Chiyanjano Chothandizira Kuchokera ku ACR ndi EULAR
Malangizo oyendetsa polymyalgia rheumatica (PMR) anamasulidwa mu September 2015, monga gawo la mgwirizano pakati pa American College of Rheumatology (ACR) ndi European League Against Rheumatism (EULAR). Zotsatirazi ndizoyikidwa zoyamba zapadziko lonse zotsatila za chithandizo ndi kasamalidwe ka odwala omwe ali ndi polymyalgia rheumatica.
Kodi Polymyalgia Rheumatica N'chiyani?
Akuti anthu pafupifupi 711,000 a ku America ali ndi polymyalgia rheumatica - chikhalidwe chimene chimayamba pang'onopang'ono. Ngakhale kuti zizindikiro zikhoza kukula mwadzidzidzi, sizimene zimachitika polymyalgia rheumatica. Zizindikiro zimaphatikizapo kuuma kwa minofu, ndipo chiuno ndi mapewa zimakhudzidwa, komanso mikono, mmwamba, ndi kumbuyo. Kawirikawiri palibe kutupa kwa manjenje. N'zotheka kukhala ndi polymyalgia rheumatica limodzi ndi matenda ena a chifuwa chachikulu . Pakhala pali kusiyana kwakukulu pakulandila ma polymyalgia rheumatica, monga nthawi yogwiritsira ntchito glucocorticoids kapena mankhwala osinthira odwala-rheumatic mankhwala (DMARDs) ndi nthawi yayitali bwanji.
Mfundo ndi Malangizo Othandizira Kuteteza PMR
Zotsatira za 2015 zomwe zinaperekedwa ndi ACR ndi EULAR zimaphatikizapo mfundo zowonjezereka komanso malangizo othandizira kupeza chithandizo chamankhwala, kutumiza kwa akatswiri, kutsata odwala, ndi njira zina zothandizira.
Malingaliro apaderawa anagawidwa monga:
- "akulimbikitsidwa kwambiri" pamene umboni umanena za phindu lopanda phindu lililonse
- "zovomerezeka" pokhapokha panalibe umboni wodzichepetsa wopindulitsa kapena pamene kupindula sikunali koopsa kwambiri
Mfundo zazikuluzi zikuphatikizapo:
- Kuloledwa kwa njira yodziwira polymalgia rheumatica, ndi kuyezetsa njira zochotsera zochitika zomwe zimatsanzira polymyalgia rheumatica.
- Musanayambe kulongosola chithandizo, vuto lililonse liyenera kulembera zotsatira zoyesa ma laboratory.
- Malingana ndi zizindikiro, ziyeso zowonjezera ziyenera kulamulidwa kuti zisaphatikize zofanana ndizo. Kugonjetsedwa kumafunika kutsimikiziridwa. Zotsatira zoopsa za kubwezeretsa kapena kupatsirana kwa nthawi yaitali ziyenera kuganiziridwa.
- Kuyenera kuyenera kuperekedwa kwa katswiri wodziwitsira.
- Zosankha zachipatala ziyenera kugawana ndi wodwala ndi dokotala.
- Odwala ayenera kukhala ndi ndondomeko yapadera ya chithandizo cha polymyalgia rheumatica.
- Odwala ayenera kukhala ndi maphunziro okhudza mankhwala a polymyalgia rheumatica.
- Wodwala aliyense akuchiritsidwa polymyalgia rheumatica ayenera kuyang'aniridwa pogwiritsa ntchito mayeso enieni. M'chaka choyamba, odwala ayenera kuwona masabata 4 mpaka 8 alionse. M'chaka chachiwiri, maulendo ayenera kukonzedwa milungu isanu ndi umodzi ndi itatu. Kuwunika kuyenera kukhala kofunikira kuti kubwezeretsanso kapena kubwezera kwa prednisone .
- Odwala ayenera kulondolera odziwa zaumoyo kuti afotokoze kusintha, monga zolaula kapena zovuta.
Malingaliro apadera a kayendedwe ka polymyalgia rheumatica ndi awa:
- Malangizo amphamvu ogwiritsira ntchito glucocorticoids mmalo mwa NSAIDs (mankhwala osagwiritsiridwa ntchito ndi anti-inflammatory drugs), kupatula kanthawi kochepa ka NSAID kapena analgesics kwa odwala omwe ali ndi ululu wokhudzana ndi zinthu zina.
- Malangizo olimbikitsa kuti nthawi yayitali yeniyeni yeniyeni ya glucocorticoid mankhwala (mwachitsanzo, gwiritsani ntchito mankhwalawa kwa nthawi yochepa kwambiri yofunikira kupeza yankho lolondola).
- Malingaliro ovomerezeka a mlingo woyambirira wa glucocorticoids pakati pa 12.5 ndi 25 mg prednisone ofanana tsiku ndi tsiku. Mankhwala apamwamba angaganizidwe kwa omwe ali pachiopsezo chachikulu cha kubwereranso ndi chiopsezo chochepa cha zochitika zovuta. Mbewu yaing'ono ingaganizidwe kwa anthu omwe ali ndi chiopsezo kapena zoopsa za zotsatira zokhudzana ndi kugwiritsira ntchito glucocorticoids. Mlingo woyamba wa 7.5 mg / tsiku unali wofooka, ndipo mlingo woyamba wa 30 mg / tsiku unali wolefuka kwambiri.
- Malangizo amphamvu pa ndondomeko zojambulidwa payekha ndi kufufuza nthawi zonse. Ndondomeko yeniyeni yoyamba kugwiritsira ntchito ndikulumikiza mlingo wa 10 mg wokwanira ofanana ndi tsiku pa masabata 4 mpaka 8. Pofuna kubwezeretsa mankhwala, mankhwalawa amayamba kuwonjezeka mpaka mlingo womwe wodwalayo amayamba asanabwerere, kenako amachepa pang'onopang'ono kwa masabata 4 mpaka 8 kuti awonongeke. Mukakhululukidwa tsiku lililonse, prednisone imatha kugwiritsidwa ntchito ndi 1 mg pakatha masabata anayi kapena 1.25 mg pogwiritsa ntchito tsiku linalake mpaka tsiku la prednisone litatha, kuti chikhululukirocho chisasokonezedwe.
- Malingaliro ovomerezeka a kugwiritsidwa ntchito kwa intramuscular methylprednisolone mmalo kapena pamlomo glucocorticoids.
- Malingaliro ovomerezeka a mlingo umodzi m'malo mogawanitsa mlingo uliwonse wa oral glucocorticoids.
- Malingaliro ovomerezeka a ntchito yoyambirira ya methotrexate kuphatikizapo glucocorticoids, makamaka odwala ena.
- Malangizo amphamvu otsutsa kugwiritsa ntchito TNF blockers .
- Malingaliro ovomerezeka a pulojekiti yodzipangira payekha kuti asunge minofu ndi ntchito, komanso kuchepetsa ngozi ya kugwa .
- Malangizo amphamvu oletsa kugwiritsira ntchito zitsamba zamakina a Chinese zotsutsa zitsamba Yanghe ndi Biqi.
Zotsatira:
2015 Malangizo a Management of Polymyalgia Rheumatica. Dejaco C. et al. Arthritis & Rheumatology Vol. 67 Nambala 10. October 2015.
http://www.rheumatology.org/Portals/0/Files/2015%20PMR%20guidelines.pdf
Polymyalgia Rheumatica. American College of Rheumatology. Idasinthidwa June 2015.
http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Polymyalgia-Rheumatica