Matenda a kutupa nyamakazi ndi matenda aakulu, opweteka kwambiri omwe amawonongeke palimodzi, kufooka , komanso kulemala . Pamene ndinapezeka kuti ndili ndi matenda a nyamakazi (m'chaka cha 1974 ndili ndi zaka 19) ndipo poyamba ndinaphunzira za njira zanga zomwe ndasinthira, cholinga changa chinawoneka mwamsanga - kulamulira kutupa, kuchepa kwa matenda, komanso kuchepetsa ululu ndi zizindikiro zina za matenda a nyamakazi .
Awonedwa ngati ndondomeko yoyenera kwa ine. Monga wodwala nyamakazi watsopano, ndinali wofunitsitsa kuyamba mankhwala ndikuletsa matendawa.
Ndinaphunzira kuti panali kuthekera kwa kukhululukidwa , komwe kunandichititsa kumva ndikulimbikitsidwa kwambiri. Chimene sindinadziwepo panthaŵiyo chinali chakuti ngakhale mankhwala, nyamakazi ingathe kuwonjezereka pang'onopang'ono. Zowonongeka zofanana zingadwale kwambiri. Inde, ndi zoona. Ngakhale ngati wodwalayo ali ndi chikhululukiro, monga momwe ziwonetsedweratu, amatha kusonyeza kukula kwa mafilimu (mwachitsanzo, umboni wa x-ray wowonongeka kwambiri).
Chithandizo Cholinga cha Kulamulira Kutupa
Kwa zaka makumi ambiri, mankhwala osokoneza bongo (DMARD), omwe amatchedwa methotrexate , Plaquenil , ndi sulfasalazine , adagwiritsidwa ntchito kuchepetsa kapena kuchepetsa matenda opatsirana ndi nyamakazi. Popezeka mankhwala osokoneza bongo ( Enbrel [etanercept] anali woyamba mu 1998), zolingazo zinakhala zovuta kwambiri pa maselo.
Ndipo tsopano, pali njira yatsopano yomwe ikuwonekera, yotchedwa Treat Treat to Target .
Phukusi lachilendo-to-Target pansi pa njira yothandizira pogwiritsa ntchito mliri wa matenda a munthu mmodzi. Cholinga chake ndi kukwaniritsa zochitika zochepa za matenda kapena kukhululukidwa kwa nthawi yeniyeni - ndipo ndondomeko iliyonse ndiyomweyi.
Poziika m'mawu osavuta kumva, kusintha kwa mankhwala kumapangidwa ngati zolinga zokhudzana ndi matenda sizikugwirizana. Ndibwino kuti muwoneke bwino. Matenda opatsirana pogwiritsa ntchito matenda (ie, mankhwala odana ndi kutupa) samapewa kuwonongeka kwa mgwirizano pamutu. Anthu ena amanena kuti ngakhale kutupa kutayika, mankhwala amtundu wa synovial odwala matenda a nyamakazi angagwirizanitse khunyu ndi kuwonongeka kwa mafupa. Kuti timvetse bwino, tiyeni tiyang'ane mosamala kwambiri momwe kuwonongeka kwa mgwirizano kumayambira ndikupita patsogolo.
Kumvetsetsa Momwe Kuwonongeka Kofanana Kumayambira
Kuwonongeka kofanana kungawonedwe mkati mwa miyezi yambiri ya nyamakazi ya nyamakazi. Matenda oyambirira a khunyu ndi mafupa amatha kugwiritsidwa ntchito ndi kusungunuka kwa maselo opweteka mu membrane ya synovial ndi kukula kwa minofu (yokhuthala ndi synovial minofu yomwe imatha kupha mafupa). Pali chingwe chochepetsera chidziwitso chomwe chimakhala ndi maselo angapo a macrophages, maselo a T, maselo a B, maselo a dendritic, ndi mapuloteni a nyuzipepala, komanso macrophages omwe amachititsa macrophages ndi synoviocytes (fibroblast-synoviocytes).
Pali mitundu yambiri ya macrophages ndi synoviocytes zomwe zimatha kutulutsa mavitamini (mapuloteni) omwe amachititsa kuti thupi liwonongeke.
Kumvetsetsa ntchito ya synovial, makamaka njira ndi njira zomwe zimagwirira ntchito pamtanda momwe zimakhala zotsekemera, zimakhala zofunikira ngati kuwonongeka kwa mgwirizano kumayendetsedwa kapena kutetezedwa. Mwachitsanzo, pa maselo a maselo, kodi n'chiyani chimayambitsa fibroblasts kuti ikhale yaukali komanso yovulaza?
Malinga ndi Kelley's Textbook of Rheumatology , mapuloteniase ochokera m'magulu atatu amachititsa kuti khunyu ikhale ndi matenda a nyamakazi: nyamakazi ya carticulus yowonongeka imawonongeka ndi mapuloteni omwe amapezeka mu synovial fluid; kupyolera mwachindunji pakati pa khungu lopangidwa ndi articular cartilage ndi proteolytic (mwachitsanzo, kuthetsa mapuloteni) synovium kapena mapepala a pannus kapena onse; kapena kuwononga kwenikweni (mwachitsanzo, chiwonongeko kuchokera mkati) ndi mapuloteniase ochokera ku chondrocytes.
Monga ofufuza amayesetsa kupeza mayankho, timakhala tikuyandikira kwambiri ndi mankhwala abwino - ndi chiyembekezo chopeza njira yothetsera kuwonongeka kwa mgwirizano. Pa matenda a nyamakazi, nyamakazi yowonongeka ingapite patsogolo pang'onopang'ono. Pamapeto pake kapena nyamakazi yapamwamba yodwala nyamakazi, pali mgwirizano wamphamvu pakati pa x-ray umboni wowonongeka pamodzi ndi kulemala. Kuchepetsa kuwonongeka kwa mgwirizano kungathandize kusungira ntchito yogwirizana.
Njira yowonongeka pamodzi mu osteoarthritis ndi yosiyana kwambiri. Chochitika chogwedezeka (mwachitsanzo, kuvulala kapena kuvala ndi kugwa) nthawi zambiri chimagwirizanitsidwa ndi ndondomeko ya kuwonongeka kwa khunyu. Kutupa kumapezeka, koma kumakhala kawiri kaŵirikaŵiri m'mimba mwa osteoarthritis. IL-1 (interleukin-1), cytokine , ingakhale ndi gawo lofunika kwambiri m'kufa kwa kagaweti kamene kamayambitsa matenda a osteoarthritis. Chondrocytes (maselo omwe amapezeka mu kakoti) amachititsa kuchuluka kwa IL-1 ndi kutupa kwa synovial kumaphatikizapo ntchito ya IL-1. Ngakhale kuti palibe kusintha kwakukulu kokhala ndi zotupa kawirikawiri komwe kumachitika mu synovium kumayambiriro kwa mitsempha ya osteoarthritis, pakuwonjezeka kwa mavitamini ndi ma chondrocytes omwe amathandiza kuwonongeka kwa khungu. Komabe, zikuoneka kuti ndizomwe zimakhala zochitika zenizeni za osteoarthritis yomwe ilipo, mtundu wochuluka wa osteoarthritis , womwe umadziwika ndi chiwonongeko chophatikizana chomwe chimayendetsedwa makamaka ndi kutupa.
Zotsatira:
Kuwonjezeka kwa chiwonongeko chogwirizanitsa ngakhale kulimbana ndi kutupa kwa nyamakazi ya nyamakazi: gawo lothandizira khunyu kumayendetsa synovial fibroblast ntchito. Floris PJG Lafeber, Willemijn H Van der Laan. Annals wa Rheumatic Diseases 2012; 71: 793-795 do: 10.1136 / annrheumdis-2011-200950
http://ard.bmj.com/content/71/6/793.full
Pathogenesis ya mgwirizano wowonongeka mu nyamakazi ya nyamakazi. Bresnihan B. Journal of Rheumatology. 1999.
http://www.ncbi.nlm.nih.gov/pubmed/10090189
Kugwirizana pakati pa mgwirizano wothandizira ndi kulemala mu nyamakazi ya nyamakazi. Rheumatology. 2000.
http://rheumatology.oxfordjournals.org/content/39/2/122.abstract
Kelley's Textbook ya Rheumatology. Kusindikiza kwachisanu ndi chinayi. Volume I. Masamba 111-113.