Buza Uchwepheshe: I-Rheumatoid Arthritis

-Delile

• UDavid Curtis, MD
• Umbuzo: Ngineminyaka engu-51 futhi ngino-OA noRA. Ngabe i-Enbrel izosiza ukulawula i-OA yami noma ingabe ingezimpawu ze-RA kuphela?
• Umbuzo: Ngine-OA enamandla futhi kwatholakala ukuthi ngine-gout. Ingabe ukudla kudlala indima ku-OA?
• Q: Bengilokhu ngithola ukuminyelwa kwe-Actemra izinyanga ezintathu, kepha bengingakutholi ukukhululeka. Udokotela wami ufuna uku-oda ukuhlolwa kwe-Vectra DA ukubona ukuthi lo muthi uyasebenza yini. Luyini lolu vivinyo futhi lunokwethenjelwa kangakanani?
• Q: Ziyini izingozi zokuphela ngokuphelele kuyo yonke imithi?
• UMBUZO: Ngine-OA ezinzwaneni zami ezinkulu no-RA emahlombe nasemadolweni. Ingabe ikhona enye indlela yokuhlehlisa umonakalo osuvele wenzekile? Futhi yini engingayenza ukuphatha ukukhathala kwemisipha?
• Q: Ingabe kwamukeleka ngasiphi isikhathi ukuya ku-ER ngezinhlungu? Yiziphi izimpawu okufanele ngabe ngiyazibika?
• Umbuzo: Isazi sami samathambo sithe ama-hormone awazithinti izimpawu, kodwa njalo ngenyanga ukugqashuka kwami ​​kuhambisana nomjikelezo wami wokuya esikhathini. Uyini umbono wakho ngalokhu?
• Joyina ingxoxo

UDavid Curtis, MD

I-rheumatoid arthritis (RA) isifo esingalapheki sokuhlasela kwamasosha omzimba. Kubonakala ngobuhlungu obuhlangene, ukuvuvukala, ukuqina, nokulahlekelwa umsebenzi ekugcineni.

Ngenkathi abantu baseMelika abangaphezu kwezigidi eziyi-1.3 behlushwa yi-RA, abekho abantu ababili abazoba nezimpawu ezifanayo noma ulwazi olufanayo. Ngenxa yalokhu, ukuthola izimpendulo ozidingayo kwesinye isikhathi kungaba nzima. Ngenhlanhla, uDkt David Curtis, MD, isazi samathambo esinelayisense esiseSan Francisco ulapha ukuzosiza.

Funda izimpendulo zakhe emibuzweni eyisikhombisa ebuzwe iziguli zangempela ze-RA.

Umbuzo: Ngineminyaka engu-51 futhi ngino-OA noRA. Ngabe i-Enbrel izosiza ukulawula i-OA yami noma ingabe ingezimpawu ze-RA kuphela?

Ukuhlalisana kwe-osteoarthritis ne-rheumatoid arthritis kuvamile ngoba sonke sizokwakha i-OA ngezinga elithile kokunye, uma kungenjalo, kwamalunga ethu esikhathini esithile empilweni yethu.

I-Enbrel (etanercept) ivunyelwe ukusetshenziswa ku-RA nakwezinye izifo ezivuthayo, ezizimele lapho kwaziwa khona ukuthi i-TNF-alpha cytokine ibamba iqhaza elibalulekile ekuqhubeni ukuvuvukala (ubuhlungu, ukuvuvukala, nokubomvu) kanye nezinto ezonakalisayo ku ithambo noqwanga. Yize i-OA inezici ezithile "zokuvuvukala" njengengxenye yezifo zayo, i-cytokine TNF-alpha ayibonakali ibalulekile kule nqubo ngakho-ke ukuvinjelwa kwe-TNF ngu-Enbrel akulindelekile futhi kuzolindeleka ukuthi kuthuthukise izimpawu noma izimpawu ze-OA .

Ngalesi sikhathi, asinazo "izidakamizwa eziguqula izifo" noma i-biologics ye-osteoarthritis. Ucwaningo lwezokwelapha lwe-OA lusebenza kakhulu futhi sonke singaba nethemba lokuthi ngokuzayo sizoba nezindlela zokwelapha ezinamandla ze-OA, njengoba senza iRA.

Umbuzo: Ngine-OA enamandla futhi kwatholakala ukuthi ngine-gout. Ingabe ukudla kudlala indima ku-OA?

Ukudla nokudla okunomsoco kudlala indima enkulu kuzo zonke izici zempilo nokuqina komzimba. Okungahle kubonakale kuyinkimbinkimbi kuwe yizincomo ezibonakalayo zokuncintisana zalezi zimo ezihlukile. Zonke izinkinga zezokwelapha zingazuza ekudleni "okuhlakaniphile".

Yize lokho ukuhlakanipha kungahluka futhi kungahluka ngokuxilongwa kwezokwelapha, futhi izincomo zabodokotela nezazi zokudla okunempilo zingashintsha ngokuhamba kwesikhathi, kuphephile ukusho ukuthi ukudla okunobuhlakani yilokho okusiza ukuthi ugcine noma uzuze isisindo somzimba esifanele, kuncike kokungalungiswa ukudla, kunothe ngezithelo, imifino, nokusanhlamvu okuphelele, futhi kuvimbela inani elikhulu lamafutha ezilwane. Amaprotheni anele, amaminerali, namavithamini (kufaka phakathi i-calcium novithamini D wamathambo anempilo) kufanele abe yingxenye yakho konke ukudla.

Ngenkathi ukugwema ngokuphelele ama-purine kungadingekile noma kunganconywa, iziguli ezithatha imishanguzo yegout zingavimbela ukutholwa kwe-purine. Kunconywa ukuthi uqede ukudla okune-purine ephezulu futhi unciphise ukudla okudliwayo ngokuqukethwe okuphakathi kwe-purine. Ngamafuphi, kungcono ukuthi iziguli zidle ukudla okubandakanya ukudla okune-low-purine. Ukuqedwa ngokuphelele kwama-purine, noma kunjalo, akunconyiwe.

Q: Bengilokhu ngithola ukuminyelwa kwe-Actemra izinyanga ezintathu, kepha bengingakutholi ukukhululeka. Udokotela wami ufuna uku-oda ukuhlolwa kwe-Vectra DA ukubona ukuthi lo muthi uyasebenza yini. Luyini lolu vivinyo futhi lunokwethenjelwa kangakanani?

Ama-Rheumatologists asebenzisa ukuhlolwa komtholampilo, umlando wezokwelapha, izimpawu, nokuhlolwa okujwayelekile kwelabhoratri ukuhlola umsebenzi wezifo. Isivivinyo esisha sha esibizwa nge-Vectra DA silinganisa iqoqo lezinto ezengeziwe zegazi. Lezi zinto zegazi zisiza ukuhlola ukuphendula kwamasosha omzimba emisebenzini yezifo.

Abantu abane-arthritis esebenzayo ye-rheumatoid (RA) engekho ku-Actemra (tocilizumab Injection) bayoba namazinga aphakeme we-interleukin 6 (IL-6). Le maki yokuvuvukala iyinto esemqoka ekuhlolweni kweVectra DA.

I-Actemra ivimba i-receptor ye-IL-6 yokwelapha ukuvuvukala kwe-RA. Izinga le-IL-6 egazini liyakhuphuka lapho i-receptor ye-IL-6 ivinjiwe. Lokhu kungenxa yokuthi akusabophekile ukuthola i-receptor yayo. Izinga eliphakeme le-IL-6 alimele umsebenzi wezifo kubasebenzisi be-Actemra. Bona. Kukhombisa nje ukuthi umuntu welashwe nge-Actemra.

Izazi ze-Rheumatologists azange zamukele kabanzi i-Vectra DA njengendlela ephumelelayo yokuhlola umsebenzi wezifo. Ukuhlolwa kwe-Vectra DA akusizi ekuhloleni impendulo yakho ekwelashweni kwe-Actemra. I-rheumatologist yakho kuzodingeka ithembele ezindleleni zendabuko ukuhlola impendulo yakho ku-Actemra.

Q: Ziyini izingozi zokuphela ngokuphelele kuyo yonke imithi?

I-Seropositive (okusho ukuthi i-rheumatoid factor is positive) i-rheumatoid arthritis cishe ngaso sonke isikhathi iyisifo esingelapheki futhi esiqhubekayo esingaholela ekukhubazekeni nasekubhujisweni ngokuhlanganyela uma kungalashwa. Yize kunjalo, kunentshisekelo enkulu (engxenyeni yeziguli nokwelapha odokotela) ekutheni ingancishiswa nini futhi kanjani futhi imiswe kanjani imithi.

Kukhona ukuvumelana okujwayelekile kokuthi ukwelashwa kwesifo samathambo kwasekuqaleni kuveza imiphumela emihle kakhulu yesiguli ngokuncipha kokukhubazeka emsebenzini, ukwaneliseka kweziguli kanye nokuvimbela ukubhujiswa ngokuhlanganyela. Kunokuvumelana okuncane kokuthi unganciphisa kanjani futhi nini futhi umise imishanguzo ezigulini ezenza kahle ekwelashweni kwamanje. Ukuqubuka kwezifo kuvamile lapho imishanguzo incishiswa noma imiswa, ikakhulukazi uma kusetshenziswa imishanguzo eyodwa yemithi futhi isiguli besisebenza kahle. Abaningi abaphatha ama-rheumatologists kanye neziguli bakhululekile ekunciphiseni nasekuqedeni i-DMARDS (njenge-methotrexate) lapho isiguli besisebenza kahle isikhathi eside kakhulu futhi sikwisayensi yezinto eziphilayo (ngokwesibonelo, i-TNF inhibitor).

Okuhlangenwe nakho komtholampilo kusikisela ukuthi iziguli zivame ukwenza kahle kakhulu uma nje zihlala ekwelashweni okuthile kepha zihlala zinama-flare abalulekile uma zimisa yonke imithi. Iziguli eziningi ezine-seronegative zenza kahle ukumisa yonke imishanguzo, okungenani isikhathi esithile, ziphakamisa ukuthi lesi sigaba seziguli singaba nesifo esihlukile kuneziguli zesifo samathambo esine-seropositive. Kuwukuhlakanipha ukunciphisa noma ukumisa imishanguzo yamathambo kuphela ngesivumelwano kanye nokwenganyelwa kwe-rheumatologist yakho yokwelapha.

UMBUZO: Ngine-OA ezinzwaneni zami ezinkulu no-RA emahlombe nasemadolweni. Ingabe ikhona enye indlela yokuhlehlisa umonakalo osuvele wenzekile? Futhi yini engingayenza ukuphatha ukukhathala kwemisipha?

I-Osteoarthritis (OA) ekuhlanganyeleni kwezinzwane ezinkulu ivame kakhulu futhi ithinta cishe wonke umuntu ngezinga elithile eneminyaka engama-60.

I-rheumatoid arthritis (RA) nayo ingathinta lejoyinti. Ukuvuvukala kolwelwesi lwelungu kubizwa ngokuthi yi-synovitis. Zombili izinhlobo ze-arthritis zingaholela ku-synovitis.

Ngakho-ke, abantu abaningi abane-RA abane-OA eyisisekelo kulokhu kuhlangana bathola ukukhululeka okukhulu ezimpawu ezinokwelashwa kwe-RA okusebenzayo, njengemithi.

Ngokumisa noma ukunciphisa i-synovitis, ukulimala koqwanga namathambo nakho kuyancipha. Ukuvuvukala okungapheli kungaholela ekuguqukeni unomphela ekubunjweni kwamathambo. Lezi zinguquko zethambo noqwanga ziyefana nezinguquko ezibangelwe yi-OA. Kuzona zozimbili lezi zigameko, ushintsho "aluguqulwa" kakhulu ngezindlela zokwelapha ezikhona namuhla.

Izimpawu ze-OA zingaxhuma futhi zinciphe, ziba zimbi ngokuhamba kwesikhathi, futhi zibhebhethekiswe ukuhlukumezeka. Ukwelashwa ngokomzimba, ukwelashwa ngezihloko nezomlomo, kanye ne-corticosteroids kungasiza ekunciphiseni izimpawu kakhulu. Kodwa-ke, ukuthatha izithasiselo ze-calcium ngeke kuthinte inqubo ye-OA.

Ukukhathala kungahlotshaniswa nemithi ehlukahlukene nezimo zezokwelapha, kufaka phakathi i-RA. Udokotela wakho angakusiza ukutolika izimpawu zakho futhi akusize uhlele ukwelashwa okuphumelela kakhulu.

Q: Ingabe kwamukeleka ngasiphi isikhathi ukuya ku-ER ngezinhlungu? Yiziphi izimpawu okufanele ngabe ngiyazibika?

Ukuya egumbini lezimo eziphuthumayo esibhedlela kungaba yinto ebizayo, edla isikhathi futhi ehlukumezekile ngokomzwelo. Noma kunjalo, ama-ER ayadingeka kubantu abagula kakhulu noma abanezifo ezisongela impilo.

I-RA ayivamile ukuba nezimpawu ezisongela impilo. Noma ngabe lezi zimpawu zikhona, zivame kakhulu. Izimpawu ezinkulu ze-RA njenge-aspericarditis, i-pleurisy, noma i-scleritis azivamile ukuba “zimbi.” Lokho kusho ukuthi abafiki masinyane (ngaphezu kwendaba yamahora) futhi kanzima. Esikhundleni salokho, lezi zibonakaliso zeRA ngokuvamile zimnene futhi ziza kancane kancane. Lokhu kukuvumela isikhathi sokuxhumana nodokotela wakho oyinhloko noma i-rheumatologist ukuthola iseluleko noma ukuvakashelwa ehhovisi.

Izimo eziningi eziphuthumayo kubantu abane-RA zihlotshaniswa nezimo ezi-comorbid ezinjenge-coronary artery disease noma isifo sikashukela. Imiphumela emibi yemithi ye-RA oyithathayo - njengempendulo yokungezwani komzimba - ingaqinisekisa uhambo oluya e-ER. Lokhu kuyiqiniso ikakhulukazi uma ukusabela kunzima. Izimpawu zifaka imfiva ephezulu, ukuqhuma okukhulu, ukuvuvukala komphimbo, noma ukuphefumula kanzima.

Okunye ukuphuthuma okungahle kube yinkinga exhumanayo yemithi yokuguqula izifo kanye nemithi ye-biologic. I-pneumonia, ukutheleleka kwezinso, ukutheleleka kwesisu, kanye nokutheleleka kohlelo lwezinzwa oluphakathi kuyizibonelo zezifo ezinzima eziyimbangela yokuhlolwa kwe-ER.

Umkhuhlane omkhulu kungaba uphawu lokutheleleka nesizathu sokubiza udokotela wakho. Ukuya ngqo ku-ER kuwukuhlakanipha uma kukhona ezinye izimpawu, njengobuthakathaka, ukuphefumula okunenkinga, nobuhlungu besifuba obukhona ngomkhuhlane omkhulu. Ngokuvamile kuwumqondo omuhle ukubiza udokotela wakho ukuze uthole iseluleko ngaphambi kokuya ku-ER, kodwa uma ungabaza, kungcono uye ku-ER ukuze uhlolwe ngokushesha.

Umbuzo: Isazi sami samathambo sithe ama-hormone awazithinti izimpawu, kodwa njalo ngenyanga ukugqashuka kwami ​​kuhambisana nomjikelezo wami wokuya esikhathini. Uyini umbono wakho ngalokhu?

Ama-hormone abesifazane angathinta izifo ezihlobene nokuzimela, kufaka phakathi i-RA. Umphakathi wezokwelapha awukuqondi ngokuphelele lokhu kusebenzisana. Kodwa siyazi ukuthi izimpawu zivame ukwanda ngaphambi kokuya esikhathini. Ukuxolelwa kwe-RA ngesikhathi sokukhulelwa kanye nama-flare-ups ngemuva kokukhulelwa nakho kubhekwa kakhulu emhlabeni jikelele.

Izifundo ezindala zikhombise ukwehla kwezehlakalo zeRA kwabesifazane abathathe amaphilisi okuvimbela inzalo. Kodwa-ke, ucwaningo lwamanje alutholanga ubufakazi obukholisayo bokuthi ukwelashwa ngokufaka ama-hormone kungavimbela i-RA. Olunye ucwaningo luye lwasikisela ukuthi kungaba nzima ukuhlukanisa phakathi kwezimpawu ezijwayelekile zangaphambi kokuya esikhathini kanye ne-RA flare-up. Kepha ukuhlobanisa i-flare nomjikelezo wakho wokuya esikhathini mhlawumbe kungaphezu kokuqondana nje. Abanye abantu bathola ukuthi kuyasiza ukukhulisa imishanguzo yabo yokwenza okufushane, njengemithi elwa nokuvuvukala engeyona eye-steroidal, ngokulindela ukuqhuma.

Joyina ingxoxo

Xhuma ne-Living yethu ne: Rheumatoid Arthritis umphakathi we-Facebook ukuthola izimpendulo nokusekelwa okunesihawu. Sizokusiza uzulazule endleleni yakho.