela yemithi emithathu ye-DMARD eyaziwa ngokuthi "ukwelashwa okuphindwe kathathu," noma ngemithi yokwenziwa ye-biologic noma ehlosiwe kungavimbela ubuhlungu obuhlangene nomonakalo.

Uma ingaphathwa kahle, i-RA ingathinta cishe zonke izingxenye zomzimba. Izinkinga zingafaka:

• Ukulimala kwezicubu zamaphaphu.
• Ingozi eyengeziwe yokwenziwa lukhuni kwemithambo yegazi, okuholela ezifweni zenhliziyo nemithambo yegazi.
• Ukulimala komgogodla lapho amathambo entamo elimala.
• Ukuvuvukala kwemithambo yegazi (i-rheumatoid vasculitis), engaholela ezinkingeni zesikhumba, zemizwa, zenhliziyo nezobuchopho.
• Ukuvuvukala nokuvuvukala kolwelwesi olungaphandle lwenhliziyo (i-pericarditis) nolwesifuba senhliziyo (i-myocarditis), okungaholela ekuhlulekeni kwenhliziyo okucinana.

Noma kunjalo, lezi zinkinga zingagwenywa ngokwelashwa okufanele. Ukwelashwa kwe-RA nakho kungadala imiphumela emibi kakhulu. Khuluma nomhlinzeki wakho ngemiphumela engemihle yokwelashwa nokuthi yini okufanele uyenze uma kwenzeka.

Shayela umhlinzeki wakho uma ucabanga ukuthi unezimpawu zesifo samathambo.

Akukho ukuvimbela okwaziwayo. Ukubhema kubonakala kuyimbi iRA, ngakho-ke kubalulekile ukugwema ugwayi. Ukwelashwa okufanele kusenesikhathi kungasiza ekuvikeleni ukulimala okuqhubekayo ngokuhlanganyela.

RA; Isifo samathambo - isifo samathambo

• Ukwakhiwa kabusha kwe-ACL - ukukhishwa
• Ukubuyiselwa kweqakala - ukukhishwa
• Ukufakwa esikhundleni kwe-Elbow - ukukhishwa

• Isifo samathambo
• Isifo samathambo
• Isifo samathambo

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UFleischmann R, uPangan AL, Ingoma IH, et al. I-Upadacitinib kuqhathaniswa ne-placebo noma i-adalimumab ezigulini ezinesifo samathambo kanye nempendulo enganele kwi-methotrexate: Imiphumela yesigaba III, isivivinyo esilawulwa kabili, esilawulwa ngokungahleliwe. I-Arthritis Rheumatol. 2019; 71 (11): 1788. I-PMID: 31287230 pubmed.ncbi.nlm.nih.gov/31287230.

UKremer JM, uRigby W, Umculi NG, et al. Impendulo eqhubekayo kulandela ukumiswa kwe-methotrexate ezigulini ezine-arthritis ye-rheumatoid ephathwe nge-tocilizumab engaphansi: imiphumela evela esilingo esingahleliwe, esilawulwayo. I-Arthritis Rheumatol. 2018; 70 (8): 1200-1208. I-PMID: 29575803pubmed.ncbi.nlm.nih.gov/29575803.

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U-O'Dell JR. Ukwelashwa kwesifo samathambo. Ku: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, abahleli. Incwadi kaKelley noFirestein yeRheumatology. Umhlaka 10. IPhiladelphia, PA: Elsevier; 2017: isahluko 71.

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