Kafukufuku angapeze yankho
Mankhwala osagwiritsidwa ntchito poletsa kutupa ( NSAIDs ) ndi imodzi mwa njira zothandizira osteoarthritis m'chiuno ndi mawondo. NSAID zimagwira ntchito potseka molekyulu, yotchedwa cyclooxygenase yomwe imalepheretsa kupanga mitundu yambiri ya ma molecule otchedwa prostaglandins. Prostaglandins ndi omwe amachititsa ntchito zosiyanasiyana m'thupi lathu, zomwe zimakhala kutupa.
Mwa kulepheretsa kaphatikizidwe ka prostaglandins NSAID imachepetsa kutentha thupi lathu, ndipo ndizo zimachepa kwambiri.
Prostaglandins amachititsanso ntchito zina zochepa mu thupi monga kusungira mimba, ndipo zotsatira zina zoipa za NSAID zimachokera kuzimitsa ntchitozo; NSAID zikhoza kukhala zovuta m'mimba, ndipo kugwiritsa ntchito kwa NSAID kwa nthawi yayitali kungayambitse zilonda zam'mimba kapena zapakati. Mankhwala awa aphunzitsidwa bwino ndipo amalembedwa kawirikawiri kwa anthu omwe ali ndi matenda a osteoarthritis. Kugwiritsiridwa ntchito kwa NSAID mu chikhalidwe ichi ndi chimodzi mwa zifukwa zochepa zolimbikitsa zomwe American Academy of Orthopedic Surgeons (AAOS) zimapanga pazitsogozo zawo zothandizira mafupa a bondo.
Madokotala kawirikawiri amapereka NSAID ngati mankhwala oyamba a OA. Pali mankhwala angapo pansi pa mankhwalawa omwe amapezeka kwambiri ndi aspirin, ibuprofen (Advil), ndi naproxen (Aleve).
Acetaminophen yomwe imatchedwanso kuti paracetamol kapena Tylenol ndi mankhwala omwe ali pafupi kwambiri ndi kalasi ya NSAID, imagwiritsidwa ntchito mofanana, koma alibe mphamvu zotsutsana ndi zotupa ndipo nthawi zambiri sizingaganizidwe kuti ndi mbali imodzi ya kalasi ya NSAID.
Ngakhale tili ndi deta zambiri zomwe zimagwiritsa ntchito ntchito za NSAD mu chikhalidwe cha OA, tili ndi deta yochepa yotiuza ife, yomwe NSAID ili yothandiza kwambiri kuposa ena.
Ndipomwe kufotokoza kwaposachedwa kumene kunabwera ku Lancet mwezi uno. Tisanapitirire, tilankhulani mwachidule za gwero la kafukufukuyu. Lancet ndi magazini yachipatala yochokera ku United Kingdom yomwe yakhala ikuzungulira kuyambira m'ma 1820, ndi imodzi mwa mabuku olemekezedwa kwambiri, ndipo yakhala nsanja ya zochitika zowopsya kwambiri m'mbiri ya mankhwala.
Chitsanzo cha zolemba zina zomwe zatulutsidwa koyamba ku Lancet ndizolemba za Lister mu 1870 za zotsatira za njira yopanda ntchito yopanga opaleshoni yomwe inali yoyamba yomwe inatsogolera opaleshoni operekera manja ndi zida zonse asanachitidwe opaleshoni . Lancet nayenso Ronald Ross akufalitsa zomwe anapeza kuti udzudzu umatulutsa malungo, McBride amafalitsa kuti thalidomide (kamodzi kamene imatchuka kwambiri ndi mankhwala okhudzidwa ndi mimba) imayambitsa zolepheretsa kubereka.
Lancet imasindikiza nkhani zapamwamba komanso mbiri yaposachedwapa yakhala ikugwira ntchito yolemba ndemanga zapamwamba zomwe zimaphatikizapo deta kuchokera ku maphunziro angapo kuti ayesere kuyankha funso lofunika kwambiri. M'magazini yawo yotsiriza, magaziniyi inayankha kuyankha funso lakuti "Kodi NSAID ndi iti yabwino pochizira ululu wokhudzana ndi matenda a mitsempha ya bondo ndi chiuno?"
Tiyeni tiime pano kwa mphindi imodzi ndikupanga kulengeza kofunika kwambiri. Phunziroli SINALI KUDZIWA KUSULIRA. Choncho palibe chidziwitso chimenechi chokhudzana ndi mauthenga othandizira kapena momwe mankhwalawa amavulazira, iwo amangoyang'ana kupambana kwa mpumulo.
Phunziroli linapeza malipoti okwana 8,973, omwe maphunziro 74 anali owerengedwa mosavuta poyerekeza ndi NSAID zisanu ndi ziwiri zosiyana ndi Tylenol. Uwu ndiwo umboni wapamwamba kwambiri womwe uyenera kusonkhanitsidwa pamutuwu. Pakati pa mayesero onsewa panali anthu pafupifupi 60,000 omwe amachitilidwa ndi NSAID zosiyanasiyana komanso mitundu yosiyanasiyana ya ululu. Kenaka amapanga meta, yomwe imapanga odwala onsewa kukhala gulu limodzi kuti aone omwe ali ndi NSAID ndi mayendedwe omwe amagwiritsidwa ntchito anali othandiza kwambiri kuthetsa ululu.
Ngakhale kuti izi ndizosavuta kuzigwiritsa ntchito, njira zowonjezereka zogwirizana ndi njirayi sizingatheke pa nkhaniyi.
Pazitsulo 22 za mankhwala osokoneza bongo anayesedwa, 5 sanachite bwino kuposa placebo (mapiritsi a shuga). Zomwezo zinali za Tylenol zosakwana 2 magalamu ndi zosachepera 3 magalamu tsiku lililonse, diclofenac (Voltaren) pa 70mg pa tsiku, Naproxen pa 750mg patsiku, ndipo ibuprofen pa 1200mg pa tsiku. Ndikofunika kuzindikira kuti izi ndizo zotsatira zenizeni za mlingo, ndipo mankhwala apamwamba a mankhwalawa nthawi zina amathandiza. Mayi asanu ndi limodzi omwe amathandiza kwambiri: diclofenac (aka Voltaren) 150 mg / tsiku, etoricoxib (aka Arcoxia) 30 mg / tsiku, 60 mg / tsiku, ndi 90 mg / tsiku, ndi rofecoxib (Vioxx) 25 mg / tsiku ndi 50 mg / tsiku.
Kuyesera kowerengera kwambiri kunasonyeza kuti diclofenac 150 mg / tsiku ndi etoricoxib 60 mg / tsiku ankachita bwino kwambiri potsitsimutsa ululu poyerekeza ndi mankhwala ena onse ndi mlingo. Poyerekeza NSAID zosiyana ndi zomwe zimawathandiza kuthetsa ntchito, zikuwoneka ngati diclofenac (Voltaren) 150mg / tsiku ndi rofecoxib (Vioxx) 25mg / tsiku.
Tisanapitilire tiyambe kuganizira mwachidule Vioxx (rofecoxib). Pamene anali kuyesedwa kwawonetseredwa kuti ndi mankhwala othandiza kupumula ululu ndi kusintha kwa ntchito, Vioxx si mankhwala abwino. A FDA achotsa pamsika chifukwa cha nkhawa za kuwonjezeka kwa mtima wa matenda komanso kupweteka kwa mgwirizano wokhudzana ndi kugwiritsa ntchito nthawi yayitali. Zili bwino ngati kupweteka kwapweteka sikungathandize chifukwa cha zotsatira zake zoopsa. Sitiyenera kuiona ngati njira yabwino.
Kotero kodi zonsezi zikutanthauza chiyani? Ili ndi deta yambiri yopitilira ndi kutanthauzira. Malingaliro anga pali malo angapo omwe amachokera kunyumba kuchokera ku meta-analyzed quality. Choyamba, paracetamol (yomwe imatchedwanso acetaminophen kapena Tylenol) ingakhale yopanda mphamvu poletsa ululu kuposa momwe tinaganizira. Tsopano ndizofunikira kuzindikira kuti phunziroli ndilolondola kwa osteoarthritis ya m'chiuno ndi bondo. Kotero mwinamwake Tylenol ndi yabwino kuthetsa ululu mmalo ena, monga mutu, phunziro ili silinena izo. Pofika ku OA m'chiuno ndi mawondo, zikuwoneka ngati Tylenol ndi chosasankha. Diclofenac pa 150mg / tsiku inali yothandiza kwambiri poletsa ululu ndi kusintha ntchito.
Izi zinkawoneka pa zotsatira pafupipafupi ndi pakati pa nthawi ya miyezi itatu pafupifupi. Kodi mankhwalawa akanachita mosiyana pa nthawi yaitali monga zaka zingapo? Mwinamwake, tifunikira maphunziro ochuluka a nthawi yaitali kuti tiwone motsimikiza. Chinthu chovuta kwambiri pa kutanthauzira deta iyi ndikuti sichikuthandizani kuti chitetezo cha mankhwalawa chikhale chonchi. NSAID zasonyezedwa kuti zowonjezera chiopsezo cha m'mimba m'mimba (m'mimba ndi m'mimba), komanso kuonjezera chiopsezo cha mtima. Ndipo mlingo umene NSAID iliyonse, ndi iliyonse ya NSAID dosing, imakweza ngozizi ndizosiyana. Chisankho choyambitsa mankhwala atsopano kuti chithandizo cha OA cha mchiuno ndi bondo chiyenera kukambidwa bwino ndi dokotala wanu, kotero kuti inu nonse mukhoze kuyeza ubwino ndi kumwa kwa mankhwala aliwonse payekha ndikusankha yankho lomwe liri lolondola kwa inu .