Irheumatoid Arthritis

I-rheumatoid arthritis (RA) sisifo esikhokelela kukudumba kwamalungu kunye nezicubu ezijikelezileyo. Sisifo sexesha elide. Inokuchaphazela namanye amalungu.

Unobangela weRA awaziwa. Sisifo esizenzekelayo. Oku kuthetha ukuba amajoni omzimba ahlasela ngempazamo izicwili ezisempilweni.

I-RA inokwenzeka nakweyiphi na iminyaka, kodwa ixhaphake kakhulu kubudala obuphakathi. Abasetyhini bafumana i-RA rhoqo kunamadoda.

Usulelo, ufuzo, kunye notshintsho lwehomoni zinokunxulunyaniswa nesi sifo. Ukutshaya kunokudityaniswa neRA.

Ayifane ixhaphake kune-osteoarthritis (OA). OA yimeko eyenzeka kubantu abaninzi ngenxa yokunxiba kunye nokukrazula kumalungu njengoko bekhula.

Uninzi lwexesha, i-RA ichaphazela amalungu kumacala omabini omzimba ngokulinganayo. Iminwe, izihlahla, amadolo, iinyawo, iingqiniba, amaqatha, iinyonga kunye namagxa zezona zichaphazeleka kakhulu.

Esi sifo sihlala siqala kancinci. Iimpawu zokuqala zinokubandakanya:

• Intlungu encinci edibeneyo
• Ukuqina
• Ukudinwa

Iimpawu ezidibeneyo zingabandakanya:

• Ukuqina kwentsasa, okuhlala ngaphezulu kweyure enye, kuyinto eqhelekileyo.
• Amalungu anokuziva efudumele, ethambile, kwaye eqinile xa engasetyenziswanga iyure.
• Intlungu edibeneyo ihlala ivakala ngokudibeneyo kumacala omabini omzimba.
• Amalungu ahlala edumba.
• Ixesha elingaphezulu, amalungu angalahla uluhlu lwazo lokuhamba kwaye anokukhubazeka.

Ezinye iimpawu zibandakanya:

• Intlungu yesifuba xa uphefumla (pleurisy)
• Amehlo omile kunye nomlomo (Sjögren syndrome)
• Ukutsha kwamehlo, ukurhawuzelela nokukhupha
• Amaqhuqhuva phantsi kolusu (amaxesha amaninzi luphawu lwesifo esibi kakhulu)
• Ubudenge, ukubetha, okanye ukutshisa ezandleni nasezinyaweni
• Ubunzima bokulala

Ukuxilongwa kwe-RA kwenziwa xa:

• Unentlungu kunye nokudumba kumalungu ama-3 nangaphezulu.
• Isifo samathambo sikhona ngaphezulu kweeveki ezi-6.
• Uvavanyo oluqinisekileyo lwento ye-rheumatoid okanye anti-CCP.
• Uyiphakamisile i-ESR okanye i-CRP.
• Ezinye iintlobo zamathambo ziye zagwetyelwa ngaphandle.

Ngamanye amaxesha ukuxilongwa kwe-RA kwenziwa nangaphandle kwazo zonke iimeko eziboniswe apha ngasentla ukuba isifo samathambo singaqhelekanga kwiRA.

Akukho luvavanyo lunokumisela ngokuqinisekileyo ukuba unayo i-RA. Uninzi lwabantu abane-RA baya kuba neziphumo zovavanyo ezingaqhelekanga. Nangona kunjalo, abanye abantu baya kuba neziphumo eziqhelekileyo kuzo zonke iimvavanyo.

Uvavanyo lweelebhu ezimbini ezilungileyo kubantu abaninzi kwaye zihlala zinceda ekufumanekeni zezi:

• Into yeRheumatoid
• Unyango lwe-anti-CCP

Ezi mvavanyo zilungile kwizigulana ezininzi ezineRA. Uvavanyo lwe-anti-CCP antibody luchaza ngakumbi i-RA.

Olunye uvavanyo olunokwenziwa lunokubandakanya:

• Gcwalisa ubalo lwegazi
• Iphaneli yeMetabolic kunye ne-uric acid
• Iprotheni esebenzayo yeC (CRP)
• Izinga le-sedimentation ye-Erythrocyte (ESR)
• Intshatsheli yomzimba
• Uvavanyo lwe-hepatitis
• X-reyi ezidibeneyo
• I-ultrasound edibeneyo okanye iMRI
• Uhlalutyo lwamanzi oludibeneyo

I-RA ihlala ifuna unyango lwexesha elide yingcali yesifo samathambo ebizwa ngokuba yirheumatologist. Unyango lubandakanya:

• Amayeza
• Ulungiso lwenyama
• Zilolonge
• Imfundo yokukunceda uqonde uhlobo lwe-RA, ukhetho lwakho lonyango, kunye nemfuno yokulandelelwa rhoqo.
• Utyando, ukuba luyafuneka

Unyango lwakwangoko lwe-RA ngamayeza abizwa ngokuba sisifo esiguqula amachiza e-antirheumatic (DMARDS) kufuneka asetyenziswe kuzo zonke izigulana. Oku kuyakucothisa ukutshabalalisa ngokudibeneyo kwaye kuthintele ukukhubazeka. Umsebenzi weRA kufuneka ujongwe kutyelelo rhoqo ukuqinisekisa ukuba isifo siyalawulwa. Injongo yonyango kukumisa ukuqhubela phambili kwe-RA.

AMAYEZA

Amayeza alwa nokudumba: Oku kubandakanya i-aspirin kunye ne-nonsteroidal anti-inflammatory drug (NSAIDs), efana ne-ibuprofen, naproxen kunye ne-celecoxib.

• La mayeza asebenza kakuhle ukunciphisa ukudumba ngokudibeneyo kunye nokudumba, kodwa kunokuba neziphumo ebezingalindelekanga zexesha elide. Ke ngoko, kufuneka zithathwe kuphela okwexeshana elincinci kwaye ngeedosi eziphantsi xa kunokwenzeka.
• Kuba abathinteli umonakalo odibeneyo ukuba usetyenziswe wedwa, kufuneka kusetyenziswe i-DMARDS nayo.

Izifo ezitshintsha amachiza e-antirheumatic (DMARDs): Ezi zihlala zingamayeza azanywa kuqala kubantu abane-RA. Ziyamiselwa kunye nokuphumla, ukomeleza umthambo, kunye neziyobisi ezichasayo.

• I-Methotrexate yeyona DMARD ixhaphakileyo yokusebenzisa isifo samathambo. I-Leflunomide kunye nehydroxychloroquine inokusetyenziswa.
• I-Sulfasalazine sisiyobisi esidla ngokudityaniswa ne-methotrexate kunye ne-hydroxychloroquine (unyango kathathu).
• Isenokuba ziiveki okanye iinyanga ngaphambi kokuba ubone isibonelelo kula machiza.
• La machiza anokuba neziphumo ebezingalindelekanga ezimandundu, ke kuyakufuneka uvavanyo lwegazi rhoqo xa uwasela.
• Amayeza e-Antimalarial - Eli qela lamayeza libandakanya ihydroxychloroquine (Plaquenil). Zihlala zisetyenziswa kunye ne-methotrexate. Isenokuba ziiveki okanye iinyanga ngaphambi kokuba ubone isibonelelo kula machiza.

I-Corticosteroids-La mayeza asebenza kakuhle kakhulu ukunciphisa ukudumba ngokudibeneyo kunye nokudumba, kodwa kunokuba neziphumo ebezingalindelekanga zexesha elide. Ke ngoko, kufuneka zithathwe kuphela okwexeshana elincinci kunye ngeedosi eziphantsi xa kunokwenzeka.

Iiarhente zebhayoloji ye-DMARD-La mayeza enzelwe ukuba achaphazele amalungu omzimba adlala indima kwinkqubo yesifo seRA.

• Banokunikwa xa amanye amayeza, ahlala e-methotrexate, engakhange asebenze. Iziyobisi zebhayoloji zihlala zongezwa kwi-methotrexate. Nangona kunjalo, kuba zibiza kakhulu, imvume yeinshurensi iyafuneka ngokubanzi.
• Uninzi lwazo zinikwe nokuba ziphantsi kolusu okanye emthanjeni. Kukho iintlobo ezininzi ezahlukeneyo zee-biologic agents.

Iiarhente zebhayoloji kunye nezinto zokwenziwa kunokuba luncedo kakhulu kunyango lweRA. Nangona kunjalo, abantu abathatha la mayeza kufuneka bajongwe ngokusondeleyo ngenxa yokungaqhelekanga, kodwa iimpendulo ezibi kakhulu:

• Usulelo olusuka kwiibhaktheriya, ii-virus kunye nefungi
• Umhlaza wolusu, kodwa hayi imelanoma
• Ukuphendula kolusu
• Ukunyanga komzimba
• Ukungaphumeleli kwentliziyo
• Ukonakala kwimithambo-luvo
• Inani leeseli ezimhlophe ezisezantsi

UKUGQIBELA

Utyando lunokufuneka ukulungisa amalungu awonakeleyo. Ugqirha lunokubandakanya:

• Ukususwa komdibaniso odibeneyo (synovectomy)
• Ukubuyiselwa ngokudibeneyo, kwiimeko ezigwenxa, kunokubandakanya ukutshintshwa kwamadolo okupheleleyo (TKR) kunye nokutshintshwa kwe-hip.

ULUNGISO LWENYAMA

Ukuzilolonga ngokuhamba-hamba kunye neenkqubo zokuzilolonga ezimiselwe yingcali yomzimba zinokulibazisa ukuphulukana nomsebenzi ngokudibeneyo kwaye zincede ukugcina izihlunu zomelele.

Ngamanye amaxesha, abanyangi baya kusebenzisa oomatshini abakhethekileyo ukufaka ubushushu obunzulu okanye ukuvuselela umbane ukunciphisa iintlungu kunye nokuphucula intshukumo edibeneyo.

Olunye unyango olunokunceda ukunciphisa iintlungu ezidibeneyo zibandakanya:

• Iindlela zokudibanisa
• Ubushushu kunye nonyango olubandayo
• Iziqwenga okanye izixhobo ze-orthotic zokuxhasa kunye nokulungelelanisa amalungu
• Amaxesha okuphumla rhoqo phakathi kwemisebenzi, kunye neeyure ezisi-8 ukuya kwezi-10 zokulala ebusuku

ISONDLO

Abanye abantu abane-RA banokuba nokunganyamezelani okanye ukungavumi ukutya okuthile. Ukutya okunezakha mzimba kuyacetyiswa. Kunokuba luncedo ukutya ukutya okuneeoyile zentlanzi (omega-3 fatty acids). Ukutshaya imidiza kufuneka kuyekwe. Utywala obuninzi kufuneka buphetshwe.

Abanye abantu banokuxhamla ngokuthatha inxaxheba kwiqela lokuxhasa i-arthritis.

Nokuba i-RA yakho iqhubela phambili okanye ayixhomekekanga kubukhali beempawu zakho kunye nempendulo yakho kunyango. Kubalulekile ukuqala unyango ngokukhawuleza. Ukutyelela rhoqo kunye ne-rheumatologist kuyadingeka ukulungelelanisa unyango.

Umonakalo osisigxina odibeneyo unokwenzeka ngaphandle konyango olufanelekileyo. Unyango lwakwangoko ngokudityaniswa kwamayeza amathathu i-DMARD indibaniselwano eyaziwa ngokuba yi "triple therapy," okanye ngamachiza e-biologic okanye ekujoliswe kuwo okwenziweyo anokuthintela iintlungu kunye nomonakalo.

Ukuba ayinyangwa kakuhle, i-RA inokuchaphazela phantse onke amalungu omzimba. Iingxaki zinokubandakanya:

• Umonakalo kwithishu yemiphunga.
• Ukwanda komngcipheko wokuqina kwemithambo, ekhokelela kwisifo sentliziyo.
• Ukulimala komqolo xa amathambo entamo onakele.
• Ukudumba kwemithambo yegazi (i-rheumatoid vasculitis), enokuthi ikhokelele kulusu, kwimithambo-luvo, entliziyweni nakwingxaki yengqondo.
• Ukudumba kunye nokudumba kwenwebu engaphandle yentliziyo (i-pericarditis) kunye nentliziyo yemisipha (i-myocarditis), enokuthi ikhokelele ekusileleni kwentliziyo.

Nangona kunjalo, ezi ngxaki zinokuphetshwa ngonyango olululo. Unyango lweRA lunokubangela iziphumo ebezingalindelekanga ezimandundu. Thetha nomboneleli wakho malunga neziphumo ebezingalindelekanga zonyango kwaye kufuneka wenze ntoni xa zisenzeka.

Tsalela umnikezeli wakho ukuba ucinga ukuba uneempawu zesifo samathambo.

Akukho sithintelo saziwayo. Ukutshaya kubonakala kusiba mandundu RA, ke kubalulekile ukuba uphephe icuba. Unyango lwakwangoko olufanelekileyo lunokunceda ukuthintela ukuqhubeka komonakalo ngokudibeneyo.

RA; Isifo samathambo - samathambo

• Ukwakhiwa kwakhona kwe-ACL-ukukhutshwa
• Ukubuyiselwa kweqatha - ukukhutshwa
• Elbow replacement - ukubhobhoza

• Irheumatoid Arthritis
• Irheumatoid Arthritis
• Irheumatoid Arthritis

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UFleischmann R, uPangan AL, Ingoma IH, et al. I-Upadacitinib xa ithelekiswa ne-placebo okanye i-adalimumab kwizigulana ezine-rheumatoid arthritis kunye nempendulo engonelanga kwi-methotrexate: Iziphumo zesigaba sesi-III, iimfama ezimbini, iimfama ezilawulwa ngokungahleliwe. Isifo samathambo Rheumatol. Ngo-2019; 71 (11): 1788. IINKCUKACHA: 31287230 pubmed.ncbi.nlm.nih.gov/31287230.

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U-O'Dell JR, uMikuls TR, uTaylor TH, et al. Unyango lwe-rheumatoid arthritis esebenzayo emva kokungaphumeleli kwe-methotrexate. N Engl J Med. Ngo-2013; 369 (4): 307-318. IINKCUKACHA: 23755969 pubmed.ncbi.nlm.nih.gov/23755969.

O’Dell JR. Unyango lwe-rheumatoid arthritis. Ku: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, ii-eds. Incwadi kaKelley kunye neFirestein yeRheumatology. Ngomhla we-10. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 71.

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