Matenda a nyamakazi

Matenda a nyamakazi (RA) ndi matenda omwe amatsogolera kutukusira kwa malo ndi ziwalo zozungulira. Ndi matenda okhalitsa. Zitha kukhudzanso ziwalo zina.

Zomwe zimayambitsa RA sizikudziwika. Ndi matenda osadziwika. Izi zikutanthauza kuti chitetezo cha mthupi molakwika chimagunda minofu yathanzi.

RA imatha kuchitika msinkhu uliwonse, koma imafala kwambiri zaka zapakati. Amayi amatenga RA pafupipafupi kuposa amuna.

Matenda, majini, ndi kusintha kwa mahomoni kumatha kulumikizidwa ndi matendawa. Kusuta amathanso kulumikizidwa ndi RA.

Ndizochepa kwambiri kuposa osteoarthritis (OA). OA chomwe ndi chikhalidwe chomwe chimachitika mwa anthu ambiri chifukwa chovala ndikung'amba pamafundo akamakalamba.

Nthawi zambiri, RA imakhudza mafupa mbali zonse ziwiri za thupi mofanana. Zala, manja, mawondo, mapazi, zigongono, akakolo, chiuno ndi mapewa ndizomwe zimakhudzidwa kwambiri.

Matendawa amayamba pang'onopang'ono. Zizindikiro zoyambirira zimatha kuphatikiza:

• Zowawa zazing'ono zophatikizika
• Kuuma
• Kutopa

Zizindikiro zonse zimatha kuphatikiza:

• Kuuma m'mawa, komwe kumatha nthawi yopitilira ola limodzi, ndikofala.
• Magulu amatha kukhala ofunda, ofewa, komanso owuma akagwiritsidwa ntchito kwa ola limodzi.
• Ululu wophatikizika umamvekanso chimodzimodzi mbali zonse ziwiri za thupi.
• Magulu nthawi zambiri amatupa.
• Pakapita nthawi, olowa amatha kutaya mayendedwe awo ndipo atha kukhala olumala.

Zizindikiro zina ndizo:

• Kupweteka pachifuwa mukamapuma (pleurisy)
• Maso owuma ndi pakamwa (Sjögren syndrome)
• Kuwotcha maso, kuyabwa, ndi kutulutsa
• Mitsempha yamagazi pansi pa khungu (nthawi zambiri chizindikiro cha matenda oopsa kwambiri)
• Dzanzi, kumva kulasalasa, kapena kutentha m'manja ndi m'mapazi
• Zovuta za kugona

Matenda a RA amapangidwa pamene:

• Mukumva kupweteka ndikutupa m'magulu atatu kapena kupitilira apo.
• Nyamakazi yakhalapo kwanthawi yayitali kuposa milungu isanu ndi umodzi.
• Muli ndi mayeso abwino a chifuwa chachikulu kapena anti anti CCP.
• Mwakwezera ESR kapena CRP.
• Mitundu ina ya nyamakazi yatulutsidwa.

Nthawi zina matenda a RA amapangidwa ngakhale popanda zonse zomwe zawonetsedwa pamwambapa ngati nyamakazi ndiyomwe imakhala ya RA.

Palibe mayeso omwe angatsimikizire ngati muli ndi RA. Anthu ambiri omwe ali ndi RA azikhala ndi zotsatira zoyeserera. Komabe, anthu ena amakhala ndi zotsatira zoyesedwa pamayeso onse.

Mayeso awiri a labu omwe ali abwino mwa anthu ambiri ndipo nthawi zambiri amathandizira pakuwazindikira ndi awa:

• Chifuwa cha nyamakazi
• Wotsutsa-CCP antibody

Mayesowa ndi abwino kwa odwala ambiri omwe ali ndi RA. Kuyesa kwa anti-CCP antibody ndikofunikira kwambiri kwa RA.

Mayesero ena omwe angachitike ndi awa:

• Kuwerengera kwathunthu kwa magazi
• Gulu lamagetsi ndi uric acid
• Mapuloteni othandizira C (CRP)
• Mlingo wa sedimentation wa erythrocyte (ESR)
• Antinuclear antibody
• Kuyesa kwa hepatitis
• Ma x-ray ophatikizana
• Olowa ultrasound kapena MRI
• Kusanthula kwamadzimadzi olowa

RA nthawi zambiri amafuna chithandizo chanthawi yayitali ndi katswiri wamatenda wotchedwa rheumatologist. Chithandizo chimaphatikizapo:

• Mankhwala
• Thandizo lakuthupi
• Chitani masewera olimbitsa thupi
• Maphunziro okuthandizani kumvetsetsa mtundu wa RA, zosankha zanu zamankhwala, komanso kufunika kotsatira nthawi zonse.
• Opaleshoni, ngati pakufunika kutero

Chithandizo choyambirira cha RA ndimankhwala omwe amatchedwa anti -heating antirheumatic drug (DMARDS) ayenera kugwiritsidwa ntchito kwa odwala onse. Izi zimachedwetsa kuwonongeka kwamgwirizano ndikupewa zolakwika. Ntchito za RA ziyenera kufufuzidwa poyendera pafupipafupi kuti zitsimikizire kuti matendawa akuyang'aniridwa. Cholinga cha chithandizo ndikuletsa kupita patsogolo kwa RA.

MANKHWALA

Mankhwala odana ndi zotupa: Izi zimaphatikizapo aspirin ndi mankhwala osagwiritsa ntchito anti-inflammatory (NSAIDs), monga ibuprofen, naproxen ndi celecoxib.

• Mankhwalawa amagwira ntchito bwino kwambiri kuti achepetse kutupa ndi kutupa, koma amatha kukhala ndi zotsatirapo zazitali. Chifukwa chake, amayenera kumwedwa kwakanthawi kochepa komanso muyezo wochepa ngati zingatheke.
• Popeza samapewa kuwonongeka kwamagulu ngati agwiritsidwa ntchito okha, DMARDS iyeneranso kugwiritsidwa ntchito.

Matenda osokoneza bongo (DMARDs): Awa nthawi zambiri ndiwo mankhwala omwe amayesedwa koyamba mwa anthu omwe ali ndi RA. Amaperekedwa limodzi ndi kupumula, kulimbitsa thupi, komanso mankhwala osokoneza bongo.

• Methotrexate ndiyo DMARD yomwe imagwiritsidwa ntchito kwambiri pamatenda a nyamakazi. Leflunomide ndi hydroxychloroquine itha kugwiritsidwanso ntchito.
• Sulfasalazine ndi mankhwala omwe nthawi zambiri amaphatikizidwa ndi methotrexate ndi hydroxychloroquine (katatu).
• Pakhoza kukhala milungu kapena miyezi musanaone phindu lililonse kuchokera ku mankhwalawa.
• Mankhwalawa atha kukhala ndi zovuta zina, chifukwa chake mufunika kuyesa magazi pafupipafupi mukamamwa.
• Mankhwala a malungo - Gulu la mankhwalawa limaphatikizanso hydroxychloroquine (Plaquenil). Amagwiritsidwa ntchito nthawi zambiri pamodzi ndi methotrexate. Pakhoza kukhala milungu kapena miyezi musanaone phindu lililonse kuchokera ku mankhwalawa.

Corticosteroids - Mankhwalawa amagwira ntchito bwino kwambiri kuti achepetse kutupa ndi kutupa, koma amatha kukhala ndi zotsatirapo zazitali. Chifukwa chake, amayenera kumwedwa kwakanthawi kochepa komanso muyezo wochepa ngati zingatheke.

Othandizira a Biologic DMARD - Mankhwalawa adapangidwa kuti azikhudza mbali zina za chitetezo cha mthupi zomwe zimathandizira pakuyambitsa matenda a RA.

• Amatha kupatsidwa ngati mankhwala ena, omwe nthawi zambiri amakhala methotrexate, sanagwire ntchito. Mankhwala a biologic nthawi zambiri amawonjezeredwa ku methotrexate. Komabe, chifukwa ndiokwera mtengo kwambiri, kuvomerezeka kwa inshuwaransi kumafunikira.
• Ambiri a iwo amaperekedwa mwina pansi pa khungu kapena mtsempha. Pali mitundu yambiri yama biologic agents.

Ma biologic ndi ma synthetic othandizira amatha kukhala othandiza kwambiri pochiza RA. Komabe, anthu omwe amamwa mankhwalawa ayenera kuyang'anitsitsa chifukwa cha zachilendo, koma zovuta zoyipa:

• Matenda ochokera ku mabakiteriya, mavairasi, ndi bowa
• Khansa yapakhungu, koma osati khansa ya pakhungu
• Khungu
• Thupi lawo siligwirizana
• Kukhumudwa kwamtima
• Kuwonongeka kwa mitsempha
• Kuchuluka kwa maselo oyera a magazi

KUGWIDWA

Kuchita opaleshoni kungafunike kuti muthetse ziwalo zomwe zawonongeka kwambiri. Kuchita opaleshoni kungaphatikizepo:

• Kuchotsa cholumikizira (synovectomy)
• Kuphatikizira kwathunthu, nthawi zovuta kwambiri, kumatha kuphatikizira kusintha kwamondo (TKR) ndikusintha m'chiuno.

CHITHANDIZO CHA THUPI

Zochita zolimbitsa thupi komanso mapulogalamu olimbitsa thupi omwe adalamulidwa ndi othandizira amatha kuchepetsa kuchepa kwa ntchito yolumikizana ndikuthandizira kulimbitsa minofu.

Nthawi zina, othandizira amatha kugwiritsa ntchito makina apadera kuti azitha kutentha kwambiri kapena kukondoweza kwamagetsi kuti achepetse kupweteka ndikusintha kayendedwe ka mgwirizano.

Mankhwala ena omwe angathandize kuchepetsa kupweteka kwamagulu ndi awa:

• Njira zothandizira
• Mankhwala otentha ndi ozizira
• Zida kapena zida zogwiritsira ntchito pochirikiza ndi kulumikiza mafupa
• Nthawi zopuma pafupipafupi pakati pa zochitika, komanso kugona maola 8 mpaka 10 usiku uliwonse

Chakudya

Anthu ena omwe ali ndi RA atha kusalolera kapena kuyanjana ndi zakudya zina. Zakudya zopatsa thanzi zimalimbikitsidwa. Kungakhale kothandiza kudya zakudya zokhala ndi mafuta ambiri a nsomba (omega-3 fatty acids). Kusuta ndudu kuyenera kuyimitsidwa. Mowa wambiri uyeneranso kupewa.

Anthu ena atha kupindula kutenga nawo mbali pagulu lothandizira nyamakazi.

Kaya RA yanu ikupita kapena ayi zimadalira kuopsa kwa zizindikilo zanu ndi momwe mungayankhire. Ndikofunika kuyamba mankhwalawa posachedwa. Maulendo obwerezabwereza a rheumatologist amafunikira kuti asinthe mankhwalawa.

Kuwonongeka kwakanthawi kwamalumikizidwe kumatha kuchitika popanda chithandizo choyenera. Kuchiza koyambirira kwamankhwala atatu a DMARD omwe amadziwika kuti "mankhwala opitilira katatu," kapena ndi mankhwala a biologic kapena olumikizidwa amatha kupewetsa kupweteka ndi kulumikizana.

RA ikapanda kuchiritsidwa, imakhudza pafupifupi gawo lililonse la thupi. Zovuta zingaphatikizepo:

• Kuwonongeka kwa minofu ya m'mapapo.
• Kuchulukitsa chiwopsezo chouma kwamitsempha, komwe kumabweretsa matenda amtima.
• Kuvulala kwa msana mafupa a khosi awonongeka.
• Kutupa kwa mitsempha yamagazi (rheumatoid vasculitis), yomwe imatha kubweretsa khungu, mitsempha, mtima, ndi mavuto am'magazi.
• Kutupa ndi kutupa kwakunja kwa mtima (pericarditis) ndi minofu yamtima (myocarditis), zomwe zimatha kubweretsa kukhumudwa kwa mtima.

Komabe, zovuta izi zitha kupewedwa ndi chithandizo choyenera. Mankhwala a RA amathanso kuyambitsa zovuta zina. Lankhulani ndi omwe amakupatsani zomwe zingachitike chifukwa chothandizidwa ndi zomwe mungachite zikachitika.

Itanani omwe akukuthandizani ngati mukuganiza kuti muli ndi matenda a nyamakazi.

Palibe njira yodziwika yopewera. Kusuta kumawoneka koipitsitsa RA, chifukwa chake ndikofunikira kupewa fodya. Chithandizo choyambirira choyenera chingathandize kupewa kuwonongeka kwamagulu.

RA; Nyamakazi - nyamakazi

• Kukonzanso kwa ACL - kutulutsa
• Kumalo kwa kumwendo - kumaliseche
• Chigoba chakumaso - kutulutsa

• Matenda a nyamakazi
• Matenda a nyamakazi
• Matenda a nyamakazi

Aronson JK. Methotrexate. Mu: Aronson JK, mkonzi. Zotsatira zoyipa za Meyler za Mankhwala Osokoneza bongo. Wolemba 16. Waltham, MA: Elsevier B.V; 2016: 886-911.

Fleischmann R, Pangan AL, Nyimbo IH, et al. Upadacitinib motsutsana ndi placebo kapena adalimumab mwa odwala omwe ali ndi nyamakazi komanso mayankho osakwanira a methotrexate: Zotsatira za gawo lachitatu, loyeserera kawiri, kuyesedwa kosasinthika. Nyamakazi Rheumatol. 2019; 71 (11): 1788. (Adasankhidwa) PMID: 31287230 adatuluka.ncbi.nlm.nih.gov/31287230.

Kremer JM, Rigby W, woyimba NG, et al. Yankho lolimbikitsidwa kutsatira methotrexate mwa odwala omwe ali ndi nyamakazi yothandizidwa ndi tocilizumab ya subcutaneous: zotsatira zoyesedwa mosasinthika. Nyamakazi Rheumatol. 2018; 70 (8): 1200-1208. PMID: 29575803pubmed.ncbi.nlm.nih.gov/29575803.

Mcinnes Ine, O'Dell JR. Matenda a nyamakazi. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. 26 wa. Philadelphia, PA: Elsevier; 2020: chap 248.

O'Dell JR, Mikuls TR, Taylor TH, ndi al. Njira zochizira nyamakazi ya nyamakazi itatha methotrexate kulephera. N Engl J Med. 2013; 369 (4): 307-318. PMID: 23755969 adasankhidwa.ncbi.nlm.nih.gov/23755969.

O'Dell JR. Chithandizo cha nyamakazi. Mu: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, olemba. Kelley ndi Firestein's Bookbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017: mutu 71.

Singh JA, Saag KG, Bridges SL, ndi al. 2015 American College of Rheumatology malangizo othandizira kuchiza nyamakazi. Nyamakazi Rheumatol. 2016; 68 (1): 1-26. PMID: 26545940 adatulutsidwa.ncbi.nlm.nih.gov/26545940.