Ngakhale kuti palibe mankhwala ochiritsira otchedwa ankylosing spondylitis (AS), njira yothetsera mankhwala yomwe imakhala ndi mankhwala komanso mankhwala amatha kuchepetsa zizindikiro za kupweteka kwa pamtima, kuuma, ndi kutupa, komanso kusintha ntchito tsiku ndi tsiku.
Mu 2015, American College of Rheumatology (ACR) inakhazikitsa malangizo ochizira matenda osokoneza bongo.
Malangizowo anali oti athandizire madokotala kuti apitirize kusamalira odwala awo omwe ali ndi AS m'njira yodalirika, pogwiritsa ntchito kafukufuku.
Monga munthu yemwe ali ndi AS (kapena ngati muli ndi wokondedwa ndi AS), kudziwa za malangizo azachipatala kudzakuthandizani kuti muziyenda matendawa ndi ovuta kwambiri motsimikizika ndi molimba mtima.
Mankhwala Osamva Steroidal Anti-Inflammatory (NSAID)
Mankhwala othandiza kwambiri a ankylosing spondylitis ndi mankhwala osagwiritsidwa ntchito ndi anti-inflammatory (NSAID). NSAID akhalapo nthawi yaitali ndipo ali othandiza kwambiri pakachepetsa kutupa thupi. Zimagwira ntchito poletsa mavitamini otchedwa cyclooxygenase enzymes (COX enzymes).
Mwa kutseka mavitaminiwa, mawere a prostaglandin amachepetsedwa m'thupi. Popeza prostaglandin amathandiza kwambiri kutupa, mwa kuchepetsa iwo, zizindikiro za kutupa monga kupweteka ndi kutupa zimachepetsedwa.
Choponderezeka cha NSAID ndi chakuti sangathe kutengedwa ndi aliyense, chifukwa chokhoza kuvulazidwa.
Ichi ndi chifukwa chake ndi kofunikira kwambiri kutenga NSAID pansi pa chitsogozo cha adokotala.
Mwachitsanzo, chinthu chodziwikiratu chomwe chingadzivulaze ndi chithandizo cha NSAID ndi chakuti chikhoza kuyambitsa kuwonongeka kwa mmimba, zilonda, ndi kutuluka magazi. NSAIDs zingakhalenso kuonjezera chiopsezo cha mtima, mtima wosalimba, kapena kupwetekedwa. Angathenso kukweza magazi a munthu ndikupangitsa mavuto a impso kapena oipa.
Kuphatikiza pa zovuta zomwe zingatheke, NSAID zingagwirizane ndi mankhwala ena. Ichi ndi chifukwa chake nkofunika kuuza madokotala mankhwala onse omwe mukuwatenga, kuphatikizapo mankhwala osokoneza bongo, mavitamini, kapena mavitamini.
Zitsanzo za NSAIDs
Pali NSAID zingapo zosiyana zomwe zimapezeka kuti zithetse AS, kuphatikizapo NSAID zotsatila komanso zolemba zina. Zitsanzo zikuphatikizapo:
- NSAIDs zapamwamba: Malangizo kapena Motrin (ibuprofen) ndi Aleve (naproxen)
- NSAIDs za mankhwala: Voltaren (diclofenac), Mobic (meloxicam), kapena Indocin (indomethacin).
NSAID zapamwamba zokhudzana ndi ibuprofen zimapezanso ndi mankhwala pa mphamvu yapamwamba.
Mtundu wina wa NSAID wodulidwa kuti uchiritse AS ndi Celebrex (celecoxib) , zomwe zingathandize kuchepetsa mavuto a m'mimba ndi m'mimba. Celebrex ndiyosankha-NSAID chifukwa imateteza khungu la COX-2 yokha (ma NSAID ena amaletsa COX-1 ndi michere COX-2). Mwa kusunga ntchito ya COX-1 ndipo imatseka COX-2, kupweteka m'mimba ndi m'mimba kumachepetsedwa. Izi zili choncho chifukwa COX-1 imathandiza kuti m'mimba azikhala m'mimba.
Matenda a Necrosis Inhibitors (TNFi)
Ngati munthu ali ndi AS sangathe kutenga NSAID, kapena ngati zizindikiro zake monga ululu ndi kuuma sizitha bwino ndi chithandizo cha NSAID, chophimba cha TNF chilimbikitsidwa.
Matenda a tumor necrosis (TNF) ndi mapuloteni omwe amagwira ntchito yotupa, motero poletsa thupi, kutentha thupi kumachepetsedwa.
Uthenga Wabwino wokhudzana ndi TNF ndi umboni wochuluka wa sayansi womwe umathandizira pothandiza kuchepetsa matenda a ankylosing spondylitis-mwa kuyankhula kwina, kudzudzula kutentha thupi. Komabe, TNF blockers si mankhwala othandiza. Iwo ali ndi zoopsa, ndipo izi ziyenera kuyeza moyenera kwa munthu aliyense.
Chifukwa chakuti TNF imathandiza kuti munthu asateteze chitetezo cha m'thupi (ngakhale kuti amachititsa kuti anthu omwe ali ndi matenda a ankylosing spondylitis) athe kuwonjezeka, akhoza kuonjezera chiopsezo cha anthu omwe ali ndi kachilombo kochepa komanso matenda aakulu.
Chitsanzo cha matenda ochepa ndi chimfine. Komabe, matenda aakulu omwe madotolo amadandaula makamaka ngati munthu atenga TNF inhibitor ndi chifuwa chachikulu. Chifukwa cha chiopsezo cha chifuwa chachikulu cha chifuwa chachikulu, chifuwa cha TB chikufunika asanayambe kulandira mankhwala a TNF. Kawirikawiri, TNF blockers zakhala zikugwirizana ndi mwayi wochuluka wa kukhala ndi khansa zina.
N'kofunikanso kudziŵa kuti anthu ena sakufuna kutenga TNF blockers monga awo okhala ndi:
- Multiple sclerosis (TNF blockers sichimaipitsa kwambiri imfa ya myelin mu ubongo ndi msana)
- Kulephera kwa mtima
- Matenda opatsirana monga chibayo
Azimayi amene ali ndi mimba kapena akuyamwitsa samakhalanso ovomerezeka ndi mankhwala a TNF.
Zitsanzo za oteteza TNF
Mu 2010, kuunika kwa SpondyloArthritis International Society (ASAS) inafalitsa ndondomeko zogwiritsira ntchito TNF blockers kwa odwala ankylosing spondylitis. Malangizowo amathandiza madokotala kudziwa omwe ali woyenera kuti adziwe mankhwala a TNF.
Mwachitsanzo, malinga ndi mfundo za ASAS, munthu ayenera kungoganiziridwa kuti ndi TNF ngati matenda ake sakusintha ndi mitundu iwiri yosiyanasiyana ya NSAID (pazifukwa zosayenera).
Mitundu ya TNF yomwe imagwiritsidwa ntchito pochiza ankylosing spondylitis ndi:
- Enbrel (etanercept)
- Remicade ndi Renflexis (infliximab)
- Humira (adalimumab)
- Simponi (golimumab)
- Cimzia (certolizumab)
Remicade ndi Renflexis (infliximab) amaperekedwa ngati kulowetsedwa kudzera mu mitsempha pamene Enbrel (etanercept), Huma (adalimumab), Simponi (golimumab), ndi Cimzia (certolizumab) amaperekedwa monga subcutaneous (mu mafuta minofu) jekeseni.
Costyx (Secukinumab)
Ngati munthu sakuyankha bwino TNFi, dokotala wawo angaganizire za Cosentyx (secukinumab). Costyx inavomerezedwa ndi US Food and Drug Administration (FDA) mu 2016 kuti athetse mankhwala osokoneza bongo a spondylitis.
Zimagwira ntchito mwa kuletsa IL-17A, yomwe imakhala yotchedwa proinflammatory cytokine (nthumwi yomwe imachititsa kuti munthu ayambe kutuluka thupi). IL-17A imadziwika kuti idzathandiza kwambiri pakukula kwa AS.
Kachilendo kaŵirikaŵiri kamaperekedwa kamodzi pamlungu pa sabata zinayi, kenaka patapita masabata anai onse pambuyo pake. Kafukufuku amasonyeza kuti ndi bwino kuloledwa, ndipo zotsatira zake zowononga zimakhala zozizira, ngati mphuno yamphongo ndi pakhosi.
Kafukufuku adakalipobe ku Cosentyx. Ngakhale zili choncho, ndizosangalatsa kuti panopa pali njira yoti anthu omwe matenda awo akupitirirabe pa TNF inhibitor kapena omwe sangathe kutenga TNF inhibitor.
Thandizo la Thupi
Kuwonjezera pa mankhwala, American College of Rheumatology imalimbikitsa mankhwala othandizira anthu omwe ali ndi mphamvu yogwira ntchito AS (kutanthauza zizindikiro za kutupa monga kupweteka kwa mgwirizano ndi kuuma). Malangizowa akuchokera pa maphunziro angapo omwe apeza kuti mankhwala othandiza kukhala othandiza kuchepetsa kupweteka ndi kukonzanso msinkhu, kuyenda, kusinthasintha, kugwira ntchito, komanso kukhala ndi moyo wabwino.
Uthenga wabwino ulibe vuto lalikulu lokhudzana ndi mankhwala. Komanso, munthu akhoza kuchita masewera olimbitsa thupi ndikuyenda kunyumba kapena mkati mwa gulu. Izi zati, kafufuzidwe umasonyeza kuti gulu loyang'aniridwa lachipatala lingakhale lopindulitsa kwambiri kuposa zochita zapakhomo.
Chomwe chingakhale chokongola kwambiri (ndi chamtengo wapatali) kwa omwe ali ndi AS ndi mtundu wa mankhwala otchedwa spa-exercise therapy. Mankhwalawa amaphatikizapo kuchita masewera olimbitsa thupi, kutayira minofu kuchokera ku jet hydrotherapy, ndi kupuma mu sitima yapamadzi. Ndipotu, kafukufuku wapeza kuti mankhwala opatsirana pogwiritsa ntchito mankhwala opangidwa ndi magulu opanga mankhwala ndi abwino kusiyana ndi mankhwala okhaokha.
Opaleshoni
Nthawi zina, opaleshoni imafunika kuti mukhale ndi matenda otchedwa ankylosing spondylitis. Izi kawirikawiri zimasungidwa kwa anthu omwe ali ndi vuto lalikulu lophatikizana pamodzi ndi ululu. Muzochitika izi, nthawi zonse kumalo opangira nsalu kumalimbikitsidwa chifukwa cha opaleshoni iliyonse. Opaleshoni yoopsa ngati imeneyi yomwe imakhudzana ndi msana imakhala yochepa kwambiri ndipo imachitidwa panthawi yomwe imakhala yotsika kwambiri (msangamsanga).
Mawu Ochokera
Ankylosing spondylitis ndi matenda aakulu, ndipo palibe mankhwala. Koma pali njira zothetsera. Ndi mankhwala oyenera a mankhwala (omwe angafunike kugwedeza pa nthawi pansi pa chitsogozo cha dokotala), mukhoza kukhala bwino ndi AS.
> Zotsatira:
> Blair Ha, Dhillon S. Secukinumab: Kuwerengera mu ankylosing spondylitis. Mankhwala . 2016 Jul; 76 (10): 1023-30.
> Callhoff J et al. Kuchita bwino kwa TNFα blockers kwa odwala ankylosing spondylitis ndi osakhala a radial spondyloarthritis: meta-analysis. Ann Rheum Dis . 2015 Jun; 74 (6): 1241-8.
> Pogwiritsa ntchito H, Kvien TK, Hagen KB. Njira zothandizira anthu kuti azitha kutulutsa spondylitis. Cochrane Database Rev Rev. 2008 Jan 23; (1): CD002822.
> van der Heijde D et al. Kukonzekera kwa ma bungwe a ASAS padziko lonse omwe amagwiritsa ntchito anti anti-TNF odwala omwe ali ndi axial spondyloarthritis. Ann Rheum Dis . 2011 Jun; 70 (6): 905-8.
> Ward MM et al. American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network 2015 Malangizo a Chithandizo cha Ankylosing Spondylitis ndi Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol . 2016 Feb; 68 (2): 282-98.