M'mabwalo ena, Machiritso pazifukwa ziwiri zikhoza kugwirizanitsa
Anthu omwe ali ndi matenda opatsirana (IBD) amakhalanso ndi matenda ena kapena zizindikiro zomwe zimatchedwa maonekedwe a m'mimba (kapena nthawi zina EIM) . Matenda a khungu amakhala ofala kwambiri kwa anthu omwe ali ndi IBD, ndipo omwe amayamba kupezeka nthawi zambiri onse komanso anthu omwe ali ndi IBD ndi psoriasis . Anthu ambiri angaganize za psoriasis ngati chiwombankhanga, koma kwenikweni ndi chikhalidwe cha machitidwe ndipo akhoza kutenga njira yomweyo yotupa ngati Crohn's disease.
Chifukwa chakuti zikhalidwe ziwirizi zingayambitsidwe ndi vuto mu kayendetsedwe ka chitetezo cha mthupi, nthawi zambiri amachizidwa ndi mankhwala omwewo. Kwa anthu omwe ali ndi IBD omwe ali ndi psoriasis, zikhalidwe zonsezi zingakhale zofunikira posankha mankhwala.
Pali mankhwala osiyanasiyana othandizira psoriasis omwe alipo kale ndipo ambiri akukonzekera. Anthu omwe ali ndi psoriasis ndi IBD adzafuna kusamalidwa ndi dermatologist yomwe ikuchitikira odwala omwe ali ndi IBD ndipo idzagwira ntchito limodzi ndi gastroenterologist .
Kodi Psoriasis N'chiyani?
Psoriasis ndi matenda a systemic omwe amachititsa chiphuphu chokwera, khungu pa khungu. Kuthamanga kumawoneka pa mbali iliyonse ya thupi, koma kawirikawiri imakhala pamapiko, maondo, ndi khungu koma imapezekanso pamilingo, misomali, ndi thunthu. Mtundu wotchuka kwambiri wa psoriasis umatchedwa plaque psoriasis ndipo mapale angayambitse kutentha kapena kuyaka.
Psoriasis ikudutsanso nthawi zolaula ndi kukhululukira. Nthaŵi zambiri, psoriasis imachiritsidwa ndi zokometsera zam'mwamba.
Kodi Psoriasis Amakhala Wotani Pakati pa Anthu Amene Ali ndi IBD?
IBD imatengedwa ngati chikhalidwe chokhala ndi chitetezo cha mthupi. Si zachilendo kwa anthu omwe ali ndi matenda omwe amatetezedwa ndi chitetezo cha mthupi kuti apange wina. Matenda a IBD ndi psoriasis onse omwe ali ndi chifukwa chosadziwika (amatchedwa matenda a idiopathic) ndipo amachititsa kutupa.
M'zaka zaposachedwapa ofufuza akupeza zambiri zokhudza kugwirizana pakati pa IBD ndi matenda a psoriatic. Psoriasis mwa anthu ambiri amatha pafupifupi 2 peresenti mpaka 3 peresenti koma kwa anthu omwe ali ndi IBD amatha kukhala apamwamba. Kafukufuku wasonyeza kuti anthu omwe ali ndi matenda a Crohn's ndi matenda a zilonda zam'mimba akhoza kukhala ndi psoriasis pafupifupi pafupifupi 13 peresenti.
Njira Yowonongeka Kwambiri
Monga ofufuza apeza zambiri zokhudza njira zotupa za IBD ndi psoriasis, zina zimagwirizanitsa pakati pa matenda awiriwa. Matenda a Crohn ndi psoriasis onse amaonedwa kuti ndi othandizira. Th1 ndi mthandizi wothandizira omwe amachititsa munthu kutuluka thupi pamene thupi limagwidwa ndi zinthu zakunja monga tizilombo toyambitsa matenda, mabakiteriya, kapena kachilombo. Ulcerative kolitis imatengedwa ngati Th2-ngati mediated chikhalidwe. Maselo a Th2 amavomerezedwa pakakhala mabakiteriya, mankhwala osokonezeka, kapena poizoni. Monga momwe magulu a T awa amamvetsetseka bwino pankhani ya chitukuko cha IBD ndi psoriasis, izo zingayambitse kulandira mankhwala othandiza kwambiri pa matendawa.
Kodi Kukhala ndi Psoriasis Kuwonjezera Kuopsa Kwakukula IBD?
Pali maphunziro owerengeka okha omwe amawoneka kuti ali ndi chiopsezo cha IBD mwa anthu omwe apezeka ndi psoriasis.
Awonetsa zotsatira zotsutsana: Ena awonetsa chiopsezo chowonjezeka cha IBD mwa omwe ali ndi psoriasis ndi ena asonyeza zosiyana. Kuonjezerapo, njira zomwe zinagwiritsidwa ntchito pa maphunzirowa sizinali zopanda zovuta zawo, zomwe zimapangitsa kuti zovutazo zikhale zovuta kupirira. Pakalipano, sichidziwika chomwe chiwopsezo chiri, koma zikuwoneka kuti ndizovuta kwa anthu omwe ali ndi psoriasis omwe ali ndi chiopsezo chowonjezeka cha kukula kwa matenda a Crohn. Zomwezo sizingakhale zoona kwa ulcerative colitis: Pali umboni wochepa wosonyeza kuti anthu omwe ali ndi psoriasis akhoza kukhala pachiopsezo chachikulu chokhala ndi ulcerative colitis.
Mankhwala opatsirana pogwiritsa ntchito maulendo ndi opangira mankhwala a Psoriasis
Pali mankhwala ambiri othandizira psoriasis, kuphatikizapo mankhwala othandiza kuwala, mankhwala opatsirana, komanso mankhwala. Nthaŵi zambiri, mankhwala oposa oposa angagwiritsidwe ntchito panthawi yomweyo kuti athetse zizindikiro za psoriasis. Kawirikawiri, mankhwala opatsirana amatha kuyesedwa poyamba, musanayambe kupita kuchipatala kapena mankhwala ovomerezeka.
- Mankhwala opatsirana. Pali mitundu yambiri ya mavitamini ndi mafuta omwe angagwiritsidwe ntchito pa psoriasis, ponseponse pa tsamba ndi mankhwala. Zina mwazochita zimaphatikizapo corticosteroids , vitamini D , retinoids, anthralin , calcineurin inhibitors (Protopic ndi Elidel) , salicylic acid, ndi phula lamakala . Nthawi zina zinyontho zimatha kugwiritsidwa ntchito polimbana ndi zouma.
- Njira yothandizira. Kuwala komwe kuli ndi ultraviolet A ndi ultraviolet B zingagwiritsidwe ntchito pochiza psoriasis. Izi zimagwiritsidwa ntchito pamodzi ndi mankhwala ena. Kuwala kwa dzuwa kunja kungagwiritsidwe ntchito, kwa nthawi yochepa. Mazira a ultraviolet angathenso kutumizidwa pogwiritsa ntchito pulojekiti, bokosi, kapena nyumba. Pa milandu yoopsa, mankhwala omwe amachititsa khungu kukhala ofunika kwambiri ku ultraviolet kuwala ingagwiritsidwenso ntchito panthawi imodzimodzimodzi ndi mankhwala othandiza kuti apindule kwambiri. Mtundu wa laser umagwiritsidwanso ntchito nthawi zina chifukwa ukhoza kulunjika malo enieni pamthupi ndi mlingo wamphamvu wa kuwala kwa ultraviolet B.
Mankhwala Oyenera Kutengera Psoriasis
Chifukwa psoriasis ndi matenda opatsirana, mankhwala omwe amaperekedwa pamlomo kapena mwa jekeseni akhoza kugwiritsidwanso ntchito. Nthawi zina, mankhwala omwe amathandizidwa kuti athetse psoriasis amaperekanso mankhwala amodzi kapena mitundu yambiri ya IBD, kuphatikizapo methotrexate, cyclosporine, ndi biologics ena:
- Cosdicx (secukinumab) : Cosdicx ndi anti-monoclonal antibody yomwe imavomerezedwa kuchiza psoriasis, psoriatic nyamakazi, ndi mawonekedwe a nyamakazi ogwiritsidwa ntchito ndi IBD otchedwa ankylosing spondylitis, ngakhale kuti sivomerezedwa kuti achite mtundu uliwonse wa IBD. Amuna amodzi amapezeka kunyumba kudzera mwa jekeseni ndi syringe yomwe imakonda kwambiri. Zotsatira zachilendo zimaphatikizapo zizindikiro zozizira, kutsegula m'mimba, ndi matenda opuma opuma.
- Cyclosporine : Cyclosporine ndi mankhwala osokoneza bongo omwe amagwiritsidwa ntchito pochiza matenda oopsa kwambiri a psoriasis ndipo nthawi zina amagwiritsidwa ntchito pa matenda a Crohn. Zina mwa zotsatira zofala kwambiri zimaphatikizapo kupweteka mutu, kupweteka kwa thupi, kuthamanga kwa magazi, ndi kutopa. Sitikulimbikitsidwa kuti tigwiritse ntchito nthawi yayitali ngati psoriasis, ndipo nthawi zambiri imatha pansi pa chaka.
- Enbrel (etanercept) : Enbrel ndi mankhwala omwe amavomerezedwa kuti athetse psoriasis komanso ankylosing spondylitis. Ndicho chophimba cha TNF, koma sichigwiritsidwe ntchito kuchiza mtundu uliwonse wa IBD. Envule imayikidwa mkati mwathu ndipo zotsatira zofala kwambiri zimakhala ndi zomwe zimachitika pa malo opangira jekeseni, monga kufiira kapena kupweteka.
- Huma (adalimumab) : Humira ndi mankhwala omwe amachiza matenda a Crohn ndi matenda a zilonda zam'mimba komanso psoriasis. Odwala angadzipatse Huma pakhomo chifukwa amabwera pakhomo lapadera. Mankhwalawa ndi anti-monoclonal antibody ndipo amaikidwa ngati TNF-inhibitor. Zotsatira zofala kwambiri ndi ululu kapena kupsa mtima pa malo opangira jekeseni, omwe amachiritsidwa kunyumba ndi ayezi kapena antihistamines.
- Methotrexate : Mankhwalawa angaperekedwe pamlomo kapena mwa jekeseni, ndipo amagwiritsidwa ntchito kuchiza psoriasis komanso matenda a Crohn ndi ankylosing spondylitis. Zina mwa zotsatira zake zikuphatikizapo kunyowa, kupweteka mutu ndi kugona. Akazi omwe amalandira methotrexate ayenera kupewa mimba chifukwa mankhwalawa amachititsa kuti mwana asakhale ndi vuto. Nthawi zambiri mankhwalawa amaperekedwa pamodzi ndi mankhwala ena a IBD ndi / kapena psoriasis.
- Otezla (apremilast) : Otezla ndi mankhwala amlomo ndipo ndiwo ovomerezeka kuti agwiritsidwe ntchito pochiza matenda a psoriatic kwa akuluakulu ndipo amavomerezedwa kuti agwiritsidwe ntchito pa psoriasis ya plaque. Zotsatira zambiri zomwe zimachitika pamayesero a zachipatala zinali zotsitsimula, kupweteka mutu, ndi kutsekula m'mimba, koma izi zimakhala bwino pakapita masabata angapo ochiritsira.
- Stelara (ustekinumab) : Stelara adalandiridwa kuti apange psoriasis ndipo tsopano akuvomerezedwa kuti adziwe matenda a Crohn. Stelara ndi mankhwala a biologic omwe ndi block block interleukin (IL) -12 ndi IL-23. Stelara poyamba amaperekedwa ndi IV koma pambuyo poti mlingo woyamba waperekedwa kunyumba kudzera mu jekeseni. Zotsatira zofala zomwe zimakhalapo zimaphatikizapo kukhumudwa, kuchitapo kanthu pa malo opangira jekeseni, kumutu kwa mutu, ndi zizindikiro zozizira.
Mawu Ochokera
Umboni ukuwonjezereka kuti psoriasis ndi IBD zimakonda kuchitika palimodzi mobwerezabwereza kusiyana ndi momwe zinaganiziramo m'mbuyomu. Sitikudziwa ngati psoriasis imachititsa kuti munthu akhale ndi mawonekedwe a IBD. Nthawi zina mankhwala omwe amachiza IBD amagwiritsidwanso ntchito pochiza psoriasis. Masewera ambiri a psoriasis amalingaliridwa kukhala ofatsa mpaka ochepa ndipo akhoza kuchiritsidwa ndi mankhwala othandiza kapena mankhwala opatsirana. Pa milandu yambiri ya psoriasis, komwe 5 peresenti mpaka 10 peresenti kapena thupi lina limakhudzidwa, mankhwala amlomo kapena biologics angagwiritsidwe ntchito. Monga momwe zilili ndi IBD, nkofunika kupitiliza chithandizo cha psoriasis kuti zisawonongeke. Pali mankhwala ambiri atsopano a psoriasis omwe akuwerengedwa panopa, ndipo tsogolo la chithandizo cha psoriasis ndi lowala.
> Zotsatira:
> Gisondi P, Del Giglio M, Cozzi A, Girolomoni G. "Psoriasis, chiwindi, ndi m'mimba." Dermatol Ther . 2010 Mar-Apr; 23: 155-159.
> Li WQ, Han JL, Chan AT, Qureshi AA. "Psoriasis, nyamakazi ya psoriatic ndi ngozi yowonjezereka ya matenda a Crohn ku Akazi a US." Zizindikiro za matenda a rheumatic . 2013; 72: 1200-1205.
> DJ wa Najarian, Gottlieb AB. "Kugwirizana pakati pa psoriasis ndi Crohn's disease." J Am Acad Dermatol . 2003 Jun; 48 (6): 805-821; mafunso 822-824.
> Strober W, Ndikumva IJ. "Ma Cytokines Opatsirana Ndi Opaleshoni mu Pathogenesis ya IBD." Gastroenterology . 2011; 140: 1756-1767.