Kusamalira Zojambula ndi Zapachigawo Mbali za Psoriatic Arthritis
Matenda a Psoriatic ndi matenda aakulu a kutupa nyamakazi omwe amapezeka ndi psoriasis, matenda a khungu. Zizindikiro za kutukumula ndi psoriasis nthawi zambiri sizichitika nthawi imodzi, ngakhale. M'magulu ambiri a nyamakazi a psoriatic, zizindikiro za psoriasis zimayamba kusonyeza zizindikiro za nyamakazi. Komabe, pafupifupi 15 peresenti yamatenda, zizindikiro za nyamakazi zimayamba pamaso pa psoriasis.
Mu 15% ya odwala, psoriatic nyamakazi imapezeka nthawi yomweyo monga psoriasis.
Pali mitundu 5 ya nyamakazi yotchedwa psoriatic nyamakazi : nyenyezi zosiyana, zosiyana kwambiri, za interphalangeal distalant, spondylitis ndi nyamakazi mutilans. Matenda oyambirira ndi mankhwala ndi ofunika kuti athetse chiwonongeko chokhazikika. Chithandizo ndicholinga choletsa kutupa, ndipo ndi mbali zofanana ndi za khungu la matendawa, zonsezi ziyenera kuthandizidwa.
Gulu lina lochita za EULAR (European League Against Rheumatism) linapanga ndondomeko yowonongeka ya zolemba za sayansi pofuna kufufuza mankhwala okhudza psmatic arthritis. Poyamba, EULAR inalembera zokambirana mu 2012. Koma pofika mu 2015, chidziwitso chinali chofunika kale chifukwa cha umboni watsopano komanso kupezeka kwa mankhwala atsopano. Mu 2012, panali magulu awiri a DMARD (matenda osinthira anti-rheumatic drugs): ma DMARD omwe amagwiritsidwa ntchito mwachidule (mafupikitsidwe a cMDMARD), omwe amapezeka ndi methotrexate , Arava (leflunomide) , Azulfidine (sulfasalazine) ndi DMARD (bifemed bDMARDs).
Pakafika chaka cha 2015, ndondomekoyi inaphatikizapo gulu lachitatu la DMARD, lotchedwa DMARD (zofupikitsa tsDMARD), zomwe zimaphatikizapo PDE (phosphodiesterase inhibitors) ndi JAK inhibitors (mwachitsanzo, Xeljanz [tofacitinib] ). Malangizo atsopano ochokera ku EULAR akuphatikizapo ndondomeko 10 ndi mfundo zisanu zowonjezereka zothandizira matenda a psoriatic.
Mfundo Zogonjetsa
- Matenda a Psoriatic ndi osiyana (ie, ali ndi mbali zosiyanasiyana) ndi matenda omwe angakhale ovuta omwe angafunike mankhwala osiyanasiyana.
- Chithandizo cha nyamakazi cha Psoriatic ayenera kuyesetsa kuti chisamalire bwino ndipo chiyenera kukhazikitsidwa pa chisankho pakati pa wodwala ndi rheumatologist , poganizira zachangu, chitetezo, ndi mtengo wa chithandizo.
- Ma rheumatologists ndi akatswiri omwe ayenera makamaka kusamalira matenda opatsirana pogonana. Pakupezekapo khungu, katswiri wa rheumatologist ndi dermatologist ayenera kuthandizana pa matenda ndi matenda.
- Cholinga chachikulu cha mankhwala a psoriatic nyamakazi ndi kuwonjezera moyo wathanzi, kuchitidwa mwa kulamulira zizindikiro , kupewa kuwonongeka kwa zomangamanga, komanso kukhala ndi ntchito yeniyeni komanso kutenga nawo mbali. Kuchepetsa kutupa n'kofunikira kuti tikwaniritse zolinga.
- Kusamalira wodwala nyamakazi pamasewero ayenera kulingalira mawonetseredwe apadera (mwachitsanzo, kupatula ziwalo), matenda a kagayidwe kake, matenda a mtima ndi zina zotero.
Malangizo
Chithandizo cha nyamakazi ya psoriatic chiyenera kuyitanitsa kukhululukidwa kapena kuchepa kwa ntchito zochepa za matenda zomwe zimachitika mwa kufufuza nthawi zonse ndikupanga kusintha kwa mankhwala ngati pakufunikira.
- NSAIDs (mankhwala osagwiritsa ntchito mankhwala otsekemera) angagwiritsidwe ntchito kuthetsa zizindikiro ndi zizindikiro za minofu.
- Odwala omwe ali ndi matenda a nyamakazi, makamaka omwe ali ndi ziwalo zambiri zotupa, kuwonongeka pamodzi ndi kutupa, kuchuluka kwa dothi la sedimentation ndi CRP , ndi / kapena mawonetsedwe ena owonjezera csDMARD ayenera kuganiziridwa kumayambiriro, ndipo methotrexate imakonda odwala omwe ali ndi khungu.
- Majekeseni a m'kati mwa corticosteroids ayenera kuonedwa kuti ndi othandizira (ie, zina) mankhwala. Corticosteroids yokhazikika pa mlingo wotsika kwambiri ingagwiritsidwe ntchito mosamala.
- Kwa odwala omwe ali ndi nyamakazi omwe amatha kusankhidwa osachepera csDMARD, chithandizo choyenera ndi bDMARD chiyenera kuyambika. BDMARD kawirikawiri ndikutseka kwa TNF .
- Odwala omwe ali ndi matenda a nyamakazi omwe sagwiritsidwa ntchito mokwanira kwa csDMARD imodzi omwe sangagwiritse ntchito blocker ya TNF, bDMARD yomwe imayang'ana IL12 / 23 (mwachitsanzo, Stelara [ustekinumab] ) kapena IL17 (mwachitsanzo, secukinumab) ingaganizidwe.
- Kwa odwala omwe ali ndi nyamakazi yowopsa omwe alibe yankho lokwanira kwa cMDARD imodzi ndipo sangagwiritse ntchito bDMARD, tsDMARD ingaganizidwe.
- Kwa odwala omwe ali ndi matenda othamanga ndi / kapena dactylitis (kutupa kwa chiwerengero chonse) omwe alibe yankho lokwanira ku ma NSAID kapena majekeseni a corticosteroids ammudzi, bDMARD iyenera kuganiziridwa. Blocker ya TNF imayesedwa poyamba.
- Kwa odwala omwe ali ndi matenda a axial, omwe alibe yankho lokwanira ku NSAID, bDMARD iyenera kuganiziridwa. Blocker ya TNF nthawi zambiri imayesedwa.
- Kwa odwala omwe amalephera kuyankha bDMARD, kusintha kwa bDMARD kumayenera kuganiziridwa. Kusinthasintha pakati pa TNF blockers kungaoneke kukhala koyenera. Mankhwala a TNF ndi awa: Enbrel (etanercept) , Remicade (infliximab) , Humira (adalimumab) , Simponi (golimumab) ndi Cimzia (certolizumab pegol) .
Zotsatira:
A European League Against Rheumatism (EULAR) amalangizidwa kuti azisamalira matenda a psoriatic ndi mankhwala a mankhwala: 2015. Annals wa Rheumatic Diseases. Gossec L. et al. 2016; 75: 499-510:: 10.1136 / annrheumdis-2015-208337
http://ard.bmj.com/content/75/3/499.full
Chidziwitso cha odwala: Nyamakazi ya Psoriatic (Pambuyo pa Zowona). Zaposachedwa. Gladman ndi Ritchlin. Kusinthidwa 4/9/15.
http://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics