Chithandizo Chothandiza Chosankha kwa Anthu Ena
Kusiyanasiyana kwa DMARD (matenda osinthira anti-rheumatic drugs) angapangidwe kuti athetse nyamakazi ya nyamakazi kusiyana ndi DMARD imodzi. Thandizo lachitatu, lomwe liri pakati pa njira zothandizira, limatanthauza kugwiritsa ntchito DMARD zitatu zosiyana; nthawi zina zingatanthauze ma DMARD awiri ndi mlingo umodzi wotsika glucocorticoid .
Kodi Pali Thandizo Liti?
Kawirikawiri kuphatikiza kwa DMARD komwe amagwiritsidwa ntchito monga katatu mankhwala a nyamakazi ya nyamakazi imakhala ndi methotrexate , sulfasalazine (dzina lake Azulfidine), ndi hydroxychloroquine (Plaquenil).
Kawirikawiri, DMARD imodzi (monotherapy) ingayesedwe poyamba, koma ngati yankholo silikukwanira, dokotala ndi wodwalayo angakambirane njira zina zothandizira.
Ndani Ayenera Kuganizira Thandizo Lachitatu?
Mu 2012, malangizo a chithandizo ochokera ku American College of Rheumatology, komanso a Canadian Rheumatology Association, adalimbikitsa kugwiritsa ntchito mankhwala ophatikizana ndi DMARD-kuphatikizapo mankhwala atatu katatu-kwa anthu omwe ali ndi nyamakazi yoyamba, ndi osauka kwambiri kufotokozera. Thandizo lachitatu lingathenso kulinganiziridwa moyenera kwa iwo omwe asayankhidwe moyenera kwa DMARD imodzi.
Malinga ndi mayiko a European League Against Rheumatism (EULAR) odwala matenda a nyamakazi m'chaka cha 2013 anali osatsimikizirika pang'ono ndipo ananena kuti odwala omwe sanatumize DMARD, monotherapy kapena mankhwala othandizira angakhale oyenera. Ngati njira yoyamba ya DMARD ikulephera, kusintha kwa DMARD yosiyana kungaganizidwe.
Maphunziro atsopano a American American College of Rheumatology omwe amachititsa kuti matenda a nyamakazi a nyamakazi athe kudwala matenda a nyamakazi, akadwala matenda a nyamakazi, ngati matenda opatsirana amakhalabe ochepa kwambiri ndi DMARD monotherapy (popanda kapena glucocorticoid), kuphatikiza DMARD kapena TNF inhibitor kapena biologic osati TNF inhibitor (osasangalatsidwa ndi dongosolo, ndi popanda kapena methotrexate) ayenera kuganiziridwa m'malo mopitiliza ndi monotherapy.
(Zindikirani: Lamulo la zokonda likusowa chifukwa maphunziro a mutu ndi mutu wa mankhwalawa akusowa. Zotsatira zamtsogolo zingagwirizane ndi mbali imeneyi.)
Kodi Maphunziro Amasonyeza Chiyani Zokhudza Katatu Opaleshoni?
Maphunziro oyambirira omwe adawonetsa phindu la mankhwala atatu katatu poyerekeza ndi monotherapy inapezeka mu zolemba za sayansi m'ma 1990. Kafukufuku wa 1999 anawonetsa mphamvu ndi kulekerera kwa katatu mankhwala (methotrexate, sulfasalazine, ndi plaquenil) ndi prednisone ya dozi yochepa poyerekeza ndi monotherapy kapena popanda prednisone wamlomo mwa anthu omwe ali ndi nyamakazi yoyamba kapena yogwira ntchito. Zinali zovomerezeka kuti katatu mankhwalawa anali othandiza popanda kukhala otetezeka kusiyana ndi monotherapy pamene akuganiza kuti akhoza kukhululukira .
Kafukufuku amene anafalitsidwa mu 2002 anapeza kuti anthu omwe ali ndi matenda a nyamakazi, mankhwala atatu ndi methotrexate, sulfasalazine, ndi plaquenil anali olekerera komanso ogwira mtima kuposa mankhwala ophatikiza ndi methotrexate ndi sulfasalazine. Thandizo lachitatu "linali lopambana" kwa methotrexate ndi hydroxychloroquine.
Mu 2010, Cochrane ndondomeko yowonongeka ndi kufotokozera meta, yomwe inagwirizana ndi methotrexate monotherapy ndi kugwiritsira ntchito mankhwala, inatsimikizira kuti panali kusiyana kwakukulu pakati pa njira.
Ambiri mwa anthu 100 mwa anthu 100 aliwonse anasiya kumwa methotrexate chifukwa cha zotsatira zake, pamene amodzi mwa anthu asanu ndi atatu (14) aliwonse amasiya kumwa methotrexate kuphatikizapo DMARD.
Zotsatira zomwe zinaperekedwa pamsonkhano wapachaka wa sayansi wa chaka cha 2013 wa American College of Rheumatology zatsimikizira kuti anthu ambiri omwe ali ndi nyamakazi ya nyamakazi amasiya katemera katatu pakatha zaka chimodzi kapena ziwiri. Kusankha chifukwa chake pali kusiyana kwakukulu kosiya, koma chifukwa chimodzi chimakhala chakuti anthu amakonda mapiritsi ochepa kuti asatenge, osati mapiritsi ambiri.
Kodi Chithandizo Chachitatu Chimatchulidwa Kawirikawiri?
Ngakhale kuli chitetezo ndi mphamvu, katemera katatu si kawirikawiri kupita kuchipatala mukamachita masewera olimbitsa thupi pamene kutchulidwa payekha sikukwanira.
Malingana ndikuti (Sparks JA et al.), Kuyambira 2009 mpaka 2014, 0.7 peresenti ya pafupifupi 25,000 nyamakazi ya nyamakazi yodwala matenda a chifuwa amatha kupita ku katatu kuchipatala chawo choyambirira cha DMARD. Poyerekeza, 11.1 peresenti ya odwala anawonjezera mankhwala osokoneza bongo kuphatikizapo DMARD yawo. Izi ndizo, ngakhale kuti zotsatira zafukufuku zasonyeza kuti mankhwala atatuwa ndi othandiza monga biologics ya nyamakazi ya nyamakazi-ndipo ndithudi ndi yotsika mtengo kwambiri.
Mankhwala atatu amodzi (methotrexate, sulfasalazine, plaquenil) ndi otsika mtengo kwambiri kuposa kuphatikiza kwa methotrexate ndi Enbrel (etanercept) -pakati pa zikwi zochepa pa odwala pa chaka. Zakhala zikuperekedwa kuti mankhwala atatuwa ayenera kuyesedwa asanakhale ndi biologic, monga Enbrel, chifukwa cha mtengo wapatali. Kuthamangira kwa Enbrel kungapangidwe patsogolo, kwa odwala omwe alibe yankho lokwanira ku mankhwala atatu.
Ngakhale kulipira kwa katatu katemera, pakadokotala, TNF inhibitor ndi kusankha kosamalidwa ngati mankhwala omwe ali ndi mankhwalawa sakukwanira. Chochititsa chidwi, ndi gulu latsopano la mankhwala likukonzedwa, lotchedwa biosimilars , lomwe lingasinthe kachiwiri. Biosimilar ndi mankhwala omwe ali ofanana kwambiri ndi mankhwala ake ovomerezeka a US. Tiyerekeze kuti izi ziyenera kupanga mankhwala omwe ali othandiza ngati mankhwala a biologic pa mtengo wotsika mtengo. Mwina zamoyo zingakhale njira yoyenera ngati methotrexate yokha imalephera.
> Zotsatira:
> Katchamart, W et al. Kukambirana kwa Cochrane. Methotrexate yekha ndi methotrexate kuphatikizapo mankhwala ena a nyamakazi ya nyamakazi. April 14, 2010.
> Mottonen, TT et al. Kusakaniza DMARD Therapy Kuphatikizapo Corticosteroids mu Matenda Oyamba Amagazi Amagazi. Kachipatala ndi Zofufuza za Rheumatology. 1999.
> O'Dell, JR, ndi al. Mankhwala Othandiza Odwala Matenda a Nyamakazi Pambuyo pa Matenda a Methotrexate. New England Journal of Medicine. July 25, 2013.
> O'Dell, JR, ndi al. Mankhwala a nyamakazi ya nyamakazi ndi methotrexate ndi hydroxychloroquine, methotrexate ndi sulfasalazine, kapena mankhwala atatu. Zotsatira za mayeso a zaka ziwiri, randomized, double-blind, a placebo. Arthritis & Rheumatology 46: 1164-1170. 2002.
> Akazi, JA, et al. Ndemanga Yachidule: Kulimbikitsidwa kwa Katatu Katemera Patatha Chithandizo Ndi Matenda Osagwirizana ndi Matenda a Antibihesetic Mankhwala Ochepetsa Matenda a Matenda a Nyamakazi ku United States Kuchokera mu 2009 mpaka 2014. Arthritis ndi Rheumatology. June 24, 2016.