Chifuwa chachikulu chotchedwa vasculitis ndi chachilendo, chovuta kwambiri cha matenda a nyamakazi omwe angathe kuika moyo pachiswe. Mu chifuwa chachikulu chotchedwa vasculitis, kutupa kumafalikira ku mitsempha yaing'ono kapena yeniyeni ya magazi m'thupi. Kawirikawiri, mitsempha imakhudzidwa, koma mitsempha imatha kukhala. Mitsempha yambiri ya magazi imakhala yosawerengeka.
Makoma a mitsempha yamagazi yowonjezereka ndipo ngati lumen ya mchere wathyola wathanzi umachepa, izo zikhoza kukhala zitatsekedwa.
Magazi operekedwa ku chiwalo amatha kusokonezeka, ngati osatsutsika. Mafupa amtunduwu amatha kukhala ndi ziwalo zambiri, kuphatikizapo khungu, maso, mitsempha, mtima, mapapo, ubongo, impso, kapena m'mimba. Koma, palinso uthenga wabwino. Odwala nyamakazi ochepa amayamba kukhala ndi matenda a chifuwa chachikulu, mwina chifukwa cha mankhwala ogwiritsidwa ntchito omwe apangidwa ndi kugulitsidwa zaka khumi zapitazi (ie, mankhwala osokoneza bongo ).
Kukula ndi Kuopsa kwa Chifuwa Choyambitsa Mafupa
Ngakhale kuchuluka kwa chifuwa chachikulu chotchedwa rheumatoid vasculitis chikuwoneka chikucheperachepera, akuganiza kuti anthu osachepera asanu kapena asanu aliwonse a odwala matenda a nyamakazi amayamba nthendayi ya vasuluitis. Komabe, kafukufuku wa autopsy wanena kuti 15-31%. Mawerengedwe a chiwerengero cha anthu odwala matenda a chifuwa chachikulu omwe amakhudzana ndi matenda a chifuwa chachikulu (massumitis) a vasculitis ndi ofunika kwambiri ndi zaka zisanu zapakati pa kufala kwa 30-50% komanso kuwonjezereka kwa chiwerengero cha matenda oopsa kapena mankhwala oopsa.
Zinthu zotsatirazi zimachulukitsa chiopsezo chotenga kachilombo ka mafupa:
- Chofunika cha chifuwa chachikulu
- Zabwino zotsutsa CCP
- Amuna (amodzi mwa ana asanu ndi atatu (9) ali ndi nyamakazi ya nyamakazi amapanga ma rumatoid vasculitis)
- Kusuta
- Kukhalapo kwa mitsempha ya nyamakazi
- Okalamba akuyamba matenda kapena nyamakazi ya nyamakazi (zaka zoposa 10)
Zizindikiro ndi Mawonetseredwe a Chifuwa Choyambitsa Mafupa
Chiwalo chilichonse cha thupi chingakhudzidwe ndi nyamakazi ya vasculitis. Khungu ndi mitsempha ya m'mimba nthawi zambiri imakhudzidwa. Ngakhale kuti kulimbikitsidwa kwa ziwalo zazikulu kumawoneka ngati kosazolowereka, kumagwirizanitsidwa ndi kuwonongeka kwakukulu ndi kufa.
Kutenga khungu kungaphatikizepo purpura, mitsempha yam'mimba, zilonda zam'mimba, ndi necrosis ya ma dijiti, makamaka zala. Livedo reticularis ndichidziwitso chofala. Kuphatikizidwa kwa khungu kumafuna kufufuza kwina kwa zina zogwirira ntchito. Matenda a scleritis , pleuritis , kapena pericarditis ndi zitsanzo za zomwe zingapangidwe. Ngati khungu likuphatikizidwa popanda kugwiritsa ntchito njira zina, zizindikirozi ndi zabwino.
Ndi njira yamanjenje yowopsa, njira zokhudzana ndi matenda a m'mimba zingayambe, monga distal symmetric sensory polyneuropathy, distal motor kapena kugwirizana kwa ubongo, kapena multipleone syndrome. Pamene vasulitis imapweteka mitsempha. pangakhale kusokonezeka, kukhumudwa, kutayika, kufooka, ndi kutaya ntchito mu manja kapena mapazi. Zizindikiro zowonjezereka zimatha kupezeka, monga fever, kulemera kwa thupi, kusowa kwa njala, ndi kutaya mphamvu.
Kuzindikira Matenda a Chifuwa Choyambitsa Mafupa
Ngakhale kuti zizindikiro zikhoza kuchititsa dokotala kuganiza kuti chifuwa chachikulu chotchedwa rheumatoid vasculitis ndi ma laboratory mayesero angapereke umboni wotsimikizirika wokhudzana ndi matenda, chidziwitso chiyenera kuti chitsimikizidwe chotsimikizira.
Khungu lokhala nalo lingakhale lopangidwa, komanso minofu kapena mitsempha mkati mwa dera lomwe lakhudzidwa, kapena gulu lokhudzidwa.
Pamene kuyesa kwa magazi chifukwa cha chifuwa chachikulu ndi anti-CCP kawirikawiri kumapangidwira m'matumbo a masamu, zotsatira siziri zenizeni. Mankhwalawa amapezeka m'magazi opanda nyamakazi. Ma antibodies anti-neutrophil cytoplasmic (ANCA) ndi anti-myeloperoxidase ndi anti-proteinase-3 ma antibodies nthawi zambiri zimakhala zolakwika mu mafupa a masamu.
Kuchiza kwa Chifuwa Choyambitsa Vasuluitis
Chithandizo cha chifuwa chachikulu chotchedwa rheumatoid vasculitis makamaka chimatsimikiziridwa ndi ziwalo zomwe zimakhudzidwa.
Komanso, nyamakazi ya nyamakazi imayenera kuchitidwa bwino pogwiritsira ntchito DMARD kapena mankhwala a biologic, monga TNF blockers . Kulamulira kutupa m'magulu onse ndi m'mitsempha ya mthupi n'kofunikira.
Mzere woyamba wa chithandizo cha matenda a rhumatus vasculitis umaphatikizapo kugwiritsa ntchito corticosteroids (kawirikawiri prednisone ). Prednisone ingagwirizane ndi methotrexate kapena azathioprine. Ndi zizindikiro zapamwamba komanso kukhudzidwa kwakukulu kwa thupi, kuyesetsa mwamphamvu kuti chitetezo chogonana chikhoza kukhala ndi cyclophosphamide komanso kuchuluka kwake kwa prednisone. Rituxan (rituximab) ikuwonekera ngati njira yoyamba yothandizira ma rhumatitis. Malingana ndi lipoti la Arthritis Care ndi Research (2012), kufufuza kwa deta kuchokera ku Autoimmunity ndi Rituximab registry kunawulula kuti kukhululukidwa kunakwaniritsidwa mu 12 mwa 17 nyamakazi ya vasculitis odwala amachiritsidwa ndi rituximab. Odwalawo anathanso kuchepetsa mlingo wawo wa prednisone.
Zotsatira:
Chifuwa chachikulu cha Vasuluitis. Johns Hopkins Vasculitis Center.
http://www.hopkinsvasculitis.org/types-vasculitis/rheumatoid-vasculitis/
Chifuwa chachikulu cha Vasuluitis. Clinical Cleveland.
http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-rheumatoid-vasculitis
Chifuwa chachikulu cha Vasuluitis. Vasculitis Foundation. September 2012.
http://www.vasculitisfoundation.org/education/forms/rheumatoid-vasculitis/
Chifuwa Choyambitsa Vasuluitis: Kutaya Mthenda Kapena Cholinga cha Zopangidwe Zatsopano? Bartels ndi Bridges. Malipoti Amakono a Rheumatology. December 2010.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950222/
Thandizo la Rituximab la vasculitis lachidziwitso limagwirizanitsa ndi nyamakazi ya nyamakazi: Zotsatira kuchokera ku Registry Autoimmunity ndi Rituximab. Puechal X et al. Matenda a Nyamakazi ndi Kafukufuku. March 2012.
http://www.ncbi.nlm.nih.gov/pubmed/22076726