Sebenzisa iMethotrexate ukunyanga i-Psoriatic Arthritis

Umxholo

• Isebenza njani i-methotrexate njengonyango lwe-psoriatic arthritis
• Izibonelelo ze-methotrexate ye-psoriatic arthritis
• Iziphumo ebezingalindelekanga ze-methotrexate ye-psoriatic arthritis
• Ukukhula komntwana
• Umonakalo wesibindi
• Ezinye iziphumo ebezingalindelekanga
• Ukusebenzisana kweziyobisi
• Isisombululo se-methotrexate esisetyenziselwa i-psoriatic arthritis
• Ezinye iindlela zokwenza i-methotrexate kunyango lwe-psoriatic arthritis
• Ezinye ii-DMARD eziqhelekileyo
• Ibhayoloji
• Ukuthatha

Ushwankathelo

I-Methotrexate (MTX) sisiyobisi esisetyenziselwe ukunyanga i-psoriatic arthritis ngaphezulu. Yedwa okanye idityaniswe nezinye iindlela zonyango, i-MTX ithathwa njengonyango lodidi lokuqala lokumodareyitha ukuya kwi-psoriatic arthritis (PsA). Namhlanje, ihlala isetyenziswa ngokudibeneyo kunye namachiza amatsha e-biologic ePSA.

I-MTX ineziphumo ebezingalindelekanga ezinokubakho. Kwicala lokudibanisa, MTX:

• ayibizi mali ininzi
• Unceda ukunciphisa ukudumba
• icoca iimpawu zolusu

Kodwa i-MTX ayikuthinteli ukutshatyalaliswa ngokudibeneyo xa kusetyenziswa yodwa.

Xoxa nogqirha wakho ukuba ngaba i-MTX iyodwa okanye idityaniswe namanye amayeza kunokuba lunyango olulungileyo kuwe.

Isebenza njani i-methotrexate njengonyango lwe-psoriatic arthritis

I-MTX sisiyobisi esine-antimetabolite, oko kuthetha ukuba iyaphazamisa ukusebenza kweeseli ngokukuthintela ekwahlukaneni. Ibizwa ngokuba sisiyobisi esiguqula i-antirheumatic drug (DMARD) kuba sinciphisa ukudumba ngokudibeneyo.

Ukusetyenziswa kwayo okokuqala, ukusukela phaya emva kwexesha koo-1940, yayikwimilinganiselo ephezulu yokunyanga leukemia yabantwana. Kwiidosi ezisezantsi, iMTX icinezela amajoni omzimba kwaye inqanda ukuveliswa kwethishu ye-lymphoid ebandakanyeka kwi-PsA.

I-MTX yamkelwa yi-U.S. YezoKutya kunye noLawulo lweeDrug (FDA) ngo-1972 ukuze isetyenziswe ne-psoriasis eqatha (edla ngokunxulunyaniswa ne-psoriatic arthritis), kodwa ikwasetyenziswa ngokubanzi “kwileyibhile” ye-PsA. "Ngaphandle kwelebheli" kuthetha ukuba ugqirha wakho angamisela izifo ezingezizo ezamkelwe yi-FDA.

Ukusebenza kwe-MTX ye-PsA khange kufundwe kwizilingo ezinkulu zeklinikhi, ngokweAmerican Academy of Dermatology (AAD). Endaweni yoko, izindululo ze-AAD ze-MTX zisekwe kumava exesha elide kunye neziphumo zoogqirha abazimisele iPSA.

Inqaku lokuphononongwa ngo-2016 libonisa ukuba akukho luhlu lolawulo olungenamkhethe olubonakalise ukuphuculwa ngokudibeneyo kwe-MTX kuleyo ye-placebo. Ityala elilawulwa ngeenyanga ezintandathu ngo-2012 labantu abangama-221 ngaphezulu kweenyanga ezintandathu alifumananga bungqina bokuba unyango lwe-MTX lulodwa luphucule ukudumba ngokudibeneyo (synovitis) kwi-PsA.

Kodwa kukho isiphumo esibalulekileyo esongezelelweyo. Uphononongo luka-2012 lufumanise ukuba unyango lwe-MTX uyenzile ukuphucula kakhulu uvavanyo ngokubanzi lweempawu zoogqirha kunye nabantu abane-PsA ababandakanyeka kuphononongo. Kwakhona, iimpawu zesikhumba zaphuculwa nge-MTX.

Olunye uphononongo, olwaxelwa ngo-2008, lwafumanisa ukuba ukuba abantu abane-PsA baphathwa kwangoko kwesi sifo kwinqanaba elonyukayo le-MTX, baneziphumo ezingcono. Kubantu abangama-59 kolu phando:

• Iipesenti ezingama-68 ziye zancipha ngeepesenti ezingama-40 kubalo oludibeneyo lokutsha
• Iipesenti ezingama-66 ziye zancipha ngeepesenti ezingama-40 kwinani lokudumba kwamalungu
• Iipesenti ezingama-57 zazinendawo ephuculweyo yePsoriasis kunye ne-Index of Severity (PASI)

Olu phando lwenziwa ngo-2008 kwiklinikhi yaseToronto apho isifundo sangaphambili singakhange sifumane sibonelelo sonyango lwe-MTX lokudumba ngokudibeneyo.

Izibonelelo ze-methotrexate ye-psoriatic arthritis

I-MTX isebenza njenge-anti-inflammatory kwaye inokuba luncedo ngokwayo kwiimeko ezinobulali ze-PsA.

Uphononongo luka-2015 lufumanise ukuba iipesenti ezingama-22 zabantu abane-PsA baphathwa kuphela nge-MTX baphumelele kwisifo esincinci.

I-MTX iyasebenza ekucoceni ukubandakanyeka kolusu. Ngesi sizathu, ugqirha wakho unokuluqala unyango lwakho nge-MTX. Akubizi kakhulu kunamachiza amatsha e-biologic aphuhliswe kwii-2000s zakuqala.

Kodwa i-MTX ayithinteli ukutshatyalaliswa ngokudibeneyo kwi-PsA. Ke ukuba usemngciphekweni wokutshatyalaliswa kwamathambo, ugqirha wakho unokongeza kwenye ye-biologics. La machiza athintela ukuveliswa kwethumba necrosis factor (TNF), into ebangela ukudumba egazini.

Iziphumo ebezingalindelekanga ze-methotrexate ye-psoriatic arthritis

Iziphumo ezisetyenziswayo ze-MTX kubantu abane-PsA zinokubaluleka. Kucingelwa ukuba i-genetics inokusabela ngokuthe ngqo kwi-MTX.

Ukukhula komntwana

I-MTX yaziwa ngokuba yingozi ekukhuleni komntwana. Ukuba uzama ukukhulelwa, okanye ukuba ukhulelwe, hlala kwi-MTX.

Umonakalo wesibindi

Umngcipheko omkhulu kukulimala kwesibindi. Phantse i-1 kubantu abangama-200 abathatha i-MTX banomonakalo wesibindi. Kodwa umonakalo ubuyela umva xa umisa iMTX. NgokweSizwe sePsoriasis Foundation, umngcipheko uqala emva kokuba ufikelele kubomi be-1.5 gram ye-MTX.

Ugqirha wakho uya kubeka esweni ukusebenza kwesibindi ngelixa uthatha iMTX.

Umngcipheko wokonakala kwesibindi uyanda ukuba:

• usele utywala
• batyebe kakhulu
• unesifo seswekile
• banesifo sezintso esingaqhelekanga

Ezinye iziphumo ebezingalindelekanga

Ezinye iziphumo ebezingalindelekanga ezinje azikho nzulu, azonwabisi kwaye zihlala zilawulwa. Oku kubandakanya:

• isicaphucaphu okanye ukugabha
• ukudinwa
• izilonda zomlomo
• urhudo
• ukulahleka kweenwele
• isiyezi
• intloko ebuhlungu
• Ukugodola
• ukwanda kwengozi yosulelo
• uvakalelo elangeni
• Ukutshisa imvakalelo kulusu

Ukusebenzisana kweziyobisi

Ezinye iziyobisi ze-counter-the-counter ezifana ne-aspirin (i-Bufferin) okanye i-ibuprofen (i-Advil) inokunyusa imiphumo emibi ye-MTX. Ezinye i-antibiotics zinokusebenzisana ukunciphisa ukusebenza kwe-MTX okanye kunokuba yingozi. Thetha nogqirha wakho malunga namayeza akho kunye nokunxibelelana okunokwenzeka neMTX.

Isisombululo se-methotrexate esisetyenziselwa i-psoriatic arthritis

Idosi yokuqala ye-MTX ye-PsA zii-5 ukuya kwi-10 milligrams (mg) ngeveki kwiveki yokuqala okanye ezimbini. Kuxhomekeke kwimpendulo yakho, ugqirha uya kuthi kancinci anyuse idosi ukufikelela kwi-15 ukuya kuma-25 mg ngeveki, ethathwa njengonyango oluqhelekileyo.

I-MTX ithathwa kanye ngeveki, ngomlomo okanye ngenaliti. I-MTX yomlomo inokuba kwipilisi okanye kwifom engamanzi. Abanye abantu banokuqhekeza idosi kwiindawo ezintathu ngemini abayithatha ngayo ukunceda kwiziphumo ebezingalindelekanga.

Ugqirha wakho unokumisela isongezelelo se-folic acid, kuba i-MTX yaziwa ukunciphisa amanqanaba abalulekileyo e-folate.

Ezinye iindlela zokwenza i-methotrexate kunyango lwe-psoriatic arthritis

Kukho ezinye iindlela zonyango zamayeza e-PsA kubantu abangakwaziyo okanye abangafuniyo ukuthatha iMTX.

Ukuba unayo i-PsA emnene kakhulu, unokukwazi ukukhupha iimpawu ngamachiza angenayo i-nonsteroidal anti-inflammatory (NSAIDs) wedwa. Kodwa i-NSAIDS inezilonda zolusu. Kukwanjalo ngenaliti yendawo ye-corticosteroids, enokunceda kwezinye iimpawu.

Ezinye ii-DMARD eziqhelekileyo

Ii-DMARD eziqhelekileyo kwiqela elinye ne-MTX zezi:

• i-sulfasalazine (Azulfidine), ephucula iimpawu ze-arthritic kodwa engayeki umonakalo odibeneyo
• leflunomide (Arava), ephucula zombini ukudibana kunye neempawu zesikhumba
• i-cyclosporine (Neoral) kunye ne-tacrolimus (Prograf), esebenza ngokuthintela umsebenzi we-calcineurin kunye ne-T-lymphocyte

Ngamanye amaxesha ii-DMARDS zisetyenziselwa ukudibanisa nezinye iziyobisi.

Ibhayoloji

Amachiza amatsha amaninzi ayafumaneka, kodwa abiza kakhulu. Uphando luyaqhubeka, kwaye kusenokwenzeka ukuba olunye unyango olutsha lunokufumaneka kwixesha elizayo.

I-Biologics ethintela i-TNF kunye nokunciphisa umonakalo odibeneyo kwi-PsA zibandakanya ezi zi-alpha-blockers ze-TNF:

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

I-Biologics ejolise kwiiproteni ze-interleukin (ii-cytokines) zinokunciphisa ukudumba kunye nokuphucula ezinye iimpawu. Oku kuvunyiwe yi-FDA kunyango lwe-PsA. Ziquka:

• ustekinumab (Stelara), i-anti-monoclonal antibody ejolise kwi-interleukin-12 kunye ne-interleukin-23
• secukinamab (Cosentyx), ejolise kwi-interleukin-17A

Olunye ukhetho lonyango sisiyobisi i-apremilast (i-Otezla), ejolise kwiimolekyuli ngaphakathi kweeseli zomzimba ezichaphazelekayo nokudumba. Imisa i-enzyme phosphodiesterase 4, okanye PDE4. I-Apremilast inciphisa ukudumba kunye nokudumba ngokudibeneyo.

Onke amayeza anyanga i-PsA aneziphumo ebezingalindelekanga, ke kubalulekile ukuba uvavanye izibonelelo kunye neziphumo ebezingalindelekanga kugqirha wakho.

Ukuthatha

I-MTX inokuba luncedo kunyango lwe-PsA kuba inciphisa ukudumba kwaye inceda iimpawu ngokubanzi. Kananjalo inokuba neziphumo ebezingalindelekanga ezimandundu, ke kuyakufuneka ukuba ubekwe esweni rhoqo.

Ukuba ngaphezu kweyodwa yamalungu akho abandakanyekayo, ukudibanisa i-MTX kunye ne-biologic DMARD kunokuba luncedo ekuyekeni ukutshatyalaliswa ngokudibeneyo. Xoxa ngazo zonke iindlela zonyango kunye nogqirha wakho, kwaye uphonononge isicwangciso sonyango rhoqo. Kusenokwenzeka ukuba uphando oluqhubekayo kunyango lwe-PsA luza kuza nakwixa elizayo.

Unokufumana ukuba luncedo ukuthetha "nomgadi wenqanawa" kwi-National Psoriasis Foundation, okanye ujoyine elinye lamaqela eengxoxo ze-psoriasis.