Kukhumudwitsa ndi kuchita pang'onopang'ono. Onsewa akufotokoza momwe mankhwala amodzi, omwe amatchedwa DMARD (matenda osinthira antirheumatic drugs), amagwiritsidwa ntchito pochizira matenda a chifuwa chachikulu ngati mankhwala ochepa kwambiri omwe amawoneka kuti ndi othandiza. DMARD imagwiritsidwanso ntchito pochitira zinthu zotupa zotere, monga ankylosing spondylitis , psoriatic nyamakazi , lupus.
Mankhwalawa amaonedwa kuti akuthetsa nzeru chifukwa amatha kuchepetsa matendawa, ngakhale kuti nthawi zambiri sangawathandize .
Popeza zingatengere miyezi 6 mpaka 8 kuti mankhwalawa atulutse yankho, iwo amawoneka ngati akugwiritsa ntchito mankhwala osakanikirana ndipo amasankhidwa ngati njira yachiwiri yoperekera mankhwala pambuyo pa aspirin ndi NSAID (mankhwala osagwiritsidwa ntchito ndi anti-inflammatory drugs) akulephera.
Sindimvetsetsa momwe DMARD imagwirira ntchito. Ma DMARD amawoneka kuti amachepetsa kutupa ngakhale kuti sali gulu ngati mankhwala odana ndi zotupa. Zili zosiyana ndi NSAIDs popeza sizichepetsanso kupanga prostaglandin, sizimathandiza kuchepetsa ululu, kapena kuchepetsa kutentha thupi. Momwemonso, DMARD imachepetsanso matendawa mwa kukonzanso chitetezo cha mthupi mwanjira ina.
Mphamvu, chitetezo, zotsatira zake, ndi nthawi yogwiritsira ntchito DMARD zafunsidwa ndi odwala okhudzidwa. Maphunziro a zaka zambiri awonetsa DMARD kukhala mankhwala othandiza kwambiri, ndi zotsatira zosayembekezereka kwambiri. Kuwunika kawirikawiri ma laboratory kumathandiza kuika chiopsezo cha zotsatirapo. Ngati amaganiza kuti ndi mankhwala ochepa, DMARD tsopano akuyambidwa ngati njira yothetsera vuto la nthawi yaitali komanso kuchepetsa kukula kwa matenda.
Golidi wa Arthritis
Atapezeka mwachangu ndi dokotala wa ku France, mchere wa golide wakhala ukugwiritsidwa ntchito pofuna kuchiza matenda a nyamakazi kwa zaka zoposa 50. Jacques Forrestier adayiratu mchere wa golide kukhala wodwala chifuwa chachikulu kuti athe kuchiza matendawa. Mmodzi wodwalayo anali ndi nyamakazi ndipo patatha miyezi yambiri akuchiritsidwa ndi golide, nyamakazi imakula bwino.
Kuyambira nthawi imeneyo golide wakhala akugwiritsidwa ntchito pochiritsa nyamakazi.
Mmene ntchito ya golidi imagwirira ntchito mosavuta koma mwachiwonekere imasokoneza ntchito za maselo oyera a magazi omwe amayambitsa zowonongeka pamodzi ndi kutupa . Ngakhale golidi ikhoza kuchepetsa chiwonongeko, sichikhoza kusintha maulendo omwe alipo.
Golide poyamba anali kupezeka ngati mankhwala osakaniza. Chifukwa chokhala ndi nthawi yowonongeka, pamafunika kuyesedwa koyambitsa magazi ndi mkodzo. Mu 1986, golidi inayamba kupezeka m'mawu amodzi ndi dzina la malonda Ridaura. Zotsatira zofala kwambiri zomwe zimagwirizanitsidwa ndi golide woyambitsa matenda ndi zowonongeka pamagulu otsika ndi zilonda za pakamwa zomwe nthawi zambiri zimatha pamene mankhwala achotsedwa. Golidi yamlomo imakhala ndi zotsatira zochepa koma ingayambitse matenda otsegula m'mimba kapena kutayika. Golide amaoneka kuti amagwira ntchito bwino kwambiri kwa odwala 10 peresenti ndipo amakhala bwino kwa ena 30-40 peresenti. Ambiri mwa anthu 100 aliwonse odwala amasiya kugwiritsa ntchito zotsatirapo kapena zolephera.
Kugwiritsira ntchito golidi kwatsikira kwambiri, makamaka ndi chitukuko cha mankhwala osokoneza bongo . Choyamba cha biologic, Enbrel, chinapezeka mu 1998.
Penicillamine
Penicillamine, wachibale wapatali wa penicillin, anakhalapo m'ma 1970.
Penicillamine amadziwika ngati chelator chifukwa imatha kumanga zitsulo zolemera m'thupi. Zomwe zimagwiritsidwa ntchito pa matenda a nyamakazi sizidziwikiratu koma zimaganiziridwa kuti zimasintha ntchito ya maselo oyera a magazi omwe amayambitsa zowonongeka. Zingakhale zogwira mtima kwambiri pamene zimaphatikizapo mkuwa umene mwachibadwa ulipo m'thupi.
Penicillamine amaperekedwa pamlomo, kuyambira ndi mlingo wochepa, ndiye pang'onopang'ono kuwonjezera mlingo. Zimatengedwa pa mimba yopanda kanthu ola limodzi kapena zisanafike. Ngati wodwalayo akuyenera kukhalabe wathanzi mpaka kalekale. Zotsatira zoyipa zimakhala zofanana ndi zomwe zimagwirizanitsidwa ndi golidi - zikopa za pakhungu, zilonda zam'kamwa, kutaya kwa kukoma ndi kukhumudwa m'mimba.
Mapuloteni mu mkodzo angakhale chizindikiro choyamba cha kuwonongeka kwa impso.
Penicillamine ingagwiritsidwe ntchito limodzi ndi NSAID, ngakhale kuti NSAID iyenera kutengedwa panthawi ya chakudya. Odwala omwe ali ndi vuto la penicillin akhoza kutenga penicillamine. Zimathandiza pafupifupi 30% odwala.
Plaquenil (Hydroxychloroquine)
Malo okhalapo akhala akupezeka kwa zaka zambiri ndipo poyamba ankagwiritsidwa ntchito kuchiza malungo. Ndizosavuta kugwiritsira ntchito, zili ndi zotsatira zochepa, ndipo sizikusowa kufufuza ndi kuyezetsa magazi. Chigwacho chimagwiritsidwa ntchito kwa odwala ali ndi nyamakazi ya nyamakazi omwe samayankha bwino kwa NSAIDs. Zikuwoneka kuti zothandiza odwala pafupifupi 30%. Amagwiritsidwanso ntchito kwa odwala okhala ndi systemic lupus.
Chigwachi chikuwoneka kuti chimasokoneza maselo a chitetezo cha mthupi. Mankhwala amaperekedwa pamlomo, mapiritsi amodzi kapena awiri patsiku. Chomwe chimakhala chovuta kwambiri ndi zotsatira za mankhwala mu retina zomwe zingathe kuwona zovuta. Kuyeza kwa ophthalmology kumalimbikitsidwa miyezi isanu ndi umodzi. NSAID zingatengedwe ndi Plaquenil ndipo nthawi zambiri zimaperekedwa pamodzi.
Methotrexate (Rheumatrex)
Methotrexate , yomwe ilipo kwa zaka zopitirira 40, imagwiritsidwa ntchito kwambiri pochiza psoriasis komanso yogwiritsidwa ntchito pochiza khansa. M'zaka za m'ma 1970, ma methotrexate ochepa anali ovomerezeka ndi ma rheumatologists kuti athetse matenda a nyamakazi pamene NSAID inalephera. Methotrexate imagwira mofulumira kuposa mankhwala ena ololera, nthawi zambiri amabweretsa kusintha kwa masabata osati miyezi.
Methotrexate ndi antimetabolite, yotsutsana ndi kugwiritsa ntchito folic acid. Zimaganiziridwa kuti ziletsa machitidwe a chitetezo cha thupi komanso kuchepetsa kutupa. Zingakhalenso kuchepetsa kukula kwa maselo mu synovial membrane yomwe imayika mgwirizano.
Methotrexate ingaperekedwe pamlomo kapena ngati mankhwala opatsirana pogwiritsa ntchito ndondomeko yoyenera ya mlingo. Pogwiritsa ntchito njira zocheperako zochepa, kugwiritsa ntchito methotrexate kwa nthawi yaitali kungayambitse chiwindi. Kuyesedwa kachitidwe ka chiwindi nthawi zonse kumafunika.
Methotrexate ingatengedwe pamodzi ndi NSAIDs. Odwala amatenga methotrexate akuchenjezedwa kuti asamwe mowa.
Sulfasalazine
Sulfasalazine ndi salicylate komanso antibiotic. Zakhala zikuchitika kuyambira m'ma 1940, poyambirira odwala odwala matenda opatsirana. PanthaĊµi ina, idagwiritsidwa ntchito pochiza nyamakazi ya nyamakazi koma ntchito yake inali yoperewera chifukwa chodandaula za zotsatira. Anagwiritsidwanso ntchito m'mayesero a zamatenda monga njira yodalirika. Panali nthawi yowonjezera chidwi pa ntchito yake ngati wothandizira odwala popanda mavuto a poizoni a golide ndi penicillamine.
Mankhwala a sulfasalazine sadziwika ngakhale ali ndi zochitika ziwiri zomwe zingatheke, kutseka kutupa ndi kulepheretsa kukula kwa mabakiteriya. Sulfasalazine ilipo mu mawonekedwe a piritsi ndi madzi. Izi ziyenera kupeĊµedwa ndi anthu omwe ali ndi chifuwa cha mankhwala a sulfa ndi / kapena aspirin ndi zina zotchedwa salicylates. Zotsatira zoyipa zimaphatikizapo kunyoza, kutsegula m'mimba, kusanza, ndi kusowa kwa njala. Zotsatira zowopsa kwambiri ndi mavuto a mkodzo, matenda a magazi, ndi zochitika zowopsa.
Posankha mankhwala alionse omwe angakuthandizeni kulimbana ndi nyamakazi, inu ndi dokotala muyenera kuwona ubwino ndi kuopsa kwa mankhwala.
> Chitsime:
> Duke University Medical Center Buku la Arthritis, David S. Pisetsky, MD