Njira Yoyenera Kuchokera Kwa Kudzikonda Kwambiri Kuchipatala
Ngakhale palibe mankhwala odwala nyamakazi, pali mankhwala ambiri omwe amatha kuchepetsa kupweteka ndi kutupa kwa matenda aakulu otupa. Amaphatikizapo mankhwala othandizira okha, zakudya, zowonjezereka komanso mankhwala opatsirana opweteka, mankhwala opatsirana, komanso mankhwala osokoneza bongo atsopano (DMARDs). Mavuto ovuta angafunike maofesi monga ngati arthrocentesis kapena opaleshoni yokonzanso kapena kubwezeretsa chiwonongekocho.
Zothetsera Pakhomo ndi Moyo Wamoyo
Matenda a kutupa nyamakazi ndi matenda aakulu, omwe amapita patsogolo omwe amafunika kuyang'aniridwa ngati gawo la moyo wanu. M'malo mochiza matendawa ndi mankhwala osokoneza bongo, muyenera kugwiritsa ntchito njira yowonjezera yomwe mukufuna kuti mukhale ndi thanzi labwino komanso kuchepetsa mavuto omwe amakupangitsani kuti mukhale oopsa.
Zonse zokhudzana ndi kukhala ndi makhalidwe abwino ndikusintha momwe mumayankhira pazowopsa.
Zakudya
Ngakhale ngati manja anu akukhudzidwa, kukhala olemera kwambiri kapena olemera kwambiri kumayambitsa kutupa chifukwa cha kutulutsa mapuloteni otupa (otchedwa cytokines ) kuchokera ku maselo a mafuta. Izi zimangowonjezera zizindikiro za nyamakazi ya nyamakazi ndikuwonjezera kupsinjika kopanda malire ku zigawo za m'munsi.
Ngakhale kuti palibe chakudya chapadera kwa anthu omwe ali ndi matenda a nyamakazi, madokotala ambiri amalimbikitsa zakudya za Mediterranean zomwe zimapatsa mapuloteni, mafuta, ndi zakudya zowonjezereka ndikulimbikitsa kuti nsomba zikhale zowonjezereka (zowononga omega-C mafuta acids ) , mbewu zonse, ndiwo zamasamba, zipatso, ndi mafuta abwino (monga mafuta a azitona).
Kuchita masewera olimbitsa thupi
Matenda a nyamakazi amadziwika ndi kuuma chifukwa cha kuwonongeka kwa matenda a synovial mu malo olowa. Pogwiritsa ntchito ndondomeko yochita masewera olimbitsa thupi , mukhoza kuchepetsa thupi ndi kuyendetsa kayendetsedwe kake kamodzi. Kukhala ndi moyo wokhayokha, kumathandiza, kumalola kuti mapepala amodzi azikhala "otetezeka" -magwirizano pamodzi monga guluu-zomwe zimatsogolera kusamutsidwa.
Kuchita masewera olimbitsa thupi kungathandizenso kuti mafupa anu akhalebe olimba ndi kulimbana ndi zizindikiro za matenda a mitsempha omwe amapezeka mwa anthu omwe ali ndi nyamakazi.
Kusuta
Tonsefe timadziwa kuti kusuta sikuli kwabwino kwa ife, koma kungakhale koipa ngati muli ndi nyamakazi. Utsi wa sigara uli ndi zinthu zonyansa kwa thupi lanu, osati kungokhalira kutukusira koma kumayambitsa kupopera kwa mitsempha ya mitsempha mpaka pamene kusindikizidwa kungathe kuimitsidwa mbali zina za thupi.
Izi zingalimbikitse chitukuko cha mitsempha yotchedwa rheumatoid vasculitis , matenda omwe amapezeka ndi matenda aakulu, zilonda za khungu ndi malungo, malungo, kutaya thupi, komanso kupweteka kwa thupi. Komanso, kafukufuku wasonyeza kuti kusuta kungathenso kuwonjezera chiopsezo chanu chopeza nyamakazi ya nyamakazi, nthawi zina ndi 300 peresenti.
Pamene kusiya ndudu kungakhale kovuta, ubwino wa umoyo wanu (wokhudzana ndi wokhudzana ndi onse) ukhoza kukhala waukulu. Lankhulani ndi dokotala wanu za njira zomwe mungasankhe. Mankhwala monga Zyban (bupropion) ndi Chantix (varenicline) angakhale ogwira ntchito kwa osuta ndipo sangasokoneze mankhwala anu a nyamakazi.
Zowonongeka za Over-the-Counter (OTC)
Monga gawo la ndondomeko yanu yothandizira mzere, dokotala wanu amapereka mankhwala osokoneza bongo ( OTC) omwe sagwiritsiridwa ntchito ndi anti-inflammatory drugs (NSAID) kuti athe kuchepetsa kupweteka pang'ono ndi kuchepa.
Izi zikuphatikizapo ma oTC otchuka monga Aleve (naproxen) kapena Advil (ibuprofen). Kuphatikiza pa kukhala ndi anti-inflammatory properties, NSAIDs ndi analgesic ndi antipyretic (kutanthauza kuti akhoza kuthetsa ululu ndi malungo, motsatira).
NSAIDs sizengereza kuchepa kwa matendawa. Ngati zizindikiro zowonjezereka, dokotala wanu angapereke NSAID zopambana monga Celebrex (celecoxib) kapena Voltaren (diclofenac) . Zotsatira za NSAID zimaphatikizapo kukwiya kwa m'mimba, kuthamanga kwa magazi, kumveka m'makutu anu, zilonda za m'mimba, ndi chiwindi cha chiwindi.
Malemba
Ngati mwapezeka kuti muli ndi nyamakazi ya magazi , dokotala wanu nthawi zambiri amapereka mankhwala osiyanasiyana, omwe amachititsa kuti zizindikirozo ndi zina zithetse vutoli .
Izi zimaphatikizapo m'kamwa ndi jekeseni ya corticosteroids, mankhwala osinthira mankhwala oletsa antirheumatic (DMARDs), ndi mankhwala omwe amayamba kumene.
Corticosteroids
Corticosteroids ndi mankhwala othandiza kwambiri koma omwe ali ndi mphamvu zomwe zingachepetse kutupa ndikuthandizira ntchito zolimbitsa thupi. Corticosteroids amagwira ntchito poyesa kortisol, hormonal adrenal yomwe imathandiza kuchepetsa kutupa, kuchepetsa thupi, kukumbukira, ndi shuga.
Nthawi zambiri amalembedwa ngati gawo la mankhwala opangidwa ndi mankhwala osiyanasiyana ndipo amaperekedwa pamlomo (mwa mapiritsi), mwa jekeseni (mu minofu kapena palimodzi), kapena mkati mwake (mu mitsempha). Prednisone ndi mankhwala omwe amagwiritsidwa ntchito kwambiri pa nyamakazi ya nyamakazi.
Corticosteroids imangotumizidwa kuti ikhale yogwiritsidwa ntchito kwa kanthawi kochepa chifukwa cha kuwonjezeka kwa zoopsa, kuphatikizapo matenda otupa mitsempha, kupweteka kwa thupi, kuphwanyidwa kosavuta, cataracts, glaucoma, ndi shuga. Akatengedwa pamlomo, amalembedwa m'munsi otsika ndipo nthawi zambiri amatengedwa m'mawa. Majekesiti amawasokoneza kwambiri ndipo samagwiritsa ntchito katatu kapena kanayi pachaka.
DMARD
Mankhwala oletsa matenda a antirheumatic (DMARDs) omwe amagwira ntchito pogwiritsa ntchito mankhwalawa amachititsa kuti thupi lonse lisamayende bwino. Monga nthendayi yokhayokha, nyamakazi ya nyamakazi imayamba chifukwa cha kusagwira ntchito kwa chitetezo cha mthupi momwe maselo amadzimadzi amayendera. Udindo wa DMARD ndikuteteza chitetezo cha mthupi lonse.
Ntchito za DMARD zimagwira ntchito mwamsanga pamene zimatengedwa mwamsanga ngati matendawa atapezeka. Pali magulu ambiri a DMARD omwe amavomerezedwa kuchipatala, kuphatikizapo mankhwala okalamba monga Plaquenil (hydroxychloroquine) ndi atsopano monga Arava (leflunomide) . Ambiri amachotsedwa pamlomo.
Pomwepo, DMARD yomwe imapezeka kwambiri ndi methotrexate . Methotrexate yakhalapo kwa zaka zopitirira 50 ndipo ikupitirira kukhala msana wa mankhwala a nyamakazi. Pakati pa ubwino wake ambiri, methotrexate ingatengedwe mwachangu kwa nthawi yaitali, kawirikawiri imafuna mlingo umodzi wa mlungu uliwonse, ndipo ingagwiritsidwe ntchito kwa ana.
Pamapeto pake, methotrexate ingayambitse chiwindi poizoni komanso kupweteka kwa mafupa. Kuyezetsa magazi nthawi zonse kumafunika kuti tipewe mavutowa. Zotsatira zina zimaphatikizapo kutopa, kunyozetsa, kupwetekedwa m'mimba, kuthamanga, kutsekula m'mimba, zilonda zamilomo, ndi kuvulaza mosavuta. Kutenga mankhwala a folic acid tsiku ndi tsiku kungathandize kuchepetsa zina mwa zotsatirazi zokhudzana ndi mankhwala.
Peŵani methotrexate ngati muli ndi pakati kapena mukuyesera kutenga mimba chifukwa zingayambitse zilema zobereka.
Zosintha Zamoyo Zosintha
Mapulogalamu a kusintha kwa zamoyo ndi mtundu watsopano wa DMARD umene umapangitsa mbali zina za chitetezo cha mthupi kusiyana ndi zonse. Zimatengedwa ngati biologic chifukwa sizinapangidwe ndi anthu koma zimachokera ku mapuloteni a anthu kapena nyama.
Ngakhale mankhwala osokoneza bongo omwe amagwiritsidwa ntchito pochizira matenda a nyamakazi ali ndi njira zosiyanasiyana zochitapo kanthu, onse amagwira ntchito potseka chithunzithunzi cha chitetezo cha mthupi: kaya tumor necrosis factor (TNF) (yomwe imaimira kutentha), interleukin (yomwe imayang'anira kuteteza thupi la chitetezo cha mthupi) ndi T-maselo (omwe amawunikira ndi kuukira ziwalo zoyembekezereka tizilombo toyambitsa matenda).
Mankhwala omwe amagwiritsidwa ntchito kawirikawiri ndi awa:
- Actemra (tocilizumab)
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- Humira (adalimumab)
- Kineret (anakinra)
- Orencia (abatacept)
- Remicade (infliximab)
- Rituxan (rituximab)
- Simponi (golimumab)
Zamoyo zimaperekedwa ndi jekeseni kapena intravenously ndipo kawirikawiri zimaperekedwa kwa anthu omwe sanamverepo mankhwala ena.
Chifukwa chakuti biologics imasokoneza machitidwe a chitetezo cha mthupi, anthu omwe akuchiritsidwa akhoza kukhala pachiopsezo chachikulu cha matenda. Choncho, chodulidwa, chowawa, kapena chizindikiro cha kachilombo ka HIV kakuyenera kuchiritsidwa ndi dokotala. Zotsatira zoyipa zimaphatikizapo kupweteka kwa tsamba, kupweteka kwa kupuma, ndi zizindikiro za chimfine.
JAK Inhibitors
Janus kinase (JAK) inhibitors ndi kalasi yatsopano ya DMARD yopanda biologic imene ntchito yake imaletsa kutentha kwa mkati mwa selo. Jafaki (ruxolitinib) ndi Xeljanz (tofacitinib) ndi zoyamba za JAK zomwe zimavomerezedwa kuti zigwiritsidwe ntchito ku US Zonsezi zimatengedwa mwachindunji ndi kuuzidwa kwa anthu omwe sanayankhe mokwanira ku methotrexate kapena alephera pa biologics.
JAK inhibitors amagwiritsidwa ntchito kuphatikiza ndi methotrexate ndipo amatengedwa kawiri tsiku ndi tsiku. Zotsatira zoyipa zimaphatikizapo kupweteka mutu, kutopa, kupweteka kwa m'mimba, zizindikiro za chimfine, kutsegula m'mimba, cholesterol chokwanira, ndi chiopsezo chowonjezeka cha matenda.
Thandizo la Thupi
Kuphatikiza pa mankhwala, dokotala wanu angakulozereni kwa katswiri wothandizira omwe angagwire ntchito nanu kuti mubwezeretse ntchito yogwirizana ndi kuyenda. Izi zimaphatikizapo opaleshoni ya thupi ndi opaleshoni ya ntchito.
Thandizo la thupi limapitiriza kumanga nyonga ndi kuyendetsa bwino. Anthu omwe ali ndi nyamakazi yochepa kwambiri amayamba kugwira ntchito ndi wodwalayo nthawi zonse ndipo amatha kufotokozera njira zosiyanasiyana zochokera ku zizindikiro kapena zolephera zawo.
Mankhwala angaphatikizepo:
- Zochita zolimbitsa mphamvu ndi zosiyana-siyana
- Mankhwala otentha ndi ozizira
- Therapeutic ultrasound
- Kutsitsimutsa kwa magetsi
- Hydrotherapy
Thandizo la ntchito likufuna kuthandizira ufulu wanu ndi kusintha moyo wanu mwa kukuthandizani kuthana ndi kuchepa kwa thupi, nthawi zambiri pogwiritsira ntchito zipangizo zothandizira.
Zitsanzo zikuphatikizapo:
- Kuika timagetsi ting'onoting'ono ting'onoting'ono tomwe timagwira ntchito mosavuta
- Kupeza mipando ya ergonomic yomwe imakulolani kukhala mosasokonezeka
- Kusankha makoswe, oyendayenda kapena zipangizo zina zogwiritsira ntchito zogwirizana ndi zosowa zanu
- Kukonzanso makabati ndi alumali kuti zinthu zikhale zovuta kuzifikira
- Kusintha mawonekedwe a kuwala ndi sliders
- Kugwiritsa ntchito lamulo la mawu m'malo molamulira makapu
Akatswiri ena, kuphatikizapo a podiatrists, odzola masewera, ndi akatswiri a maganizo, angayesedwe kuthana ndi zovuta zina zakuthupi ndi zamalingaliro.
Njira Zotsata Pre-Surgical
Kuchita opaleshoni nthawi zonse kumakhala ngati njira yomaliza ngati muli ndi nyamakazi. Musanayambe kuganizira opaleshoni, dokotala wanu angafunike kufufuza njira zochepa zowonongeka, makamaka ngati muli aang'ono komanso ngati muli ndi thanzi labwino.
Zina mwazochita ndi njira yotchedwa arthrocentesis yomwe madzi amachokera mu malo ogwirizana ndi singano kuti athetse mavuto. Kaŵirikaŵiri amagwiritsidwa ntchito ngati chodziŵika cha matenda odwala matenda koma amatha kukhala ogwira mtima pomwe amadzimadzi amadzipweteka kwambiri.
Nthenda yotchedwa arthrocentesis ikhoza kuchitidwa yokha kapena isanayambe kuwombera mphuno ya corticosteroid. Majekeseni ena opangidwa ndi intra-articular amathandiza kugwiritsa ntchito hyaluronic acid kuti awononge malo olowa nawo kapena plasma (PLP) omwe amachokera m'magazi a munthu mwiniyo kuti athandizidwe kupanga ziwalo zomwenso zimawonongeka.
Komabe, padzakhala nthawi pamene arthrocentesis sidzapereka chithandizo choyembekezeka, ndipo opaleshoni ndiyo njira yokhayo.
Opaleshoni
Ngati kupweteka kwanu kumakhala kovuta, dokotala wanu angakulimbikitseni opaleshoni kukonzanso chophwanyika chowonongeka kapena kuchichotsa. Kawirikawiri, opaleshoni imangoganiziridwa ngati zosankha zina zonse zatopa ndipo mukuwoneka kuti ndinu woyenera payekha.
Kukonzekera Pamodzi
Pamene nyamakazi ya nyamakazi imayamba kukula, timagulu ting'onoting'ono timatha kutengeka. pamene kutaya kwa kalisera ndi fupa kumapangitsa kuti mgwirizano uwononge mgwirizano ndi mawonekedwe ake, zomwe zimapangitsa kuwonongeka kwa mgwirizano . Makamaka m'magulu ang'onoang'ono omwe sangasankhe, madokotala opaleshoni amagwiritsa ntchito njira zosiyanasiyana kuti athandize kubwezeretsa ndi kuchepetsa ululu.
Zina mwazokonzanso:
- Arthrodesis , yomwe imadziwikanso kuti fupa ndi mgwirizano wa fusion, imagwiritsidwa ntchito kuthetsa ululu wosakanikirana wothandizana ndi kugwirana mafupa palimodzi kuti zisawonongeke.
- Arthroscopy ndi njira yomwe phokoso lamakono (lotchedwa arthroscope) limalowetsedwera mu malo ophatikizana kotero kuti ziwalo za fupa ndi karotila zikhoza kupezeka ndi kuchotsedwa.
- Mtsinje wa Carpal umatulutsidwa , womwe umatchedwanso mitsempha yotulutsa mitsempha, ndi opaleshoni yomwe chimango cha kanyumba cha carpal chadambasula kuti chikhale ndi malo ambiri a mitsempha ndi matope.
- Synovectomy imaphatikizapo kuchotsedwa kwa chipinda chogwiritsira ntchito, chotchedwa synovium, pamene chimawombera nthawi zambiri ndipo chimayambitsa kusamvana kwa mgwirizano.
Zowonongeka Pamodzi
Kuchita opaleshoni yowonjezereka , yomwe imatchedwanso arthroplasty, yakhala ikufala kwambiri kwa anthu omwe ali ndi nyamakazi ya nyamakazi. Chisankho chofufuza njira yogwirizanitsa pamodzi chidzakhazikitsidwa poyang'ana zizindikiro za thupi, mbiri ya chithandizo, ndi zofufuza kuchokera ku zojambula zojambula.
Komanso, msinkhu wanu ukhoza kutenga gawo lalikulu pa chisankho choperekedwa kuti prostheses yowonjezera imatha kukhala paliponse kuyambira zaka 15 mpaka 20. Momwemo, madokotala ambiri opaleshoni adzafuna kuchepetsa njirayo malinga ndi momwe zingathekere, kawirikawiri mpaka mutakhala kwinakwake zaka 50.
(Ndikunenedwa kuti, anthu ambiri omwe ali ndi nyamakazi ya nyamakazi akukhala m'malo mwa 60s oyambirira chifukwa cha kuwonjezeka kwa ma DMARD atsopano.)
Popeza kuti DMARD imagwira ntchito popondereza chitetezo cha mthupi, muyenera kusiya kuchipatala bwino musanayambe kuchita opaleshoni kuti muchepetse chiopsezo chachikulu chotenga matendawa.
Masiku ano, mawotchi ndi nsapato m'malo mwake akhala otetezeka komanso ogwira mtima ndi opambana 90%. Matenda opatsirana opatsirana mwa anthu omwe ali ndi nyamakazi ya nyamakazi ndi ofanana kwambiri ndi wina aliyense ndipo angaphatikizepo kuwonongeka kwa mitsempha, matenda, magazi, ndi kusokoneza mgwirizano.
Mankhwala Osakaniza Owonjezera (CAM)
Polimbana ndi matenda osatha, moyo wathanzi, anthu omwe ali ndi matenda a nyamakazi amayamba kulandira mankhwala othandizira kuti azitsatira chithandizo chamankhwala awo.
Ngakhale mankhwala ambiri oterewa amapindulitsa, onse enieni ndi ozindikira, ndikofunikira kuti muyankhule ndi dokotala wanu za mankhwala enaake, mankhwala, kapena mankhwala omwe mungakhale nawo. Izi zingalepheretse kugwiritsira ntchito mankhwala omwe angachepetse mankhwala anu kapena zotsatira zoopsa zomwe zingakuchititseni kudwala.
Zina mwa mankhwala omwe amaonedwa kuti ndi opindulitsa kuchiza nyamakazi ya nyamakazi:
- Mafuta a nsomba ali ndi ma omega-3 fatty acids ambiri omwe thupi limagwiritsa ntchito kuchepetsa kutupa. Kafukufuku ambiri awonetsa kuti mafuta owonjezera magalamu atatu a tsiku ndi tsiku angapereke chithandizo chochepa cha kupweteka kwa nyamakazi ndi kuuma. Komabe, mavitamini ophera nsomba ayenera kupewedwa mwa anthu omwe amagwiritsa ntchito magazi ngati warfarin chifukwa akhoza kuonjezera chiopsezo cha magazi.
- Manyowa , madzulo madzulo , ndi mafuta a currant , omwe amawoneka mu gel-cap ndi madzi, amapanga omega-6 fatty acids omwe ali ndi anti-inflammatory properties opindulitsa kwa anthu odwala nyamakazi. Kugwiritsa ntchito moyenera kuyenera kupewa monga borage ingayambitse kuwononga chiwindi pa mlingo waukulu, pamene madzulo a primrose akhoza kusokoneza mankhwala a phenothiazine ogwiritsidwa ntchito m'maganizo a maganizo.
Zina zowonjezereka zothandizira mankhwala owonjezera monga glucosamine, chondroitin, acupuncture, ndi maginito mankhwala sichinawonetsedwe kukhala othandiza makamaka pochiza nyamakazi ya nyamakazi.
> Zotsatira:
> Padziko Lonse la Mankhwala Opatsirana Ndi Omwe Amawonjezera. "Lipoti la Kafufuzidwe: Matenda a Matenda a Matenda a Mitsempha ndi Othandizira Omwe Amawathandiza." Bethesda, Maryland; zasinthidwa pa May 4, 2016.
> Nikiphorou, E .; Konan, S .; MacGregor, A. et al. "Kuchiza opaleshoni ya nyamakazi ya nyamakazi; Nthawi yatsopano?" Bone Joint J. 2014; 96-B: 1287-9. DOI: 10.1302 / 0301-620X.96B.34506.
> Singh, J .; Saag, K .; Mabwalo, L. et al. "2015 College of America ya Rheumatology Guideline ya Chithandizo cha Matenda a Chifuwa Chakumwa. 2016: 68 (1); 1-25. DOI: 10.1002 / acr.22783.
> Smolen, J ;; Aletaha, D .; ndi McInnes, I. "Matenda a nyamakazi. " Lancet. 2017; 388 (10055): 2023-38. DOI: 10.1016 / So140-6736 (16) 30173-8.
> Sugiyama, D .; Nishimura, K .; Tamaki, K. et al. "Zotsatira za kusuta zimayambitsa matenda a nyamakazi: nyota yofufuza zofufuza. " Annals Rheum Dis. 2010; 69 (1): 70-81. DOI: 10.1136 / ard.2008.096487.