Kusetshenziswa iMethotrexate Ukwelapha I-Psoriatic Arthritis

-Delile

• Isebenza kanjani i-methotrexate njengokwelashwa kwe-psoriatic arthritis
• Izinzuzo ze-methotrexate ye-psoriatic arthritis
• Imiphumela emibi ye-methotrexate ye-psoriatic arthritis
• Ukukhula kwengane
• Ukulimala kwesibindi
• Eminye imiphumela emibi
• Ukusebenzisana kwezidakamizwa
• Isilinganiso se-methotrexate esisetshenziselwa i-psoriatic arthritis
• Ezinye izindlela ze-methotrexate ekwelapheni i-psoriatic arthritis
• Amanye ama-DMARD ajwayelekile
• I-Biologics
• Ukuthatha

Ukubuka konke

I-Methotrexate (MTX) yisidakamizwa esisetshenziselwe ukwelapha i-psoriatic arthritis ngaphezulu kokungaphezulu. Yodwa noma ihlanganiswe nezinye izindlela zokwelapha, i-MTX ibhekwa njengokwelashwa komugqa wokuqala kwe-psoriatic arthritis (PsA) elinganiselayo. Namuhla, kuvame ukusetshenziswa ngokuhlanganiswa nemithi emisha ye-biologic ye-PsA.

I-MTX inemiphumela emibi engaba yingozi. Ngasohlangothini oluhle, i-MTX:

• akubizi
• kusiza ukunciphisa ukuvuvukala
• isula izimpawu zesikhumba

Kodwa i-MTX ayivimbeli ukubhujiswa okuhlangene lapho isetshenziswa yodwa.

Xoxa nodokotela wakho ukuthi ngabe i-MTX iyodwa noma ihlanganiswe nezinye izidakamizwa kungaba yindlela enhle yokwelashwa kuwe.

Isebenza kanjani i-methotrexate njengokwelashwa kwe-psoriatic arthritis

I-MTX yisidakamizwa se-antimetabolite, okusho ukuthi siphazamisa ukusebenza okujwayelekile kwamaseli, uwavimbe ekuhlukaniseni. Ibizwa ngokuthi yisidakamizwa esiguqula isifo semishanguzo (i-DMARD) ngoba sinciphisa ukuvuvukala kwamalunga.

Ukusetshenziswa kwayo kokuqala, okwenzeka ngasekupheleni kwawo-1940, kwakusezingeni eliphakeme lokwelapha i-leukemia yengane. Ngamanani aphansi, i-MTX icindezela amasosha omzimba futhi ivimbela ukukhiqizwa kwezicubu ze-lymphoid ezibandakanyeka ku-PsA.

I-MTX yagunyazwa yi-U.S. Food and Drug Administration (FDA) ngo-1972 ukuthi isetshenziswe nge-psoriasis enamandla (okuvame ukuhlobene ne-psoriatic arthritis), kodwa futhi isetshenziswe kakhulu “off label” ye-PsA. “Ukuphuma kwelebula” kusho ukuthi udokotela wakho angakunika izifo ezingezona ezivunyelwe yi-FDA.

Ukusebenza kwe-MTX ye-PsA akukaze kufundwe ezivivinyweni ezinkulu zemitholampilo, ngokwe-American Academy of Dermatology (AAD). Esikhundleni salokho, izincomo ze-AAD ze-MTX zisuselwa kulwazi lwesikhathi eside nemiphumela yodokotela abayinikeze i-PsA.

I-athikili yokubuyekeza ka-2016 ikhombisa ukuthi akukho cwaningo lokulawulwa ngokungahleliwe olukhombise ukuthuthuka ngokuhlanganyela kwe-MTX kunaleyo ye-placebo. Isivivinyo sezinyanga eziyisithupha sango-2012 sabantu abangu-221 ezinyangeni eziyisithupha asibutholanga ubufakazi bokuthi ukwelashwa kweMTX kukodwa kuthuthukise ukuvuvukala kwamalunga (synovitis) ePsA.

Kepha kunomphumela obalulekile owengeziwe. Ucwaningo luka-2012 lwathola ukuthi ukwelashwa kwe-MTX wenze kuthuthukisa kakhulu ukuhlolwa okuphelele kwezimpawu ngabo bobabili odokotela nabantu abane-PsA ababambe iqhaza ocwaningweni. Futhi, izimpawu zesikhumba zenziwa ngcono nge-MTX.

Olunye ucwaningo, olwabikwa ngo-2008, lwathola ukuthi uma abantu abane-PsA belashwa kusenesikhathi kulesi sifo ngomthamo owandisiwe we-MTX, baba nemiphumela engcono. Kubantu abangu-59 abakucwaningo:

• Amaphesenti angama-68 abe nokwehla kwamaphesenti angama-40 ekubalweni okuhlangene okushisayo
• Amaphesenti angama-66 abe nokwehla kwamaphesenti angama-40 ekubhalweni kwamalungu okuvuvukala
• Amaphesenti ama-57 abe ne-Psoriasis Area ne-Severity Index (i-PASI) ethuthukisiwe

Lolu cwaningo lwango-2008 lwenziwa emtholampilo waseToronto lapho ucwaningo lwangaphambilini lwalungatholanga nzuzo yokwelashwa kweMTX ngokuvuvukala okuhlangene.

Izinzuzo ze-methotrexate ye-psoriatic arthritis

IMTX isebenza njenge-anti-inflammatory futhi ingaba wusizo iyodwa kumacala amancane we-PsA.

Ucwaningo lwango-2015 luthole ukuthi amaphesenti angama-22 abantu abane-PsA abaphathwa kuphela nge-MTX bathole umsebenzi omncane wezifo.

I-MTX iyasebenza ekususeni ukubandakanyeka kwesikhumba. Ngalesi sizathu, udokotela wakho angaqala ukwelashwa kwakho nge-MTX. Kubiza kancane kunezidakamizwa ezintsha ze-biologic ezenziwe ekuqaleni kweminyaka yama-2000.

Kepha i-MTX ayivimbeli ukubhujiswa okuhlangene ku-PsA. Ngakho-ke uma usengozini yokubhujiswa kwamathambo, udokotela wakho angangeza kwesinye sezinto eziphilayo. Le mithi ivimbela ukukhiqizwa kwe-tumor necrosis factor (TNF), into ebangela ukuvuvukala egazini.

Imiphumela emibi ye-methotrexate ye-psoriatic arthritis

Imiphumela emibi yokusetshenziswa kwe-MTX kubantu abane-PsA ingabonakala. Kucatshangwa ukuthi izakhi zofuzo zingaphendula ngazinye ku-MTX.

Ukukhula kwengane

I-MTX yaziwa njengokulimaza ekukhuleni kwengane. Uma uzama ukukhulelwa, noma uma ukhulelwe, hlala kude ne-MTX.

Ukulimala kwesibindi

Ingozi enkulu ukulimala kwesibindi. Cishe umuntu oyedwa kwabangu-200 abathatha iMTX banomonakalo wesibindi. Kepha umonakalo ubuyela emuva uma umisa iMTX. Ngokuya ngeNational Psoriasis Foundation, ubungozi buqala ngemuva kokufinyelela ekuqongeleleni impilo yonke kwama-1.5 amagremu we-MTX.

Udokotela wakho uzoqapha ukusebenza kwesibindi sakho ngenkathi uthatha i-MTX.

Ingozi yokulimala kwesibindi iyanda uma:

• uphuze utshwala
• zikhuluphele
• unesifo sikashukela
• babe nokusebenza kwezinso okungajwayelekile

Eminye imiphumela emibi

Eminye imiphumela emibi engaba khona ayimbi kangako, ayizizwa kahle futhi imvamisa iyalawuleka. Lokhu kufaka phakathi:

• isicanucanu noma ukuhlanza
• ukukhathala
• izilonda zomlomo
• isifo sohudo
• ukulahleka kwezinwele
• isiyezi
• ikhanda
• Ukugodola
• ingozi eyengeziwe yokutheleleka
• ukuzwela ekukhanyeni kwelanga
• umuzwa ovuthayo ezilondeni zesikhumba

Ukusebenzisana kwezidakamizwa

Eminye imishanguzo yezinhlungu ezithengiswa ekhawunteni njenge-aspirin (iBufferin) noma ibuprofen (Advil) ingakhuphula imiphumela emibi ye-MTX. Amanye ama-antibiotic angasebenzisana ukunciphisa ukusebenza kwe-MTX noma angaba yingozi. Khuluma nodokotela wakho ngemithi yakho kanye nokuxhumana okungenzeka ne-MTX.

Isilinganiso se-methotrexate esisetshenziselwa i-psoriatic arthritis

Umthamo wokuqala we-MTX we-PsA ngama-milligram ama-5 kuye kwayi-10 ngesonto evikini lokuqala noma amabili. Ngokuya ngempendulo yakho, udokotela uzokwengeza kancane umthamo ufike ku-15 kuye ku-25 mg ngesonto, okubhekwa njengokwelashwa okujwayelekile.

I-MTX ithathwa kanye ngesonto, ngomlomo noma ngomjovo. I-MTX yomlomo ingaba iphilisi noma ifomu eliketshezi. Abanye abantu bangahle bahlukanise umthamo ube izingxenye ezintathu ngosuku abalithatha ngalo ukusiza ngemiphumela emibi.

Udokotela wakho angaphinde anikeze isengezo se-folic acid, ngoba i-MTX yaziwa ukunciphisa amazinga abalulekile e-folate.

Ezinye izindlela ze-methotrexate ekwelapheni i-psoriatic arthritis

Kunezinye izindlela zokwelapha i-PsA kubantu abangakwazi noma abangafuni ukuthatha iMTX.

Uma une-PsA emnene kakhulu, ungakwazi ukukhulula izimpawu ngezidakamizwa ezingezona ukuvuvukala (ama-NSAID) wedwa. Kepha i-NSAIDS enezilonda zesikhumba. Kuyafana nokujova kwendawo kwama-corticosteroids, angasiza ngezimpawu ezithile.

Amanye ama-DMARD ajwayelekile

Ama-DMARD ajwayelekile eqenjini elifanayo ne-MTX yilawa:

• i-sulfasalazine (i-Azulfidine), ezokwenza ngcono izimpawu ze-arthritic kepha ayiyeki ukulimala okuhlangene
• leflunomide (Arava), okumele ithuthukise zombili izimpawu zokuhlangana nezesikhumba
• i-cyclosporine (Neoral) ne-tacrolimus (Prograf), esebenza ngokuvimbela umsebenzi we-calcineurin ne-T-lymphocyte

Lawa ma-DMARDS kwesinye isikhathi asetshenziswa ngokuhlangana nezinye izidakamizwa.

I-Biologics

Imishanguzo emisha eminingi iyatholakala, kodwa le ibiza kakhulu. Ucwaningo luyaqhubeka, futhi kungenzeka ukuthi ezinye izindlela zokwelapha ezintsha zingatholakala esikhathini esizayo.

Ama-biologics avimbela i-TNF futhi anciphise ukulimala okuhlangene ku-PsA afaka lawa ma-TNF alpha-blockers:

• i-etanercept (Enbrel)
• i-adalimumab (Humira)
• infliximab (i-Remicade)

Ama-biologics akhombe amaprotheni e-interleukin (ama-cytokines) anganciphisa ukuvuvukala futhi athuthukise ezinye izimpawu. Lokhu kuvunyelwe i-FDA ekwelapheni i-PsA. Kubandakanya:

• i-ustekinumab (Stelara), i-antibody e-monoclonal ehlose i-interleukin-12 ne-interleukin-23
• i-secukinamab (Cosentyx), ekhomba i-interleukin-17A

Enye indlela yokwelashwa i-apremilast yezidakamizwa (i-Otezla), ekhomba ama-molecule ngaphakathi kwamaseli omzimba abandakanyeka ekuvukeleni. Imisa i-enzyme phosphodiesterase 4, noma i-PDE4. I-Apremilast inciphisa ukuvuvukala nokuvuvukala okuhlangene.

Yonke imithi elapha i-PsA inemiphumela engemihle, ngakho-ke kubalulekile ukuhlola izinzuzo nemiphumela emibi nodokotela wakho.

Ukuthatha

I-MTX ingaba ukwelashwa okuwusizo kwe-PsA ngoba inciphisa ukuvuvukala futhi isiza izimpawu ngokuphelele. Futhi ingaba nemiphumela emibi kakhulu, ngakho-ke uzodinga ukubhekwa njalo.

Uma kunamalungu akho angaphezu kweyodwa, ukuhlanganisa iMTX ne-biologic DMARD kungasiza ekunqandeni ukubhujiswa okuhlangene. Xoxa nodokotela wakho ngazo zonke izindlela zokwelashwa, futhi ubuyekeze uhlelo lokwelashwa njalo. Kungenzeka ukuthi ucwaningo oluqhubekayo ngamakhambi e-PsA luzoqhamuka ngokuzayo.

Ungakuthola futhi kuwusizo ukukhuluma ne "navigator yesiguli" e-National Psoriasis Foundation, noma ujoyine elinye lamaqembu ayo okuxoxa nge-psoriasis.