Mukhozanso Kugwiritsa Ntchito Ankylosing Spondylitis & Psoriatic Arthritis
Zimadziwika kuti anthu omwe ali ndi matenda a nyamakazi (RA) ali ndi chiopsezo chowonjezereka cha kufooka ndi kufa kwa matenda a mtima - vuto lomwe limanenedwa kukhala lofanana ndi la anthu omwe ali ndi matenda a shuga a mtundu wachiwiri. Kwa anthu omwe ali ndi nyamakazi, pali chiopsezo chowonjezereka cha matenda a mtima wamtundu wa myocardial (matenda a mtima) ndi imfa mwadzidzidzi. Kufala kwa matenda a myocardial infarction ndi ochulukitsa kawiri kuposa anthu odwala nyamakazi poyerekeza ndi anthu ambiri.
Mgwirizano wa pakati pa mtima ndi matenda a nyamakazi ndi ovuta komanso amawoneka okhudzana ndi zinthu zingapo. Zomwe zimayambitsa matenda amtima (mwachitsanzo, matenda oopsa kwambiri, kunenepa kwambiri, kusuta fodya, shuga, cholesterol yapamwamba), komanso chifuwa chachikulu cha matenda a nyamakazi, zimathandiza.
Matenda a Mitsempha mu Matenda a Matenda a Nyamakazi: Zimene Timadziwa
Kwa zaka zambiri, ochita kafukufuku akhala akuphunzira bungweli ndipo ngati atanganidwa kwambiri ndi matenda opatsirana m'maganizo mwa anthu omwe ali ndi matenda a nyamakazi . Zomwe zinanenedwa kuti nyamakazi yodwala nyamakazi yokha ndiyo yodziika yekha payekha chifukwa cha matenda a mtima. Zomwe ofufuza apeza zikuphatikizapo:
- Pali chiopsezo chachikulu cha matenda a mtima omwe amayamba msanga kudwala matenda a nyamakazi, omwe angayambitse ngakhale matenda asanakwane.
- Kutupa kumathandiza kwambiri m'maganizo a mtima.
- Anthu omwe ali ndi nyamakazi ya nyamakazi amaoneka kuti ali ndi matenda a atherosclerosis , omwe amadziona kuti ndi otupa. Zingakhale kuti kutupa kwa nyamakazi ya nyamakazi pamodzi ndi kuchuluka kwa mankhwala osokoneza bongo amachititsa kupanga mapangidwe.
- Kutupa kwa magazi kumatenda kuwonjezeka kwambiri , kumayambitsa matenda , komanso kutuluka kwa ma leukocyte (maselo oyera a m'magazi) mkati mwa mitsempha ya mitsempha. Kutsata kwa leukocyte kuti mitsempha ya endothelium ndilo khalidwe losiyanitsa la kutupa.
- Kutupa koopsa komwe kumakhudzana ndi matenda a nyamakazi kuphatikizapo matenda a mtima chifukwa cha moyo umatha kuwonjezera matenda a mtima m'matenda a nyamakazi.
N'chifukwa Chiyani Kugwirizana Kofunika Kwambiri?
Pafupifupi theka la imfa zonse mwa anthu omwe ali ndi matenda a nyamakazi amagwirizanitsidwa ndi matenda a mtima. Kufa kwa mtima kumawonjezeka ndi 50 peresenti ndipo chiopsezo cha matenda a mtima chikuwonjezeka ndi 48 peresenti pakati pa anthu odwala nyamakazi poyerekeza ndi anthu ambiri (Avina-Zubieta).
Anthu omwe ali ndi matenda a nyamakazi kwa nthawi yayitali, omwe ali ndi maonekedwe owonjezera (ie, amakhudza zambiri kuposa ziwalo), komanso omwe ali ndi chifuwa chachikulu komanso anti-CCP (autoantibodies) ali ndi chiopsezo chachikulu cha kufa kwa mtima. Kusamalira chiopsezo n'kofunikira.
Zolinga Zachilendo Zogwira Mtima Kuopsa kwa RA
Mu 2009, EULAR (European League Against Rheumatism) inasonkhanitsa gulu kuti lizipereka malangizo kuti athetse vuto la mtima kwa anthu omwe ali ndi nyamakazi. Zotsatirazo zasinthidwa mu 2015/2016.
Pali mfundo zitatu zowonjezera zomwe zimaperekedwa ndi EULAR-ndi 10 zomwe zikuperekedwa, chimodzi ndi chatsopano ndi zisanu ndi chimodzi anasinthidwa kuchokera mu 2009.
Mfundo Zogonjetsa:
1) Madokotala ayenera kudziwa kuti ali ndi chiopsezo chachikulu cha matenda a mtima kwa anthu omwe ali ndi nyamakazi poyerekeza ndi anthu ambiri.
2) Wodwala matenda a rheumatologist ayenera kuonetsetsa kuti matenda a mtima wamaganizo akuyendetsedwa ndi matenda odwala matenda a nyamakazi ndi matenda ena opweteka.
3) Kugwiritsiridwa ntchito kwa NSAIDs (mankhwala osagwiritsidwa ntchito ndi anti-inflammatory drugs) ndi corticosteroids ayenera kukhala molingana ndi malangizidwe ochokera ku EULAR ndi ASAS (Kufufuza kwa Spondyloarthritis International Society).
Zomwe 10 Zikuphatikizapo:
1) Matendawa ayenera kuyang'aniridwa bwino mu nyamakazi ya nyamakazi, ankylosing spondylitis , ndi psoriatic nyamakazi kuti athetse chiopsezo cha matenda a mtima.
2) Matenda a m'magazi amawunikira anthu omwe ali ndi nyamakazi, ankylosing spondylitis, kapena psoriatic nyamakazi kamodzi pakatha zaka zisanu ndipo mwinamwake akutsata kusintha kwakukulu kochiritsira.
3) Kuyerekezera kwa ngozi kwa matenda a mtima m'magazi a nyamakazi, ankylosing spondylitis, kapena nyamakazi ya psoriatic iyenera kuchitidwa molingana ndi ndondomeko za dziko, ndi SCORE CVD pangozi yachitukuko ngati palibe malangizo.
4) Kachilombo kamodzi kake ndi kachulukidwe ka lipoprotein cholesterol chiyenera kugwiritsidwa ntchito pa matenda a mtima wamatenda a nyamakazi, ankylosing spondylitis, ndi psoriatic nyamakazi ndi lipids ayenera kuyeza pamene matenda akutsitsika kapena kukhululukidwa. Zipangizo zopanda kudya zimalandiridwa.
5) Zitsanzo zowonongeka m'maganizo ziyenera kusinthidwa kwa anthu omwe ali ndi nyamakazi chifukwa cha kuchuluka kwa 1.5.
6) Kuwunika kwa mapuloteni otchedwa atherosclerotic plaques pogwiritsira ntchito carotid ultrasound kungatengedwe ngati mbali ya mtima woyezetsa magazi omwe ali ndi nyamakazi.
7) Malangizowo a moyo ayenera kutsindika za zakudya zathanzi, kuchita masewero olimbitsa thupi, ndi kusuta fodya.
8) Matenda a mtima a m'magazi ayenera kuchitidwa malinga ndi ndondomeko za mafupa a nyamakazi, ankylosing spondylitis, ndi psoriatic nyamakazi. Ma anti-hypertensives ndi statins angagwiritsidwe ntchito monga momwe alili ambiri.
9) NSAID ziyenera kuchenjezedwa mosamala za matenda a nyamakazi ndi nyamakazi, makamaka kwa anthu omwe ali ndi matenda a mtima kapena matenda omwe amadziwika bwino.
10) Kuchiza chithandizo cha nthawi yaitali, mlingo wa corticosteroids uyenera kusungidwa pansi ndipo uyenera kugwiritsidwa ntchito ngati chikhululukiro kapena matenda ochepa amapezeka. Kupitiriza kwa corticosteroids kuyenera kuyang'aniranso nthawi zonse.
Zofufuza Zopeza Zomwe Zaperekedwa pa Msonkhano wa ACR wa 2016
Pamsonkhano wa pachaka wa American College of Rheumatology, womwe unachitikira mu November 2016, panali maphunziro osachepera atatu omwe anali ndi matenda a mtima m'matenda a nyamakazi. Chimodzi mwa maphunziro (chidziwitso cha ID: 664363 ACR Newsroom) chinatha kuti zaka zoposa 15, anthu omwe ali ndi matenda a nyamakazi amakhala ndi chiopsezo chachikulu cha matenda a mtima monga anthu ambiri-mlingo wofanana ndi mtundu wa shuga 2.
Phunziro lina (chidziwitso cha ID: 663451 ACR Newsroom) chikuwunika ngati anthu omwe ali ndi nyamakazi yogwira mtima koma alibe matenda amtima ali ndi umboni wa kutupa kwa minocardial kutupa. Anaganiziranso ngati kutupa kwa myocardial kunayankhidwa ndi mankhwala a DMARD (matenda osinthira anti-rheumatic drugs) . Ochita kafukufuku anapeza kuti panali ngati kutukuka kwa minocardial ndipo zinawoneka ngati zikuchitidwa mankhwala ndi DMARD.
Phunziro lachitatu (chidziwitso cha ID: 664367 ACR Newsroom) chinayang'anitsitsa kusamalidwa kwa matenda a mtima kwa anthu omwe ali ndi matenda opatsirana. Anagwiritsidwa ntchito kuti ngakhale kuti pali mankhwala ochepetsa kupatsirana kwambiri kwa mankhwala ochepetsa matenda a hypertensive and lipid, odwala ochepa omwe amawapatsa mankhwalawa ndi ochepa.
Mfundo Yofunika Kwambiri
Kwa nthawi yayitali, chiopsezo cha matenda a mtima m'thupi mwa anthu omwe ali ndi matenda a nyamakazi amanyalanyaza ndipo akuyang'aniridwa. Ngozi yomwe imayambitsa matenda oopsa kwambiri, kunenepa kwambiri, kusuta fodya, ndi matenda a dyslipidemia, komanso njira yotupa yomwe ikupitirira mu nyamakazi ya nyamakazi, sayenera kunyalanyazidwa. Pali chosowa cha rheumatology ndi madokotala oyambilira kuti azitha kugwira ntchito mogwirizana kuti athetse vuto la mtima ndi matenda okhudzana ndi nyamakazi.
Ngakhale kuti kafukufuku wagogomezera kufunika kokhala ndi chiopsezo cha mtima chokhudzana ndi nyamakazi ya nyamakazi, kafukufuku amafunikanso. Zolinga zamankhwala zowonongeka bwino zidakalibebe. Pali zowonjezereka zotsatila zowonjezereka zowonjezera kuchepetsa chiopsezo cha matenda a mtima mwa anthu omwe ali ndi nyamakazi ya mafupa kapena matenda ena opatsirana.
> Zotsatira:
> Agca R. et al. Zolinga za EULAR za matenda a mtima matenda odwala matenda odwala matenda a nyamakazi ndi mitundu ina ya matenda opatsirana: 2015/2016. Annals wa Rheumatic Diseases . October 2016.
> Barber CE et al. Mipata Yothetsera Mavuto a Mitsempha ya Mitsempha Yachifuwa: Kuyeza Kuchita Kugwiritsa Ntchito Zizindikiro Zogwira Mtima. Journal of Rheumatology . November 2016.
> Solomo DH et al. Kufotokozera mliri wa mtima wokhudzana ndi nyamakazi ya nyamakazi: zizindikiro za chiopsezo chachikhalidwe motsatira zizindikiro za matenda a nyamakazi. Annals wa Rheumatic Diseases . November 2010.
> Tournadre, Anne ndi al. Kusamalira ngozi ya mtima kwa odwala omwe ali ndi nyamakazi yotupa: amaganizira mozama. Kupititsa Patsogolo pa Matenda a Musculoskeletal . 2016.
> van-Breulelen-van der Stoep DF et al. Matenda a mtima m'matenda a nyamakazi: momwe mungachepetse chiopsezo? Atherosclerosis . November 2013.