Funsani Katswiri: Matenda a Nyamakazi

Zamkati

• Wolemba David Curtis, MD
• Q: Ndili ndi zaka 51 ndipo ndili ndi OA ndi RA. Kodi Enbrel athandizira kuwongolera OA yanga kapena ndi zongokhala ndi RA?
• Q: Ndili ndi OA yovuta ndipo ndinapezeka ndi gout. Kodi zakudya zimathandiza mu OA?
• Q: Ndakhala ndikulandila Actemra infusions kwa miyezi itatu, koma sindimakhala ndikumverera mpumulo. Dokotala wanga akufuna kuyitanitsa mayeso a Vectra DA kuti awone ngati mankhwalawa akugwira ntchito. Kuyesa uku ndi kotani ndipo ndi kodalirika motani?
• Q: Ndi zoopsa ziti zoti mankhwala onse azichotsedwa?
• Q: Ndili ndi OA mu chala changa chachikulu chakumapazi ndi RA m'mapewa ndi maondo anga. Kodi pali njira iliyonse yothetsera kuwonongeka komwe kwachitika kale? Ndipo ndingatani kuti ndithane ndi kutopa kwa minofu?
• Q: Ndi nthawi iti pomwe ndikololedwa kupita ku ER kukamva ululu? Zizindikiro ziti zomwe ndiyenera kunena?
• Q: Katswiri wanga wamatenda adati mahomoni samakhudza zizindikilo, koma mwezi uliwonse zomwe ndimachita zimafanana ndi nthawi yanga yakusamba. Maganizo anu ndi otani pa izi?
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Wolemba David Curtis, MD

Matenda a nyamakazi (RA) ndi matenda osachiritsika. Amadziwika ndi ululu wophatikizana, kutupa, kuuma, komanso kutayika kwa ntchito.

Pomwe anthu opitilira 1.3 miliyoni aku America akudwala RA, palibe anthu awiri omwe azikhala ndi zofananira kapena zomwezo. Chifukwa cha izi, kupeza mayankho omwe mungafune nthawi zina kumakhala kovuta. Mwamwayi, a Dr. David Curtis, MD, katswiri wazamatsenga wokhala ndi zilolezo ku San Francisco wabwera kudzathandiza.

Werengani mayankho ake pamafunso asanu ndi awiri omwe amafunsidwa ndi odwala enieni a RA.

Q: Ndili ndi zaka 51 ndipo ndili ndi OA ndi RA. Kodi Enbrel athandizira kuwongolera OA yanga kapena ndi zongokhala ndi RA?

Kupezeka kwa nyamakazi ya nyamakazi ndi nyamakazi ndikofala chifukwa tonsefe tidzakhala ndi OA pamlingo wina, mwinanso osati ambiri, amalumikizidwe athu nthawi ina m'miyoyo yathu.

Enbrel (etanercept) imavomerezedwa kuti igwiritsidwe ntchito mu RA ndi matenda ena otupa, omwe amadzimadzimitsa okha omwe amadziwika kuti TNF-alpha cytokine imathandiza kwambiri kuyambitsa kutupa (kupweteka, kutupa, ndi kufiyira) komanso zowononga pa fupa ndi chichereŵechereŵe. Ngakhale OA ili ndi zina mwa "zotupa" ngati gawo la matenda ake, cytokine TNF-alpha sikuwoneka kuti ndiyofunikira panthawiyi motero TNF yotsekedwa ndi Enbrel sichiyenera kuyembekeza kusintha zizindikiritso za OA .

Pakadali pano, tiribe "mankhwala osinthira matenda" kapena biologics ya nyamakazi. Kafukufuku m'machiritso a OA ndiwothandiza kwambiri ndipo tonse titha kukhala ndi chiyembekezo kuti mtsogolomo tidzakhala ndi mankhwala othandiza a OA, monga timachitira RA.

Q: Ndili ndi OA yovuta ndipo ndinapezeka ndi gout. Kodi zakudya zimathandiza mu OA?

Zakudya ndi zakudya zabwino zimathandiza kwambiri pazochitika zonse zathanzi lathu. Zomwe zingawoneke zovuta kwa inu ndizomwe zikuwoneka ngati zotsutsana pazikhalidwe zosiyanasiyana. Mavuto onse azachipatala atha kupindula ndi chakudya "chanzeru".

Ngakhale zomwe zili zanzeru zimatha kusiyanasiyana ndi matenda, ndipo malingaliro a asing'anga ndi akatswiri azakudya amatha kusintha pakapita nthawi, ndizotheka kunena kuti chakudya chanzeru ndichomwe chimakuthandizani kuti mukhale ndi thupi labwino, chimadalira osasinthidwa zakudya, zili ndi zipatso, ndiwo zamasamba, ndi mbewu zonse, ndipo zimachepetsa mafuta ambiri azinyama. Mapuloteni okwanira, mchere, ndi mavitamini (kuphatikiza calcium ndi vitamini D yamafupa athanzi) ayenera kukhala gawo la chakudya chilichonse.

Ngakhale kupewa kupewa purines sikofunikira kapena kulimbikitsidwa, odwala omwe amamwa mankhwala a gout amatha kulepheretsa kudya kwa purine. Ndikulimbikitsidwa kuchotsa zakudya zomwe zili ndi purine wambiri ndikuchepetsa kudya komwe kumakhala ndi purine pang'ono. Mwachidule, ndibwino kuti odwala azidya zakudya zopangidwa ndi zakudya zochepa za purine. Kuthetsa kwathunthu kwa purines, komabe, sikuvomerezeka.

Q: Ndakhala ndikulandila Actemra infusions kwa miyezi itatu, koma sindimakhala ndikumverera mpumulo. Dokotala wanga akufuna kuyitanitsa mayeso a Vectra DA kuti awone ngati mankhwalawa akugwira ntchito. Kuyesa uku ndi kotani ndipo ndi kodalirika motani?

Rheumatologists amagwiritsa ntchito kuyesedwa kwachipatala, mbiri yazachipatala, zizindikilo, komanso kuyezetsa labotale pafupipafupi kuti aone ngati ali ndi matenda. Kuyesa kwatsopano kotchedwa Vectra DA kumayesa magulu ena owonjezera amwazi. Izi zamagazi zimathandizira kuwunika momwe chitetezo chamthupi chimayankhira pantchito zamatenda.

Anthu omwe ali ndi matenda a nyamakazi (RA) omwe sali pa Actemra (tocilizumab Injection) nthawi zambiri amakhala ndi interleukin 6 (IL-6). Chowotcha ichi ndichofunikira kwambiri pakuyesa kwa Vectra DA.

Actemra imatseka cholandilira cha IL-6 kuti chithetse kutupa kwa RA. Mulingo wa IL-6 m'magazi umakwera pamene cholandirira cha IL-6 chatsekedwa. Izi ndichifukwa choti sichilumikizidwanso ndi wolandila. Miyezo yokwera ya IL-6 sikuyimira zochitika zamatenda mwa ogwiritsa ntchito a Actemra. Iwo. Zimangowonetsa kuti munthu wathandizidwa ndi Actemra.

Ma Rheumatologists sanavomereze Vectra DA ngati njira yothandiza kuwunika zochitika zamatenda. Kuyeza kwa Vectra DA sikothandiza pakuwunika momwe mungayankhire pa mankhwala a Actemra. Rheumatologist wanu adzadalira njira zachikhalidwe kuti muwone kuyankha kwanu kwa Actemra.

Q: Ndi zoopsa ziti zoti mankhwala onse azichotsedwa?

Seropositive (kutanthauza kuti nyamakazi ndi yabwino) nyamakazi ya nyamakazi nthawi zambiri imakhala matenda osachiritsika omwe amatha kubweretsa kulemala ndikuwonongeka kwamphamvu ngati atapanda kuchiritsidwa. Komabe, pali chidwi chachikulu (kwa odwala komanso kuchiritsa madokotala) momwe angachepetsere ngakhale kuletsa mankhwala.

Pali kuvomerezana kwakukulu kuti chithandizo chamatenda a nyamakazi choyambirira chimabweretsa zotsatira zabwino kwambiri za odwala ndikuchepetsa kuchepa kwa ntchito, kukhutira ndi wodwala komanso kupewa kuwonongedwa. Palibe mgwirizano wofanana pa momwe angachepetse kapena kusiya mankhwala kwa odwala omwe akuchita bwino pakadali pano. Matenda amayamba kufala ngati mankhwala achepetsedwa kapena atayimitsidwa, makamaka ngati mankhwala osagwiritsidwa ntchito osakwatiwa akugwiritsidwa ntchito ndipo wodwalayo akuchita bwino. Ambiri omwe amachiza rheumatologists ndi odwala amakhala omasuka kuchepetsa ndikuchotsa DMARDS (monga methotrexate) pomwe wodwalayo akhala akuchita kwa nthawi yayitali komanso ali pa biologic (mwachitsanzo, TNF inhibitor).

Zomwe akumana nazo kuchipatala zikusonyeza kuti odwala nthawi zambiri amachita bwino bola akadapatsidwa mankhwala koma nthawi zambiri amakhala ndi zotupa ngati atasiya mankhwala onse. Odwala ambiri omwe ali ndi vuto loyambitsa matendawa amatha kuyimitsa mankhwala onse, kwakanthawi kwakanthawi, ndikuwonetsa kuti gulu la odwala atha kukhala ndi matenda osiyana ndi omwe amadwala nyamakazi ya nyamakazi. Ndikwanzeru kuchepetsa kapena kuyimitsa mankhwala a rheumatoid pokhapokha ndi mgwirizano ndi kuyang'anira kwa omwe amachiza rheumatologist.

Q: Ndili ndi OA mu chala changa chachikulu chakumapazi ndi RA m'mapewa ndi maondo anga. Kodi pali njira iliyonse yothetsera kuwonongeka komwe kwachitika kale? Ndipo ndingatani kuti ndithane ndi kutopa kwa minofu?

Osteoarthritis (OA) mu chala chachikulu chakuphazi ndi chofala kwambiri ndipo imakhudza pafupifupi aliyense pamlingo wazaka 60.

Matenda a nyamakazi (RA) amathanso kukhudzanso mgwirizanowu. Kutupa kwa mapangidwe olumikizana amatchedwa synovitis. Mitundu yonse ya nyamakazi imatha kubweretsa synovitis.

Chifukwa chake, anthu ambiri omwe ali ndi RA omwe ali ndi zovuta zina za OA mgwirizanowu amapeza mpumulo waukulu kuzizindikiro zothandizidwa ndi RA, monga mankhwala.

Mwa kuyimitsa kapena kuchepetsa synovitis, kuwonongeka kwa karoti ndi fupa kumachepetsanso. Kutupa kwanthawi yayitali kumatha kubweretsa kusintha kwamafupa. Kusintha kwa mafupa ndi karoti uku ndikofanana ndi kusintha komwe kumachitika chifukwa cha OA. M'magawo onse awiriwa, kusintha sikungasinthidwe kwenikweni ndi chithandizo chomwe chilipo masiku ano.

Zizindikiro za OA zimatha kumera ndikucheperachepera, kumawonjezeka pakapita nthawi, komanso kukulitsidwa ndi zoopsa. Kuchita masewera olimbitsa thupi, kugwiritsa ntchito mankhwala apakamwa ndi pakamwa, ndi corticosteroids zitha kuthandiza kuchepetsa zizindikilo kwambiri. Komabe, kutenga zowonjezera ma calcium sikungakhudze njira ya OA.

Kutopa kumatha kuphatikizidwa ndi mankhwala osiyanasiyana komanso matenda, kuphatikiza RA. Dokotala wanu amatha kuthandizira kutanthauzira zizindikilo zanu ndikuthandizani kukonzekera chithandizo chothandiza kwambiri.

Q: Ndi nthawi iti pomwe ndikololedwa kupita ku ER kukamva ululu? Zizindikiro ziti zomwe ndiyenera kunena?

Kupita kuchipatala chadzidzidzi kumakhala kovuta, kotenga nthawi, komanso kovutitsa mtima. Komabe, ma ER amafunikira anthu omwe akudwala kwambiri kapena ali ndi matenda owopsa.

RA sakhala ndi zizindikiritso zowopsa zamoyo. Ngakhale pamene zizindikirozi zilipo, ndizochepa kwambiri. Zizindikiro zazikulu za RA monga aspericarditis, pleurisy, kapena scleritis nthawi zambiri zimakhala "zovuta". Izi zikutanthauza kuti samabwera mwachangu (patadutsa maola ochepa) komanso mwamphamvu. M'malo mwake, mawonetseredwe awa a RA amakhala ofatsa ndipo amabwera pang'onopang'ono. Izi zimakupatsani nthawi yolumikizana ndi adotolo oyambira kapena a rheumatologist kuti akupatseni upangiri kapena kupita ku ofesi.

Zadzidzidzi zambiri mwa anthu omwe ali ndi RA zimalumikizidwa ndi comorbid zinthu monga matenda amitsempha yamagazi kapena matenda ashuga. Zotsatira zoyipa za mankhwala a RA omwe mukumwa - monga zosavomerezeka - zitha kutsimikizira ulendo wopita ku ER. Izi ndizowona makamaka ngati zomwe zimachitika ndizovuta. Zizindikiro zimaphatikizapo kutentha thupi, zotupa zazikulu, kutupa pakhosi, kapena kupuma movutikira.

Vuto lina lomwe lingachitike ndi vuto lopatsirana la kusintha kwa matenda ndi mankhwala a biologic. Chibayo, matenda a impso, matenda am'mimba, komanso matenda apakati amanjenje ndi zitsanzo za matenda ovuta omwe amayambitsa kuwunika kwa ER.

Kutentha kwakukulu kungakhale chizindikiro cha matenda komanso chifukwa choyimbira dokotala. Kupita mwachindunji ku ER ndi kwanzeru ngati zizindikiro zina zilizonse, monga kufooka, kupuma movutikira, ndi kupweteka pachifuwa kulipo ndi malungo. Kawirikawiri ndibwino kuti muitane dokotala wanu kuti akupatseni malangizo musanapite ku ER, koma mukakayikira, ndibwino kuti mupite ku ER kuti mukawunike mwachangu.

Q: Katswiri wanga wamatenda adati mahomoni samakhudza zizindikilo, koma mwezi uliwonse zomwe ndimachita zimafanana ndi nthawi yanga yakusamba. Maganizo anu ndi otani pa izi?

Mahomoni achikazi amatha kukhudza matenda okhudzana ndi autoimmune, kuphatikiza RA. Achipatala samamvetsetsabe izi. Koma tikudziwa kuti nthawi zambiri matenda amakula msambo. Kukhululukidwa kwa RA panthawi yapakati komanso kutha pambuyo pathupi ndizowonanso konsekonse.

Kafukufuku wakale akuwonetsa kuchepa kwa zochitika za RA mwa azimayi omwe adamwa mapiritsi oletsa kubereka. Komabe, kafukufuku wapano sanapeze umboni wokhutiritsa wakuti mankhwala obwezeretsa mahomoni amatha kuletsa RA. Kafukufuku wina wanena kuti mwina zingakhale zovuta kusiyanitsa pakati pa zikhalidwe zisanachitike msambo ndi RA flare-up. Koma kugwirizanitsa moto ndi msambo wanu mwina sikungokhala mwangozi. Anthu ena amawona kuti zimathandizira kuwonjezera mankhwala awo akanthawi kochepa, monga nonsteroidal anti-kutupa, poyembekezera kuwuka.

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