Kugwiritsa Ntchito Methotrexate Kuchiza Psoriatic Arthritis

Zamkati

• Momwe methotrexate imagwirira ntchito ngati chithandizo cha psoriatic nyamakazi
• Ubwino wa methotrexate yamatenda a psoriatic
• Zotsatira zoyipa za methotrexate yamatenda a psoriatic
• Kukula kwa mwana
• Kuwonongeka kwa chiwindi
• Zotsatira zina zoyipa
• Kuyanjana kwa mankhwala
• Mlingo wa methotrexate wogwiritsira ntchito psoriatic nyamakazi
• Njira zina za methotrexate zochizira nyamakazi ya psoriatic
• Ma DMARD ena wamba
• Zamoyo
• Kutenga

Chidule

Methotrexate (MTX) ndi mankhwala omwe akhala akugwiritsidwa ntchito pochizira nyamakazi ya psoriatic kuposa. Yokha kapena kuphatikiza mankhwala ena, MTX imawerengedwa kuti ndi mankhwala oyamba a psoriatic arthritis (PsA). Masiku ano, amagwiritsidwa ntchito limodzi ndi mankhwala atsopano a biologic a PsA.

MTX ili ndi zovuta zoyipa. Mbali yabwino, MTX:

• ndi wotsika mtengo
• amathandiza kuchepetsa kutupa
• amathetsa khungu

Koma MTX siyimaletsa kuwonongeka kogwirizana mukamagwiritsa ntchito nokha.

Kambiranani ndi dokotala ngati MTX yokha kapena kuphatikiza mankhwala ena akhoza kukhala chithandizo chabwino kwa inu.

Momwe methotrexate imagwirira ntchito ngati chithandizo cha psoriatic nyamakazi

MTX ndi mankhwala a antimetabolite, omwe amatanthauza kuti amasokoneza magwiridwe antchito am'magazi, kuwalepheretsa kugawa. Amatchedwa mankhwala osintha matenda (DMARD) chifukwa amachepetsa kutupa kwamalumikizidwe.

Kugwiritsa ntchito kwake koyamba, kuyambira kumapeto kwa zaka za m'ma 1940, kunali kwakukulu kuti athetse khansa ya m'magazi ya ana. Mlingo wochepa, MTX imapondereza chitetezo cha mthupi ndipo imalepheretsa kupanga minofu ya mitsempha yotchedwa PsA.

MTX inavomerezedwa ndi U.S. Food and Drug Administration (FDA) mu 1972 kuti igwiritsidwe ntchito ndi psoriasis yoopsa (yomwe nthawi zambiri imakhudzana ndi psoriatic nyamakazi), komanso imagwiritsidwanso ntchito "off label" ya PsA. "Kuchotsa chizindikiro" kumatanthauza kuti dokotala akhoza kukulemberani matenda ena kupatula omwe amavomerezedwa ndi FDA.

Kuchita bwino kwa MTX kwa PsA sikunaphunzirepo pamayesero akulu azachipatala, malinga ndi American Academy of Dermatology (AAD). M'malo mwake, malingaliro a AAD a MTX amachokera pazomwe zakhala zikuchitika kwa nthawi yayitali komanso zotsatira za madotolo omwe adawalembera PsA.

Nkhani yowunikira mu 2016 ikuwonetsa kuti palibe kafukufuku wowongolera mwachisawawa yemwe adawonetsa kusintha kwamgwirizano kwa MTX kuposa kwa placebo. Kuyesedwa kwa miyezi isanu ndi umodzi kwa 2012 kwa anthu 221 m'miyezi isanu ndi umodzi sikunapeze umboni uliwonse woti chithandizo cha MTX chokha chidawongolera kutupa palimodzi (synovitis) ku PsA.

Koma pali zotsatira zina zofunika. Kafukufuku wa 2012 adapeza kuti chithandizo cha MTX anachita imathandizira kwambiri kuwunika kwa zizindikiritso za madotolo komanso anthu omwe ali ndi PsA omwe akuchita nawo kafukufukuyu. Komanso, zizindikiro zakhungu zidakonzedwa ndi MTX.

Kafukufuku wina, yemwe adanenedwa mu 2008, adapeza kuti ngati anthu omwe ali ndi PsA amathandizidwa koyambirira kwa matendawa ndi kuchuluka kwa MTX, amakhala ndi zotsatirapo zabwino. Mwa anthu 59 omwe anali mu kafukufukuyu:

• 68% idatsika ndi 40% pakuwerengera kophatikizana
• 66% anali ndi kuchepa kwa 40% kwa ziwerengero zotupa
• 57% anali ndi Psoriasis Area ndi Severity Index (PASI) yabwino

Kafukufukuyu wa 2008 adachitika ku chipatala cha Toronto komwe kafukufuku wakale sanapeze mwayi wothandizidwa ndi MTX pathupi limodzi.

Ubwino wa methotrexate yamatenda a psoriatic

MTX imagwira ntchito ngati anti-yotupa ndipo itha kukhala yothandiza payokha pamagulu ochepa a PsA.

Kafukufuku wa 2015 adapeza kuti 22 peresenti ya anthu omwe ali ndi PsA amathandizidwa ndi MTX okha samachita matenda ochepa.

MTX imagwira ntchito pochotsa khungu. Pachifukwa ichi, dokotala wanu atha kuyamba kulandira chithandizo ndi MTX. Ndiotsika mtengo kuposa mankhwala atsopano a biologic omwe adapangidwa koyambirira kwa 2000s.

Koma MTX siyimateteza kuwonongedwa kwa mgwirizano mu PsA. Chifukwa chake ngati muli pachiwopsezo cha kuwonongeka kwa mafupa, dokotala wanu atha kuwonjezera pa imodzi mwama biologics. Mankhwalawa amaletsa kupanga chotupa necrosis factor (TNF), chinthu choyambitsa kutupa m'magazi.

Zotsatira zoyipa za methotrexate yamatenda a psoriatic

Zotsatira zoyipa zogwiritsira ntchito MTX kwa anthu omwe ali ndi PsA zitha kukhala zofunikira. Zimaganiziridwa kuti ma genetics atha kuchita momwe angachitire ndi MTX.

Kukula kwa mwana

MTX imadziwika kuti ndi yowopsa pakukula kwa mwana. Ngati mukuyesera kutenga pakati, kapena ngati muli ndi pakati, khalani kutali ndi MTX.

Kuwonongeka kwa chiwindi

Chiwopsezo chachikulu ndikuwonongeka kwa chiwindi. Pafupifupi 1 mwa anthu 200 omwe amatenga MTX ali ndi vuto la chiwindi. Koma kuwonongeka kumasintha mukayimitsa MTX. Malinga ndi National Psoriasis Foundation, chiwopsezo chimayamba mukafika pakukula kwa magalamu 1.5 a MTX.

Dokotala wanu adzawunika momwe chiwindi chanu chimagwirira ntchito mukamatenga MTX.

Chiwopsezo cha kuwonongeka kwa chiwindi chikuwonjezeka ngati:

• kumwa mowa
• onenepa
• kukhala ndi matenda ashuga
• kugwira ntchito ya impso modzidzimutsa

Zotsatira zina zoyipa

Zotsatira zina zoyipa zomwe sizingachitike sizowopsa, zimangokhala zosasangalatsa ndipo nthawi zambiri zimatha kuwongoleredwa. Izi zikuphatikiza:

• nseru kapena kusanza
• kutopa
• zilonda mkamwa
• kutsegula m'mimba
• kutayika tsitsi
• chizungulire
• mutu
• kuzizira
• chiopsezo chowonjezeka cha matenda
• kutengeka ndi kuwala kwa dzuwa
• kutentha pamatenda akhungu

Kuyanjana kwa mankhwala

Mankhwala ena owawa ngati aspirin (Bufferin) kapena ibuprofen (Advil) atha kukulitsa zovuta za MTX. Maantibayotiki ena amatha kulumikizana kuti achepetse mphamvu ya MTX kapena atha kukhala owopsa. Lankhulani ndi dokotala wanu zamankhwala anu komanso momwe mungachitire ndi MTX.

Mlingo wa methotrexate wogwiritsira ntchito psoriatic nyamakazi

Mlingo woyambira wa MTX wa PsA ndi mamiligalamu 5 mpaka 10 (mg) sabata iliyonse sabata yoyamba kapena awiri. Kutengera yankho lanu, dokotala adzawonjezera pang'onopang'ono kuti afike 15 mpaka 25 mg pa sabata, yomwe imadziwika kuti ndi mankhwala wamba.

MTX imatengedwa kamodzi pa sabata, pakamwa kapena jekeseni. MTX wamlomo akhoza kukhala mapiritsi kapena mawonekedwe amadzimadzi. Anthu ena amatha kuphwanya mlingowu m'magawo atatu patsiku lomwe amamwa kuti athandizire ndi zovuta zina.

Dokotala wanu amathanso kukupatsani mankhwala owonjezera a folic acid, chifukwa MTX imadziwika kuti imachepetsa magawo ofunikira.

Njira zina za methotrexate zochizira nyamakazi ya psoriatic

Pali mitundu ina ya mankhwala a PsA kwa anthu omwe sangathe kapena sakufuna kutenga MTX.

Ngati muli ndi PsA wofatsa kwambiri, mutha kuthetsa zizolowezi ndi mankhwala osagwiritsidwa ntchito ndi anti-inflammatory (NSAIDs) okha. Koma NSAIDS yokhala ndi zotupa pakhungu. N'chimodzimodzinso ndi jakisoni wakomweko wa corticosteroids, omwe angathandize ndi zizindikilo zina.

Ma DMARD ena wamba

Ma DMARD ochiritsira omwe ali mgulu limodzi ndi MTX ndi awa:

• sulfasalazine (Azulfidine), yomwe imathandizira kukonza matenda amitsempha koma siyimitsa kuwonongeka kwamagulu
• leflunomide (Arava), yomwe imathandizira kusintha ziwonetsero zonse zolumikizana komanso khungu
• cyclosporine (Neoral) ndi tacrolimus (Prograf), yomwe imagwira ntchito poletsa calcineurin ndi T-lymphocyte

Ma DMARD awa nthawi zina amagwiritsidwa ntchito limodzi ndi mankhwala ena.

Zamoyo

Mankhwala atsopano ambiri alipo, koma awa ndi okwera mtengo kwambiri. Kafukufuku akupitilizabe, ndipo zikuwoneka kuti njira zina zamankhwala zatsopano zitha kupezeka mtsogolo.

Biologics yomwe imalepheretsa TNF ndikuchepetsa kuwonongeka kwa mgwirizano mu PsA ikuphatikiza awa a TNF alpha-blockers:

• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Kutulutsa)

Biologics yomwe imayang'ana mapuloteni a interleukin (cytokines) amatha kuchepetsa kutupa ndikuwongolera zina. Awa ndi ovomerezeka ndi FDA pochiza PsA. Zikuphatikizapo:

• ustekinumab (Stelara), anti-monoclonal antibody yomwe imayang'ana interleukin-12 ndi interleukin-23
• secukinamab (Cosentyx), yomwe imayang'ana interleukin-17A

Njira ina yothandizira ndi mankhwala apremilast (Otezla), omwe amalimbana ndi mamolekyulu mkati mwa maselo amthupi omwe amakhudzidwa ndi kutupa. Imayimitsa enzyme phosphodiesterase 4, kapena PDE4. Apremilast amachepetsa kutupa ndi kutupa palimodzi.

Mankhwala onse omwe amachiza PsA ali ndi zovuta, chifukwa chake ndikofunikira kuwunika maubwino ndi zoyipa zake ndi dokotala wanu.

Kutenga

MTX ikhoza kukhala chithandizo chothandiza kwa PsA chifukwa imachepetsa kutupa ndipo imathandizira zizindikiritso zonse. Zitha kukhalanso ndi zovuta zoyipa, chifukwa chake muyenera kuyang'aniridwa pafupipafupi.

Ngati pali malo ophatikizira amodzi, kuphatikiza MTX ndi DMARD ya biologic kungakhale kothandiza poletsa kuwonongeka. Kambiranani zonse zomwe mungachite ndi dokotala wanu, ndipo onaninso dongosolo lamankhwala nthawi zonse. Zikuwoneka kuti kafukufuku wopitilira mu njira za PsA adzabwera mtsogolo.

Muthanso kupezanso kothandiza kukambirana ndi "woyendetsa wodwala wodwala" ku National Psoriasis Foundation, kapena kulowa nawo m'modzi mwa magulu ake okambirana za psoriasis.