Buza iNgcali: Isifo samathambo

Umxholo

• UDavid Curtis, MD
• Umbuzo: Ndineminyaka engama-51 ubudala kwaye ndine-OA kunye neRA. Ngaba i-Enbrel iyakunceda ukulawula i-OA yam okanye ngaba yeempawu zeRA nje?
• Umbuzo: Ndine-OA eqatha kwaye kwafunyaniswa ukuba ndine-gout. Ngaba idayethi idlala indima kwi-OA?
• Q: Ndifumana i-Actemra infusions iinyanga ezintathu, kodwa khange ndive nakuphi na ukukhululeka. Ugqirha wam ufuna uku-odola uvavanyo lwe-Vectra DA ukubona ukuba liyasebenza na eliyeza. Luyintoni olu vavanyo kwaye luthembeke kangakanani?
• Q: Zithini iingozi zokuhamba usiya kuwo onke amayeza?
• Umbuzo: Ndine-OA kuzwane lwam olukhulu neRA emagxeni nakumadolo. Ngaba ikhona indlela yokuguqula umonakalo osele wenzekile? Kwaye ndingenza ntoni ukulawula ukudinwa kwezihlunu?
• Q: Kweliphi ixesha eyamkelekileyo ukuya kwi-ER ngeentlungu? Zeziphi iimpawu ekufanele ukuba ndizenza?
• Umbuzo: Ugqirha wam wamathambo wathi iihormoni azichaphazeli mpawu, kodwa inyanga nenyanga ukuvutha kwam kungqinelana nomjikelo wam wokuya exesheni. Luthini uluvo lwakho koku?
• Joyina incoko

UDavid Curtis, MD

I-rheumatoid arthritis (RA) sisifo esingapheliyo sokuzimela. Lubonakala ziintlungu ezidibeneyo, ukudumba, ukuqina, kunye nelahleko ekugqibeleni lomsebenzi.

Ngelixa ngaphezulu kwesigidi se-1.3 seMelika siphethwe yi-RA, akukho bantu babini abaya kuba neempawu ezifanayo okanye amava afanayo. Ngenxa yoku, ukufumana iimpendulo ozifunayo ngamanye amaxesha kunokuba nzima. Ngethamsanqa, uGqirha David Curtis, MD, ugqirha wamathambo onelayisensi oseSan Francisco ulapha ukunceda.

Funda iimpendulo zakhe kwimibuzo esixhenxe ebuzwe zizigulana zokwenene zeRA.

Umbuzo: Ndineminyaka engama-51 ubudala kwaye ndine-OA kunye neRA. Ngaba i-Enbrel iyakunceda ukulawula i-OA yam okanye ngaba yeempawu zeRA nje?

Ukubakho kwe-osteoarthritis kunye ne-rheumatoid arthritis kuqhelekile kuba sonke siza kuphuhlisa i-OA ukuya kuthi ga kwinqanaba elithile kwezinye, ukuba akunjalo, kumalungu ethu ngaxa lithile ebomini bethu.

I-Enbrel (etanercept) ivunyiwe ukuba isetyenziswe kwi-RA nakwezinye izifo ezivuthayo, ezizimeleyo apho kwaqatshelwa ukuba i-cytokine ye-TNF-alpha idlala indima ebalulekileyo ekuqhubeni ukudumba (iintlungu, ukudumba, kunye nokubomvu) kunye nezinto ezonakalisayo ithambo kunye nentlala. Nangona i-OA inezinto ezithile "zokukrala" njengenxalenye yezifo zayo, i-cytokine TNF-alpha ayibonakali ibalulekile kule nkqubo kwaye ke ngenxa yoko i-TNF blockade ka-Enbrel ayenzi njalo kwaye ayizukulindeleka ukuba iphucule iimpawu okanye iimpawu ze-OA .

Ngeli xesha, asinazo "iziyobisi eziguqula izifo" okanye i-biologics ye-osteoarthritis. Uphando kunyango lwe-OA lusebenza kakhulu kwaye sonke sinokuba nethemba lokuba kwixa elizayo siza kuba neendlela zonyango ezinamandla ze-OA, njengoko sisenza kwiRA.

Umbuzo: Ndine-OA eqatha kwaye kwafunyaniswa ukuba ndine-gout. Ngaba idayethi idlala indima kwi-OA?

Ukutya kunye nokutya okunesondlo kudlala indima ebalulekileyo kuyo yonke imiba yempilo kunye nokuqina komzimba. Yintoni enokubonakala inzima kuwe ziingcebiso ezikhuphisanayo ezibonakalayo kwezi meko zahlukileyo. Zonke iingxaki zonyango zinokuxhamla kwisidlo "esilumkileyo".

Nangona into enobuqili inokuthi kwaye yahluka ngokuxilongwa kwezonyango, kwaye iingcebiso zoogqirha nezesondlo zinokutshintsha ngokuhamba kwexesha, kukhuselekile ukuthi ukutya okunengqiqo kukunceda ukugcina okanye ukufezekisa ubunzima bomzimba obufanelekileyo, kuxhomekeke kokungalungiswanga ukutya, kutyebile kwiziqhamo, imifuno, kunye neenkozo ezipheleleyo, kwaye kuthintela isixa esikhulu samafutha ezilwanyana. Iiprotheyini ezifanelekileyo, iiminerali, kunye neevithamini (kubandakanya ikhalsiyam kunye nevithamin D yamathambo asempilweni) kufuneka abe yinxalenye yako konke ukutya.

Ngelixa ukunqanda ngokupheleleyo i-purines kungafuneki okanye kungacetyiswa, abaguli abathatha amayeza e-gout banokuthintela ukutyiwa kwe-purine. Kuyacetyiswa ukuba kupheliswe ukutya okuphezulu kwi-purines kunye nokunciphisa ukutya okuphakathi komxholo we-purine. Ngamafutshane, kungcono ukuba izigulana zitye ukutya okubandakanya ukutya okune-purine ephantsi. Ukupheliswa ngokupheleleyo kwe-purines, nangona kunjalo, akukhuthazwa.

Q: Ndifumana i-Actemra infusions iinyanga ezintathu, kodwa khange ndive nakuphi na ukukhululeka. Ugqirha wam ufuna uku-odola uvavanyo lwe-Vectra DA ukubona ukuba liyasebenza na eliyeza. Luyintoni olu vavanyo kwaye luthembeke kangakanani?

Iingcali zeRheumatologists zisebenzisa uviwo lweklinikhi, imbali yezonyango, iimpawu, kunye nokuvavanywa rhoqo kwelebhu ukuvavanya imeko yesifo. Uvavanyo olutsha olubizwa ngokuba yiVectra DA luthatha ingqokelela yezinto ezongezelelekileyo zegazi. Ezi zinto zegazi zinceda ukuvavanya impendulo yamajoni omzimba kwimisebenzi yesifo.

Abantu abane-rheumatoid arthritis (RA) engekho kwi-Actemra (tocilizumab Injection) baya kuba namanqanaba aphezulu e-interleukin 6 (IL-6). Esi siphawuli sokudumba sisixhobo esiphambili kuvavanyo lweVectra DA.

I-Actemra ibhloka i-receptor ye-IL-6 yokunyanga ukudumba kwe-RA. Inqanaba le-IL-6 egazini liyenyuka xa i-receptor ye-IL-6 ivaliwe. Kungenxa yokuba ayisabophelelwanga kwi-receptor yayo. Amanqanaba aphakamileyo e-IL-6 akabonakalisi imisebenzi yesifo kubasebenzisi be-Actemra. Bona. Ibonisa nje ukuba umntu uphathwe nge-Actemra.

Iingcali zeRheumatologists azamkelanga ngokubanzi iVectra DA njengendlela efanelekileyo yokuvavanya isenzo sesifo. Ukuvavanywa kweVectra DA akuncedi ekuvavanyeni impendulo yakho kunyango lweActemra. I-rheumatologist yakho iya kufuneka ixhomekeke kwiindlela zendabuko zokuvavanya impendulo yakho kwi-Actemra.

Q: Zithini iingozi zokuhamba usiya kuwo onke amayeza?

I-Seropositive (ithetha ukuba i-rheumatoid factor inesimo esihle) i-rheumatoid arthritis ihlala isisifo esinganyangekiyo nesinokuqhubela phambili esinokukhokelela ekukhubazekeni nasekutshatyalalisweni ngokudibeneyo ukuba asinyangwa. Nangona kunjalo, kukho umdla omkhulu (kwicala lezigulana kunye nokunyanga oogqirha) ukuba kuncitshiswa nini kwaye njani kunye nokuyeka amayeza.

Kukho ukuvumelana ngokubanzi ukuba unyango lwe-rheumatoid arthritis kwangoko luvelisa ezona ziphumo zibalaseleyo zesigulana ngokuncitshiswa kokukhubazeka emsebenzini, ukoneliseka kwesigulana kunye nokuthintela ukutshatyalaliswa ngokudibeneyo. Kukho ukuvumelana okuncinci malunga nendlela kunye nexesha lokunciphisa okanye lokumisa amayeza kwizigulana eziqhuba kakuhle kunyango lwangoku. Izifo zesifo ziqhelekile xa amayeza ancitshisiwe okanye emisiwe, ngakumbi ukuba kusetyenziswa amayeza amiselweyo kwaye isiguli siqhuba kakuhle. Uninzi lwee-rheumatologists kunye nezigulana zikhululekile ukunciphisa kunye nokuphelisa i-DMARDS (njenge-methotrexate) xa isiguli siqhuba kakuhle ixesha elide kwaye sikwi-biologic (umzekelo, i-TNF inhibitor).

Amava ezonyango abonisa ukuba izigulana zihlala zisebenza kakuhle ngokude nje ukuba zihlale kunyango oluthile kodwa zihlala zinamafutha abalulekileyo ukuba ayayeka onke amayeza. Izigulana ezininzi ezine-seronegative zenza kakuhle ukuyeka onke amayeza, ubuncinci kangangexesha elithile, iphakamisa ukuba olu didi lwezigulana lunokuba nesifo esahlukileyo kunezigulana zesifo samathambo. Kububulumko ukunciphisa okanye ukuyeka amayeza e-rheumatoid kuphela ngesivumelwano kunye nolawulo lwe-rheumatologist yakho.

Umbuzo: Ndine-OA kuzwane lwam olukhulu neRA emagxeni nakumadolo. Ngaba ikhona indlela yokuguqula umonakalo osele wenzekile? Kwaye ndingenza ntoni ukulawula ukudinwa kwezihlunu?

I-Osteoarthritis (OA) kwilungu lezinzwane elikhulu liqheleke kakhulu kwaye ichaphazela phantse wonke umntu ukuya kuthi ga kwiminyaka engama-60.

I-rheumatoid arthritis (RA) inokuchaphazela eli dibeneyo ngokunjalo. Ukuvuvukala kwimbumba yelungu kubizwa ngokuba yi-synovitis. Zombini ezi ntlobo ze-arthritis zinokubangela i-synovitis.

Ke ngoko, abantu abaninzi abane-RA abane-OA engaphantsi kwesi sihlanganisi bafumana ukukhululeka okukhulu kwiimpawu zonyango olusebenzayo lwe-RA, njengamayeza.

Ngokumisa okanye ukunciphisa i-synovitis, umonakalo kwi-cartilage kunye nethambo liyancitshiswa. Ukudumba okungapheliyo kunokubangela utshintsho olusisigxina kubume bamathambo. Olu tshintsho lwethambo kunye nentlala ziyafana notshintsho olwenziwe yi-OA. Kuzo zombini ezi meko, utshintsho alubalulekanga "ukubuyela umva" ngonyango olukhoyo namhlanje.

Iimpawu ze-OA zinokuthambisa zize zinciphe, ziba mandundu ngokuhamba kwexesha, kwaye zibe mandundu ngenxa yomothuko. Unyango lomzimba, amayeza asemzimbeni kunye nomlomo, kunye ne-corticosteroids inokunceda ukunciphisa iimpawu ngokubonakalayo. Nangona kunjalo, ukuthatha i-calcium supplements akuyi kuba nefuthe kwinkqubo ye-OA.

Ukudinwa kunokudityaniswa namayeza ahlukeneyo kunye neemeko zonyango, kubandakanya iRA. Ugqirha wakho unokukunceda ukutolika iimpawu zakho kwaye akuncede ucwangcise olona nyango lusebenzayo.

Q: Kweliphi ixesha eyamkelekileyo ukuya kwi-ER ngeentlungu? Zeziphi iimpawu ekufanele ukuba ndizenza?

Ukuya kwigumbi likaxakeka esibhedlele kunokuba lixabiso elininzi, ixesha elininzi, kunye namava abuhlungu emphefumlweni. Nangona kunjalo, ii-ER ziyimfuneko kubantu abagula kakhulu okanye abanezifo ezisongela ubomi.

I-RA kunqabile ukuba ibe neempawu ezisongela ubomi. Nokuba ezi mpawu zikhona, zinqabile kakhulu. Iimpawu ezinzulu zeRA ezifana ne-aspericarditis, pleurisy, okanye scleritis kunqabile ukuba "ziqine." Oko kuthetha ukuba azizi ngokukhawuleza (ngaphezulu komcimbi weeyure) kwaye ngokuqatha. Endaweni yokuba, ezi zinto zibonakalisiweyo zeRA zihlala zimnene kwaye ziza ngokuthe ngcembe. Oku kukuvumela ukuba unxibelelane nogqirha okanye ugqirha wamathambo ukuze ufumane iingcebiso okanye undwendwele iofisi.

Uninzi lwexesha likaxakeka kubantu abane-RA banxulunyaniswa neemeko comorbid ezinje nge-coronary artery disease okanye isifo seswekile. Iziphumo ebezingalindelekanga zamayeza e-RA owathathayo- njengempendulo engahambelaniyo- unokuqinisekisa uhambo oluya e-ER. Oku kuyinyani ngakumbi xa impendulo iphezulu. Iimpawu zibandakanya umkhuhlane omkhulu, irhashalala elibi, ukudumba komqala, okanye ingxaki yokuphefumla.

Olunye unxunguphalo olunokubakho sisifo esosulelayo sokuguqula isifo kunye nonyango lwebhayoloji. I-pneumonia, usulelo lwezintso, usulelo lwesisu, kunye nosulelo lwenkqubo ye-neva yimizekelo yezifo ezigwenxa ezibangelwa kuvavanyo lwe-ER.

Umkhuhlane ophezulu unokuba luphawu losulelo kunye nesizathu sokubiza ugqirha. Ukuya ngqo kwi-ER kububulumko ukuba naziphi na ezinye iimpawu, ezinje ngobuthathaka, ingxaki yokuphefumla, kunye nentlungu yesifuba ikhona nefiva ephezulu. Ngokuqhelekileyo kuluvo oluhle ukubiza ugqirha wakho ngengcebiso ngaphambi kokuya kwi-ER, kodwa xa ungathandabuzeki, kungcono uye kwi-ER ukuze ufumane uvavanyo olukhawulezileyo.

Umbuzo: Ugqirha wam wamathambo wathi iihormoni azichaphazeli mpawu, kodwa inyanga nenyanga ukuvutha kwam kungqinelana nomjikelo wam wokuya exesheni. Luthini uluvo lwakho koku?

Ihomoni yabasetyhini inokuchaphazela izifo ezinxulumene nokuzimela, kubandakanya i-RA. Uluntu lwezonyango alukayiqondi ngokupheleleyo le ntsebenziswano. Kodwa siyazi ukuba iimpawu zihlala zanda ngaphambi kokuya exesheni. Uxolelo lwe-RA ngexesha lokukhulelwa kunye ne-flare-ups emva kokukhulelwa zikwangumbono jikelele.

Izifundo ezindala zibonise ukwehla kweziganeko ze-RA kwabasetyhini abathathe iipilisi zolawulo lokuzalwa. Nangona kunjalo, uphando lwangoku alufumananga ubungqina obukholisayo bokuba unyango olungena endaweni yehomoni lunokuthintela iRA. Olunye uphononongo lucebise ukuba kunokuba nzima ukwahlula phakathi kweempawu zaphambi kokuba sexesheni kunye neRA flare-up. Kodwa ukudibanisa i-flare kunye nomjikelezo wakho wokuya esikhathini kunokuba ngaphezulu kokungahambelani. Abanye abantu bayafumanisa ukuba kuyanceda ukunyusa amayeza abo asebenza ixesha elifutshane, njengamayeza angasebenziyo wokulwa nokudumba, ngokulindela ukuvutha.

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