Mankhwala Ochepetsa Matenda a Mitsempha

Malangizo Ogwiritsira Ntchito DMARD ndi Biologic Dawa

Mu 2012, American College of Rheumatology (ACR) inasintha malingaliro ochizira matenda a nyamakazi . Malingaliro a ACR a 2012 omwe amagwiritsidwa ntchito pogwiritsa ntchito mankhwala osokoneza bongo (DMARDs) ndi mankhwala a biologic odwala nyamakazi ndi ndondomeko ya malingaliro a 2008.

Zosintha za 2012 zatchulidwa:

1. zizindikiro zoyambira kapena kusinthasintha DMARD ndi mankhwala osokoneza bongo

1. kugwiritsa ntchito biologics omwe ali oopsa kwambiri, kuphatikizapo omwe ali ndi chiwindi cha hepatitis, kulephera mtima kwa mtima, ndi malignancy
2. Kuyezetsa TB kwa odwala kuyambira kapena pakali pano akugwiritsa ntchito mankhwala osokoneza bongo
3. katemera kwa odwala omwe akuyamba kapena pakali pano kutenga DMARD kapena mankhwala osokoneza bongo

Malingalirowa adachokera ku zofufuza za PubMed ndi Database Cochrane ya Zomwe Zapangidwe, kuyesa zochitika zachipatala, ndi lingaliro la akatswiri. Mabukuwa anafufuzidwa 8 DMARD: azathioprine (Imuran), cyclosporine , hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate , minocycline (Minocin), golide , sulfasalazine (azulfidine) ndi mankhwala 9 biologic: abatacept (Orencia) , adalimumab (Humira), anakinra (Kineret), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituxab (Rituxan), ndicilizumab (Actemra). Chifukwa cha kugwiritsa ntchito mankhwala osokoneza bongo komanso kusowa kwa deta zatsopano zomwe zinachokera kufukufuku, azathioprine, cyclosporine, golide, ndi anakinra sizidaphatikizidwenso.

Orencia, Rituxan, Kineret, ndi Actemra si mankhwala osokoneza bongo a TNF. Enbrel, Remicade, Huma, Simponi, ndi Cimzia ndi TNF.

Kwa odwala matenda a nyamakazi oyambirira (omwe amadziwika kuti ali ndi nyamakazi ya nyamakazi kwa miyezi yosachepera 6) ndipo odwala omwe ali ndi matenda a nyamakazi amachiritsidwa ndi mankhwala ena alionse a DMARD kapena mankhwala a biologic, cholinga cha chithandizo ndizochepa zochitika za matenda kapena kukhululukidwa.

Kuyambitsa kapena Kusintha DMARD ndi Biologic Dawa

• DMARD monotherapy (mankhwala omwe ali ndi mankhwala osakanizidwa amodzi) adalimbikitsidwa ku matenda a nyamakazi oyambirira omwe ali ndi matenda ochepa kapena omwe ali ndi matenda ochepa / omwe ali ndi matenda osawerengeka (mwachitsanzo, matenda osagwirizana ndi matendawa).
• Mankhwala othandizira a DMARD analimbikitsidwa ndi odwala matenda a nyamakazi oyambirira omwe ali ndi matenda oyenerera kapena apamwamba komanso maonekedwe osayenera.
• Kugwiritsa ntchito mtengo wa TNF ndi wopanda methotrexate kunalimbikitsidwa kwa odwala nyamakazi oyambirira omwe ali ndi matenda akuluakulu komanso zizindikiro zosalongosoka. Ngati blocker ya TNF ndi infliximab (Remicade), iyenera kugwiritsidwa ntchito ndi methotrexate.
• Kwa odwala omwe ali ndi nyamakazi ya nyamakazi, ngati patapita miyezi itatu ya DMARD monotherapy wodwala akusiya kuchoka ku matenda ochepa mpaka kuntchito kapena kudwala, methotrexate, hydroxychloroquine, kapena leflunomide (Arava) ayenera kuwonjezeredwa.
• Pambuyo pa miyezi itatu ya methotrexate kapena methotrexate / DMARD mankhwala othandizira, yikani mankhwala ena osakhala ndi methotrexate DMARD kapena mutembenuzire ku DMARD ina yosakhala ya methotrexate ngati wodwala wodwalayo akadali ndi matenda oopsa - kapena kuwonjezera kapena kusintha kusungira TNF, abatacept ( Orencia), kapena rituximab (Rituxan).

• Pambuyo pa miyezi itatu ndikuchiritsidwa ndi TNF blocker, ngati wodwala ali ndi matenda ochepa / omwe ali okhudzana ndi kusayankhidwa kapena kutaya phindu la mankhwala, kusintha kwa TNF kapena bloc non-TNF biologicalic.
• Ngati pali zochitika zolimbitsa thupi / zokhudzana ndi matenda pambuyo pa miyezi 6 yothandizidwa ndi osakhala TNF biologic chifukwa chosayankhidwa kapena kutaya phindu, wodwalayo ayenera kusinthidwa ku zosiyana osati za TNF biologic kapena kwa TNF blocker.
• Ngati wodwalayo ali ndi matenda akuluakulu ndipo alephera kutseka TNF chifukwa cha choipa chachikulu, kutembenukira kwa osakhala TNF biologic akulimbikitsidwa.

• Ngati wodwalayo ali ndi matenda ochepa / omwe ali ndi matenda akuluakulu ndipo amalephera kutseka TNF chifukwa cha zovuta zowononga, kusintha kwa TNF kapena osakaniza TNF biologic.
• Ngati wodwala ali ndi matenda ochepa / apamwamba pambuyo polephera kusalankhula ndi TNF biologic chifukwa cha zovuta, kusintha kwa wina wosakhala TNF kapena kutseka kwa TNF akulimbikitsidwa.

Kugwiritsira Ntchito Biologics mu Chifuwa cha Matenda Odwala Matenda a Matenda Odwala Matenda a Chiwindi, Malignancy, kapena Kulephera kwa Mtima Wokongola

• Kuvomerezeka (Enbrel) kumalimbikitsa odwala nyamakazi odwala matenda a chiwindi a C.
• Mankhwala osokoneza bongo sakuvomerezeka ku matenda a nyamakazi odwala matenda a chiwindi a B kapena ena odwala matenda a chiwindi a B.
• Kuyambira kapena kubwezeretsanso chithandizo cha biologic akulimbikitsidwa kwa odwala omwe amachiritsidwa ndi matenda oopsa a zaka zoposa zisanu zapitazo kapena odwala omwe athandizidwa pa khansa ya khungu la nonmelanoma kuposa zaka zisanu zapitazo.
• Mankhwala a TNF sakuvomerezeka ku matenda a nyamakazi odwala matenda odwala matenda a nyamakazi odwala kapena ochepa kwambiri.

Chifuwa chachikulu (TB)

• Kuyeza kwa matenda opatsirana pogwiritsa ntchito TB kumalimbikitsa odwala nyamakazi odwala matenda a nyamakazi.
• Mosasamala kanthu za zifukwa zomwe zimayambitsa matenda opatsirana a TB, chifuwa cha tuberculin khungu kapena interferon-gamma-release-assay ayenera kuchitidwa kwa odwala omwe ali okonzeka kuyamba mankhwala a biologic.

Katemera wa Odwala Kuyambira kapena kulandira DMARD kapena mankhwala a Biologic

• Katemera wodwala (pneumococcal, fuluwenza, ndi hepatitis B), kachilombo (papillomavirus yaumunthu), ndi katemera wa herpes zoster ayenera kupatsidwa asanayambe DMARD kapena mankhwala a biologic.
• Ngati sizinachitike kale, katemera wophedwa kapena wowonjezera ayenera kuperekedwa kwa odwala omwe atenga kale DMARD kapena mankhwala a biologic.
• Katemera wa herpes zoster angaperekedwe kwa omwe atenga kale DMARD.

ZOCHITIKA - 2015 ACR Malangizo ochizira Matenda a Nyamakazi

Zotsatirazo zinayambanso kutulutsidwa mu 2015 ngati ndondomeko ya malangizo a 2012. Chipangizo cha 2015 chimaphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo (DMARD), a biologic agents, Xeljanz (tofacitinib) , ndi glucocorticoids kumayambiriro (osakwana miyezi 6) ndipo adakhazikika (miyezi 6 kapena kuposa) nyamakazi ya nyamakazi. Zomwe zimaperekedwanso mu chitsogozo cha 2015 ndizolimbikitsa kugwiritsa ntchito njira zothandizira anthu , mankhwala osokoneza bongo komanso kusiya mankhwala, komanso kugwiritsa ntchito mabungwe a biologic ndi DMARD kwa odwala matenda a hepatitis, congestive mtima failure, malignancy, ndi matenda aakulu.

Chitsogozochi chimagwiritsa ntchito katemera kwa odwala kuyambira kapena kulandira mankhwala a DMARD kapena mankhwala osokoneza bongo, kuyang'anira chifuwa chachikulu kwa odwala kuyamba kapena kulandira mawotchi a biologic kapena tofacitinib, ndi kuyang'anira ma laboratory a DMARD. Malangizowa akuphatikizapo malingaliro 74 omwe 23% amawoneka amphamvu ndipo 77% ali ndi zifukwa. Mutha kuchipeza apa: 2015 American College of Rheumatology Guide kwa Chithandizo cha Matenda a Chifuwa.

_Chitsime:

_{Kukonzekera kwa 2008 ACR Zotsatira za Kugwiritsa Ntchito DMARD ndi Biologics mu Chithandizo cha Rheumatoid Arthritis. Matenda a Nyamakazi ndi Kafukufuku. pp. 625-639. Singh JA et al. May 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract}

_{Chipatala cha American American Rheumatology Guideline cha Chithandizo cha Chifuwa cha Arthritis Singh JA et al. Matenda a Nyamakazi ndi Kafukufuku DOI 10.1002 / acr.22783
http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf}