Umbhali: Lewis Jackson
Umhla Wokudalwa: 13 Ucanzibe 2021
Hlaziya Umhla: 17 Eyenkanga 2024
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Umxholo

Yintoni i-psoriatic arthritis?

I-Psoriatic arthritis (i-PsA) yimeko edibanisa ukudumba, ukudumba kwamalungu e-arthritis kunye ne-psoriasis. I-Psoriasis ngesiqhelo ibangela ukurhawuzelela, amabala abomvu anamaxolo ukuba avele kulusu nakwisikhumba.

Phantse i-7.5 yezigidi zabantu baseMelika bane-psoriasis, kwaye ukuya kuthi ga kwiipesenti ezingama-30 zaba bantu baphuhlisa i-PsA. I-PsA inokuba nobulali okanye ibenzima kwaye ibandakanye elinye okanye amaninzi amalungu.

Ukuba wena okanye umntu omthandayo ufumene ukuxilongwa kwe-PsA, unokuba nemibuzo malunga nokuba ubomi bunjani ngale meko.

Iindidi ze-psoriatic arthritis

Zintlanu iintlobo zePSA.

I-Symmetric PsA

Olu hlobo luchaphazela amalungu ngokufanayo kumacala omabini omzimba wakho, ke omabini la madolo akho asekhohlo nawasekunene, umzekelo. Iimpawu zingafana nezo zesifo samathambo (RA).

I-Symmetric PsA ithambekele ekubeni yomelele kwaye ibangele ukukhubazeka ngokudibeneyo kune-RA. Nangona kunjalo, i-symmetric PsA inokukhubaza. Malunga nesiqingatha sabantu abane-PsA banolu hlobo.

I-Asymmetric PsA

Oku kuchaphazela ukudibana okanye amalungu kwelinye icala lomzimba wakho. Amalungu akho anokuziva ukuba buhlungu kwaye ajike abomvu. I-Asymmetric PsA ihlala ithambile. Ichaphazela malunga neepesenti ezingama-35 zabantu abane-PsA.


Indawo eyahlukileyo ye-interphalangeal ephambili kwi-PsA

Olu hlobo lubandakanya amalungu asondeleyo kwizikhonkwane zakho. Ezi ziyaziwa njengamajoyina e-distal. Kwenzeka malunga neepesenti ezili-10 zabantu abane-PsA.

I-Spondylitis PsA

Olu hlobo lwe-PsA lubandakanya umqolo wakho. Umqolo wakho wonke ukusuka entanyeni yakho ukuya kumqolo wakho osezantsi unokuchaphazeleka. Oku kunokwenza intshukumo ibabuhlungu kakhulu. Izandla zakho, iinyawo, imilenze, iingalo kunye nesinqe sinokuchaphazeleka.

I-Psoriatic arthritis mutilans

Olu luhlobo oluqatha, olugwenxa lwe-PsA. Phantse iipesenti ezintlanu zabantu abane-PsA banolu hlobo. I-Psoriatic arthritis mutilans ihlala ichaphazela izandla neenyawo zakho. Inokubangela nentlungu entanyeni yakho nasemqolo ongezantsi.

Zithini iimpawu zesifo se-psoriatic arthritis?

Iimpawu ze-PsA zahlukile kumntu ngamnye. Banokuba nobulali ukuya kubukhali. Ngamanye amaxesha imeko yakho iyakuxolelwa kwaye uya kuziva ungcono okwethutyana. Ngamanye amaxesha iimpawu zakho zingangcono. Iimpawu zakho zixhomekeka kuhlobo lwe-PsA onayo.

Iimpawu ngokubanzi ze-PsA zibandakanya:


  • idumbile, amalungu adibeneyo kwelinye okanye omabini amacala omzimba wakho
  • ukuqina kwasekuseni
  • ukudumba kweminwe neenzwane
  • izihlunu ezibuhlungu kunye nemisipha
  • amabala esikhumba anamaxolo, anokuba mandundu xa iintlungu ezidibeneyo zisenyuka
  • Nentloko enesihlwitha yohambayo
  • ukudinwa
  • ukukhonkxa kwezikhonkwane
  • Ukwahlula isikhonkwane sakho kwibhedi yesikhonkwane
  • umbala obomvu
  • iintlungu zamehlo (uveitis)

I-Spondylitis PsA, ngakumbi, inokubangela ezi zinto zilandelayo:

  • umqolo obuhlungu kunye nokuqina
  • iintlungu, ukudumba, kunye nobuthathaka kwakho:
    • isinqe
    • amadolo
    • amaqatha
    • iinyawo
    • ingqiniba
    • izandla
    • izihlahla
    • amanye amalungu
    • iinzwane ezidumbileyo okanye iminwe

I-Symmetric PsA ichaphazela amalungu amahlanu okanye nangaphezulu kumacala omabini omzimba wakho. I-Asymmetric PsA ichaphazela amalunga angaphantsi kwesihlanu, kodwa inokuba kumacala ahlukeneyo.

I-Psoriatic arthritis mutilans ikhubaza amalungu akho. Inokunciphisa iminwe kunye neenzwane ezichaphazelekayo. I-PsA ekude ibangela iintlungu kunye nokudumba kumalungu okudibanisa iminwe neenzwane. Funda ngakumbi malunga nefuthe le-11 le-psoriatic arthritis emzimbeni wakho.


Imifanekiso ye-psoriatic arthritis

Yintoni ebangela i-psoriatic arthritis?

Kwi-PsA, amajoni akho omzimba ahlasela amalungu akho kunye nolusu. Oogqirha abazi ngokuqinisekileyo ukuba yintoni ebangela olu hlaselo. Bacinga ukuba isuka kwindibaniselwano yemfuza kunye nezinto zokusingqongileyo.

I-PsA ibaleka kwiintsapho. Malunga neepesenti ezingama-40 zabantu abanale meko banesalamane esinye okanye nangaphezulu abane-PsA. Into ethile kwindalo esingqongileyo ihlala ibangela isifo kwabo banotyekelo lokuphuhlisa i-PsA. Inokuba yintsholongwane, uxinzelelo olugqithisileyo, okanye ukwenzakala.

Iphathwa njani i-psoriatic arthritis?

Injongo yonyango lwe-PsA kukuphucula iimpawu, njengokukhawuleza kolusu kunye nokudumba ngokudibeneyo.

Izikhokelo ezitsha zincomela indlela "yokuphatha ukujolisa", esekwe kukhetho lomntu ngamnye. Injongo ethile yonyango kunye nendlela yokulinganisa inkqubela phambili igqityiwe, emva koko ugqirha usebenza kunye nawe ukukhetha unyango.

Unokukhetha iindlela ezininzi zonyango. Isicwangciso sonyango esiqhelekileyo siya kubandakanya enye okanye ezingaphezulu kwezi zilandelayo:

Izidakamizwa ezichasayo ezichasayo (i-NSAID)

La mayeza anceda ukulawula iintlungu kunye nokudumba. Iinketho ze-over-the-counter (OTC) zibandakanya ibuprofen (Advil) kunye ne naproxen (Aleve). Ukuba ukhetho lwe-OTC alusebenzi, ugqirha wakho unokumisela ii-NSAID kwiidosi eziphezulu.

Ukuba zisetyenziswe ngokungachanekanga, ii-NSAID zinokubangela:

  • isisu esiswini
  • isisu esophayo
  • ukuhlaselwa yintliziyo
  • ukubetha
  • ukulimala kwesibindi kunye nezintso

Iziyobisi eziguqula iziyobisi ezichasene ne-antirheumatic (DMARDs)

La mayeza anciphisa ukuvuvukala ukukhusela umonakalo odibeneyo kunye nokucotha ukuqhubela phambili kwe-PsA. Zingalawulwa ngeendlela ezahlukeneyo, kubandakanya umlomo, inaliti, okanye ukumnika.

Ii-DMARD eziqhelekileyo zichazwe ziquka:

  • imethotrexate (Trexall)
  • leflunomide (Arava)
  • sulfasalazine (Azulfidine)

I-Apremilast (i-Otezla) yi-DMARD entsha ethathwe ngomlomo. Isebenza ngokuthintela i-phosphodiesterase 4, i-enzyme ebandakanyeka kukudumba.

Iziphumo ebezingalindelekanga ze-DMARD zibandakanya:

  • ukulimala kwesibindi
  • uxinzelelo lomongo wethambo
  • usulelo lwemiphunga

Ibhayoloji

Okwangoku kukho iintlobo ezintlanu zeziyobisi ze-biologic zokunyanga isifo se-psoriatic. Zahlulwe ngokoko zijolise kuzo kwaye zithintela (ibhlokhi okanye ukunciphisa) emzimbeni:

  • I-tumor necrosis factor-alpha (TNF-alpha) inhibitors:
    • adalimumab (Humira)
    • isatifikethi (Cimzia)
    • igolimumab (iSimponi)
    • I-etanercept (i-Enbrel)
    • infliximab (I-Remicade)
  • I-interleukin 12 kunye ne-23 (IL-12/23) inhibitors:
    • ustekinumab (uStelara)
  • I-interleukin 17 (IL-17) inhibitors
    • secukinumab (iCosentyx)
    • brodalumab (uSiliq)
    • ixekizumab (iTaltz)
  • I-interleukin 23 (IL-23) inhibitors
    • guselkumab (Tremfya)
    • itildrakizumab-asmn (Ilumya)
  • T-iseli inhibitors
    • Ukubulala (Orencia)

Ngokwezikhokelo zonyango ezitsha ezikhutshwe ngo-Novemba ngo-2018, la mayeza ayacetyiswa njengonyango lodidi lokuqala.

Ufumana i-biologics ngokusebenzisa inaliti phantsi kolusu lwakho okanye njengokufakwa. Ngenxa yokuba la mayeza anciphisa impendulo yakho yomzimba, anokunyusa umngcipheko wosulelo olubi. Ezinye iziphumo ebezingalindelekanga zibandakanya isicaphucaphu kunye norhudo.

IiSteroids

La mayeza anokuhlisa ukudumba. Kwi-PsA, bahlala betofelwe kumalungu achaphazelekayo. Iziphumo zibandakanya iintlungu kunye nomngcipheko omncinci wosulelo ngokudibeneyo.

Amajoni omzimba

Amayeza afana ne-azathioprine (Imuran) kunye ne-cyclosporine (Gengraf) ezolisa impendulo engasebenziyo yomzimba kwi-PsA. Azisetyenziswanga ngoku ngoku ukuba i-TNF-alpha inhibitors ikhona. Ngenxa yokuba buthathaka impendulo yomzimba yokuzikhusela, ii-immunosuppressants zinokunyusa umngcipheko wosulelo.

Unyango lwezihloko

Iikhrim, iigel, ii-lotions, kunye neoyile zinokukhawulezisa ukurhawuzelela kwe-PsA. Olu nyango luyafumaneka kwikhawuntara kunye nonyango.

Izinketho zibandakanya:

  • anthralin
  • i-calcitriol okanye i-calcipotriene, eziziintlobo zevithamini D-3
  • i-salicylic acid
  • iikhrimu ze-steroid
  • i-tazarotene, ephuma kwi-vitamin A

Unyango olukhanyayo kunye namanye amayeza e-PsA

Unyango olukhanyayo lusebenzisa amayeza, alandelwe kukukhanya kukukhanya, ukunyanga irhashalala yolusu.

Amanye amayeza ambalwa anyanga iimpawu ze-PsA. Oku kubandakanya secukinumab (Cosentyx) kunye ne-ustekinumab (Stelara). La machiza atofelwe phantsi kolusu lwakho. Banokunyusa umngcipheko wosulelo kunye nomhlaza. Funda ngakumbi ngeendlela ezininzi zonyango lwe-PsA.

Ngaba indlela yokuphila inokutshintsha iimpawu ze-psoriatic arthritis?

Kukho izinto onokuzenza ekhaya ukunceda ukuphucula iimpawu zakho:

Yongeza umthambo kwimisebenzi yakho yemihla ngemihla

Ukugcina amalungu akho eshukuma kunokunciphisa ukuqina. Ukusebenza ubuncinci imizuzu engama-30 ngemini kuya kukunceda ukunciphisa umzimba kwaye kukunike amandla. Buza ugqirha wakho ukuba loluphi uhlobo lomthambo olukhuselekileyo kumalungu akho.

Ukuhamba ngebhayisikile, ukuhamba, ukuqubha, kunye nolunye uqeqesho lwamanzi kunqabile kumalungu kunokwenza umthambo okuphezulu njengokubaleka okanye ukudlala intenetya.

Yahlukana nemikhwa emibi

Ukutshaya akulunganga kumalungu akho kunye nomzimba wakho uphela. Buza ugqirha wakho malunga neengcebiso, amayeza, okanye ukutshintshwa kwenicotine ukukunceda uyeke.

Nciphisa nokusela utywala. Ingadibana namanye amayeza e-PsA.

Nciphisa uxinzelelo

Ukuxinezeleka kunye noxinzelelo kunokubangela ukuba i-arthritis flares ibe mandundu. Cinga, ziqhelanise neyoga, okanye uzame ezinye iindlela zokunciphisa uxinzelelo lwengqondo kunye nomzimba.

Sebenzisa iipakethe ezishushu nezibandayo

Ukucinezelwa okufudumeleyo kunye neepakethe ezishushu zinokunciphisa ukukhathazeka kwemisipha. Iipakethe ezibandayo zinokunciphisa iintlungu kumalungu akho.

Hambisa ukukhusela amalungu akho

Vula iingcango ngomzimba wakho endaweni yeminwe yakho. Phakamisa izinto ezinzima ngezandla zozibini. Sebenzisa izivuli zebhotile ukuvula iziciko.

Cinga ngezixhobo zendalo kunye neziqholo

I-Omega-3 fatty acids ineempawu ezichasayo. La mafutha asempilweni, afumaneka kwizongezo ezininzi, anciphisa ukudumba kunye nokuqina kwamalungu.

Ngelixa uphando lubonisa ukuba kukho izibonelelo zezempilo, uLawulo lokuTya kunye neDrug alubek 'esweni ubunyulu okanye umgangatho wezongezo. Kubalulekile ukuba uthethe nogqirha wakho ngaphambi kokuba uqale ukuthatha izongezo.

Ngokunjalo, iturmeric, ispice esinamandla, ikwanyusa idosi yeepropathi ezichasene nokudumba kwaye inokunceda ukunciphisa ukudumba kunye ne-PsA flare-ups. I-Turmeric inokongezwa kuso nasiphi na isitya. Abanye abantu bade bayichukumise iti okanye iileta, njengobisi lwegolide.

Olunye unyango lwendalo kunye nolunye unyango kunokuba luncedo kwaye kunciphise ezinye iimpawu zePSA.

Ukutya okunyanga isifo samathambo

Ngelixa kungekho kutya okanye ukutya kuya kunyanga i-PsA, ukutya okunesondlo kunokunceda ukunciphisa ukudumba kunye nokunciphisa iimpawu. Utshintsho olusempilweni kwindlela otya ngayo lunokuhlawula kakhulu amalungu akho kunye nomzimba ekuhambeni kwexesha.

Ngamafutshane, yitya ngakumbi iziqhamo kunye nemifuno. Banceda ukunciphisa ukudumba kunye nokulawula ubunzima bakho. Ubunzima obugqithisileyo bubeka uxinzelelo ngakumbi kumalungu asele ebuhlungu. Nciphisa ushukela kunye namafutha, avuthayo. Beka ugxininiso kwimithombo yamafutha asempilweni, njengeentlanzi, iimbewu, kunye namandongomane.

Amanqanaba e-Psoriatic arthritis

I-PsA ayilandeli indlela efanayo kumntu ngamnye ofunyenwe enale meko. Abanye abantu banokuba neempawu nje ezincinci kunye nefuthe elinomda kumalungu abo. Kwabanye, ukukhubazeka ngokudibeneyo kunye nokwandiswa kwethambo kunokwenzeka ekugqibeleni.

Akucaci ukuba kutheni abanye abantu befumana ukuqhubela phambili kwesi sifo ngokukhawuleza kwaye abanye bengenzi njalo. Kodwa ukuxilongwa kwangoko kunye nonyango kunokunceda ukunciphisa iintlungu kunye nokucotha ukonakala kwamalungu. Kubalulekile ukuba uthethe nogqirha wakho nje ukuba uqale ukufumana iimpawu okanye iimpawu ezibonisa i-PsA.

Inqanaba lokuqala le-PsA

Kumanqanaba okuqala esi sifo samathambo, unokufumana iimpawu ezinobulali njengokudumba ngokudibeneyo kunye noluhlu oluncitshisiweyo lokuhamba. Ezi mpawu zinokwenzeka ngaxeshanye uphuhlise izilonda zesikhumba se-psoriasis, okanye zinokwenzeka kwiminyaka kamva.

Ii-NSAID zonyango oluqhelekileyo. La mayeza athoba iintlungu kunye neempawu, kodwa azicothisi iPSA.

I-PsA ephakathi

Ngokuxhomekeka kuhlobo lwe-PsA onayo, inqanaba eliphakathi okanye eliphakathi ngokuqinisekileyo liya kubona ukwanda kweempawu ezifuna unyango oluqhubela phambili, njenge-DMARD kunye ne-biologics. La mayeza anokunceda ukunciphisa iimpawu. Banokukunceda ukucothisa ukuqhubela phambili komonakalo ngokunjalo.

Ukuhamba kwexesha kwinqanaba le-PsA

Okwangoku, izicubu zethambo zichaphazeleka kakhulu. Ukukhubazeka ngokudibeneyo kunye nokwandiswa kwethambo kunokwenzeka. Unyango lujolise ekunciphiseni iimpawu nasekukhuseleni iingxaki eziya zisiba mandundu.

Ukuchonga isifo se-psoriatic arthritis

Ukuchonga i-PsA, ugqirha wakho kufuneka akhuphe ezinye izizathu zesifo samathambo, ezinje ngeRA kunye negawuthi, ngemifanekiso kunye novavanyo lwegazi.

Olu vavanyo lokucinga lukhangela ukonakala kwamalungu kunye nezinye izicwili:

  • X-reyi. Oku kujonga ukudumba nokonakala kwamathambo namalungu. Lo monakalo wahlukile kwi-PsA kunezinye iintlobo zesifo samathambo.
  • MRIs. Amaza erediyo kunye neemagnethi ezinamandla zenza imifanekiso engaphakathi komzimba wakho. Le mifanekiso inokunceda ugqirha wakho ukuba ahlole ngokudibeneyo, i-tendon, okanye i-ligament umonakalo.
  • Ukuskena kwe-CT kunye nee-ultrasound. Oku kunokunceda oogqirha baqonde ukuba iPSA ihambele phambili kangakanani kunye nokuba achaphazeleka kangakanani amalungu.

Uvavanyo lwegazi lwezi zinto lunceda ukuvavanya nakuphi na ukudumba okukhoyo emzimbeni wakho:

  • C-protein esebenzayo. Le yinto isibindi sakho esivelisayo xa kukho ukudumba emzimbeni wakho.
  • Inqanaba le-sedimentation ye-Erythrocyte. Oku kutyhila ukuba kungakanani ukudumba emzimbeni wakho. Nangona kunjalo, ayinakucacisa ukuba ukudumba kuvela kwi-PsA okanye ezinye izizathu ezinokubakho.
  • Irheumatoid factor (RF). Amajoni akho omzimba avelisa le autoantibody. Ihlala ikhona kwi-RA kodwa i-negative kwi-PsA. Uvavanyo lwegazi lwe-RF lunokunceda ugqirha wakho ukuba axelele ukuba unayo iPS okanye iRA.
  • Ulwelo oludibeneyo. Olu vavanyo lwenkcubeko lususa isixa esincinci samanzi emadolweni okanye kwelinye ilungu. Ukuba iikristali ze-uric acid zikulwelo, unokuba ne-gout endaweni ye-PsA.
  • Iiseli ezibomvu zegazi. Inani eliphantsi leeseli ezibomvu zegazi ukusuka kwi-anemia liqhelekile kubantu abane-PsA.

Akukho vavanyo lwegazi okanye imaging olunokumisela ukuba unayo iPSA. Ugqirha wakho usebenzisa indibaniselwano yovavanyo ukulawula ezinye izizathu ezinokubakho. Funda ngakumbi malunga nolu vavanyo kunye nento abanokuyixelela ugqirha wakho malunga namalungu akho.

Izinto ezinobungozi kwi-psoriatic arthritis

Kungenzeka ukuba ufumane i-PsA ukuba:

  • Unayo i-psoriasis
  • Unomzali okanye umntakwabo kunye nePSA
  • aphakathi kweminyaka engama-30 ukuya kwengama-50 (nangona abantwana bengayifumana nayo)
  • Ndine-strep throat
  • une-HIV

I-PsA ikubeka emngciphekweni weengxaki ezibandakanya:

  • i-psoriatic arthritis mutilans
  • iingxaki zamehlo, ezinje ngokudibana okanye ukudumba
  • isifo sentliziyo

Yintoni enokubangela i-psoriatic arthritis flare-up?

I-PsA flare-ups iyenza mandundu imeko kangangexesha elithile. Izinto ezithile zinokucima i-PsA flares. Izinto ezibangela wonke umntu zahlukile.

Ukufunda okubangela, gcina idayari yempawu. Yonke imihla, bhala phantsi iimpawu zakho kunye nento obuyenza xa beqala. Qaphela ukuba utshintshe nantoni na kwinkqubo yakho, ngokungathi uqala ukuthatha iyeza elitsha.

Iziphumo eziqhelekileyo ze-PsA zibandakanya:

  • usulelo, njengomqala womqala kunye nosulelo oluphezulu lokuphefumla
  • ukwenzakala, njengokucheba, ukukrwela, okanye ukutshiswa lilanga
  • isikhumba esomileyo
  • uxinzelelo
  • kubanda, imozulu eyomileyo
  • ukutshaya
  • ukusela kakhulu
  • uxinzelelo
  • ubunzima obugqithisileyo
  • amayeza, afana ne-lithium, i-beta-blockers, kunye neziyobisi ezichasayo

Nangona ungeke ukwazi ukuziphepha zonke ezi zinto zibangela, ungazama ukulawula uxinzelelo, uyeke ukutshaya, kunye nokunciphisa ukusela utywala.

Buza ugqirha wakho ukuba uthatha nawaphi na amayeza awaziwayo ukuseta iimpawu ze-PsA. Ukuba kunjalo, unokufuna ukutshintshela kwichiza elitsha.

Akusoloko kunokwenzeka ukumisa i-flares, kodwa unokusebenza kwaye ufunde iindlela zokunciphisa umngcipheko we-flares.

I-Psoriatic arthritis vs rheumatoid arthritis

I-PsA kunye ne-RA zimbini zeentlobo ezininzi zesifo samathambo. Ngelixa banokwabelana ngegama eliqhelekileyo kunye neempawu ezininzi ezifanayo, izizathu ezahlukeneyo ezibangela oko.

I-PsA ivela kubantu abane-psoriasis. Le yimeko yesikhumba ebangela izilonda kunye namabala anamaxolo kumphezulu wolusu.

I-RA sisifo sokuzimela. Kwenzeka xa umzimba ngempazamo uhlasela izicwili ezikumalungu. Oku kubangela ukudumba kwaye ekugqibeleni iintlungu kunye nokutshatyalaliswa ngokudibeneyo.

I-PsA yenzeka phantse ngokulinganayo emadodeni nakwabafazi, kodwa abasetyhini kunokwenzeka ukuba baphuhlise i-RA. I-PsA ihlala iqala ukubonisa phakathi kweminyaka engama-30 ukuya kwengama-50 kubantu abaninzi. I-RA ihlala iqala ukukhula kancinci kamva kubudala obuphakathi.

Kumanqanaba abo okuqala, zombini i-PsA kunye ne-RA zabelana ngeempawu ezifanayo. Oku kubandakanya iintlungu, ukudumba, kunye nokuqina ngokudibeneyo. Njengoko iimeko ziqhubeka, kunokucaca ukuba yeyiphi imeko onayo.

Ngethamsanqa, ugqirha ngekhe alinde ukuba i-arthritis iqhubeke ukuze ifumane isifo. Uvavanyo lwegazi kunye nokucinga kunokunceda ugqirha wakho athathe isigqibo sokuba yeyiphi imeko echaphazela amalungu akho.

Funda ngakumbi ngale meko kunye nendlela baphathwa ngayo.

Imbonakalo

Umbono womntu wonke uhlukile. Abanye abantu baneempawu ezibuthathaka kakhulu ezibangela iingxaki amaxesha ngamaxesha. Abanye baneempawu ezibi kakhulu kunye nezothathaka.

Okukhona zisiba mbi iimpawu zakho, kokukhona iPSA iya kuchaphazela amandla akho okujikeleza. Abantu abanomonakalo omkhulu ngokudibeneyo banokukufumanisa kunzima ukuhamba, ukunyuka izinyuko, kunye nokwenza eminye imisebenzi yemihla ngemihla.

Imbonakalo yakho iya kuchaphazeleka ukuba:

  • Ufumene ukuxilongwa kwe-PsA usemncinci.
  • Imeko yakho yayinzima xa ufumana isifo.
  • Uninzi lolusu lwakho lugutyungelwe irhashalala.
  • Abantu abambalwa kusapho lwakho bane-PsA.

Ukuphucula imbonakalo yakho, landela irejimeni yonyango ekuyalelwa ngugqirha. Kuya kufuneka uzame ngaphezulu kwesiyobisi esinye ukuze ufumane eyona nto isebenzela wena.

Funda eli nqaku ngeSpanish

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