Bvunza Nyanzvi: Rheumatoid Arthritis

Zvemukati

• David Curtis, MD
• Mubvunzo: Ndine makore makumi mashanu nemashanu uye ndine vese OA uye RA. Enbrel inobatsira kubatsira kudzora OA yangu kana ndeye chete zveRA zviratidzo?
• Mubvunzo: Ndine OA yakaoma uye ndakawanikwa ndine gout. Kudya kunobatsira here muOA?
• Mubvunzo: Ndanga ndichigamuchira Actemra infusions kwemwedzi mitatu, asi ndanga ndisiri kunzwa chero zororo. Chiremba wangu anoda kuraira Vectra DA bvunzo kuti aone kana uyu mushonga uri kushanda. Chii ichi bvunzo uye chakavimbika sei?
• Mubvunzo: Ndeipi njodzi yekuenda zvachose kunze kwemishonga yese?
• Mubvunzo: Ndine OA mune chigunwe changu chihombe uye RA mumapfudzi nemabvi. Pane chero nzira yekudzosera kukanganisa kwakatoitwa kare? Uye chii chandingaite kugadzirisa kuneta kwemhasuru?
• Mubvunzo: Panguva ipi zvinogamuchirwa kuenda kuE ER yekutambudzika? Ndezvipi zviratidzo zvandinofanira kunge ndichitaura?
• Mubvunzo: Rheumatologist yangu yakati mahormone haakanganise zviratidzo, asi mwedzi wega wega ma flare-ups anoenderana nekuenda kwangu kumwedzi. Ndeupi maonero ako pane izvi?
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David Curtis, MD

Rheumatoid arthritis (RA) chirwere chisingaperi choga. Iyo inoratidzirwa nekurwadziwa pamwe chete, kuzvimba, kuomarara, uye pakupedzisira kurasikirwa nebasa.

Nepo vanopfuura mamirioni 1.3 maAmerican vachitambura neRA, hapana vanhu vaviri vanozove nezviratidzo zvakafanana kana chiitiko chakafanana. Nekuda kweizvi, kuwana mhinduro dzaunoda dzimwe nguva kungave kwakaoma. Neraki, Dr. David Curtis, MD, chiremba ane ruzivo rheumatologist anogara muSan Francisco ari pano kuzobatsira.

Verenga mhinduro dzake kumibvunzo minomwe yakabvunzwa nevarwere chaivo veRA.

Mubvunzo: Ndine makore makumi mashanu nemashanu uye ndine vese OA uye RA. Enbrel inobatsira kubatsira kudzora OA yangu kana ndeye chete zveRA zviratidzo?

Kugarisana kweosteoarthritis uye rheumatoid arthritis zvakajairika sezvo isu tese tichikudziridza OA kune imwe nhanho mune imwe, kana isiri yakawanda, yemasangano edu pane imwe nguva muhupenyu hwedu.

Enbrel (etanercept) inogamuchirwa kuti ishandiswe muRA uye zvimwe zvinoputira, autoimmune chirwere icho chinozivikanwa kuti iyo TNF-alpha cytokine inoita basa rakakosha mukutyaira kuzvimba (kurwadziwa, kuzvimba, uye kutsvuka) pamwe nekuparadza zvinhu pa pfupa uye shwashwa. Kunyangwe OA iine zvimwe zvinhu zve "kuzvimba" sechikamu chehurwere hwayo, iyo cytokine TNF-alpha inoita kunge isingakoshe mukuita uku uye nekudaro TNF yakavharirwa naEnbrel haina uye haizotarisirwa kuvandudza zviratidzo kana zviratidzo zveOA .

Panguva ino, isu hatina "chirwere chinoshandura zvinodhaka" kana biologics yeosteoarthritis. Kutsvagisa mune OA kurapa kuri kushanda uye isu tese tinogona kutarisira kuti mune ramangwana tichava nemasimba ekurapa kweOA, sezvatinoita RA.

Mubvunzo: Ndine OA yakaoma uye ndakawanikwa ndine gout. Kudya kunobatsira here muOA?

Kudya uye kudya kunovaka muviri kunoita basa rakakosha mune zvese zvikamu zvehutano hwedu uye kugwinya. Izvo zvinogona kutaridzika kunge zvakaoma kwauri ndizvo zvinoita kukwikwidza kurudziro kune aya akasiyana mamiriro. Matambudziko ese ekurapa anogona kubatsirwa nekudya "kwakangwara".

Kunyangwe izvo zvine hungwaru zvichikwanisa uye zvichisiyana nekuongororwa kwehutano, uye kurudziro yavanachiremba uye vezvehutano inogona kuchinja nekufamba kwenguva, zvakachengeteka kutaura kuti kudya kwakangwara ndiko kunokubatsira kuchengetedza kana kuita huremu hwemuviri hwakanaka, kunotsamira pane zvisina kugadziriswa chikafu, chakafuma muchero, miriwo, uye zviyo zvakakwana, uye chinotadzisa huwandu hwakawanda hwemafuta emhuka. Mapuroteni akakwana, zvicherwa, uye mavitamini (kusanganisira calcium uye vhitamini D yemapfupa ane hutano) anofanirwa kuve chikamu chekudya kwese.

Kunyangwe kudzivirira zvachose purines hakudi kana kukurudzira, varwere vanotora mishonga yegout vanogona kudzora kudya kwepine. Zvinokurudzirwa kubvisa chikafu chakakwira muine purine uye kuderedza kudya kwezvikafu zvine zvine mwero purine zvemukati. Muchidimbu, zvakanakira varwere kuti vadye chikafu chinosanganisira yakaderera-purine chikafu. Kubvisa kwakazara kwepurine, zvisinei, hazvikurudzirwe.

Mubvunzo: Ndanga ndichigamuchira Actemra infusions kwemwedzi mitatu, asi ndanga ndisiri kunzwa chero zororo. Chiremba wangu anoda kuraira Vectra DA bvunzo kuti aone kana uyu mushonga uri kushanda. Chii ichi bvunzo uye chakavimbika sei?

Rheumatologists vanoshandisa kuongororwa kwekiriniki, nhoroondo yezvokurapa, zviratidzo, uye kuongororwa kwerabhoritari nguva dzose kuti vaongorore chiitiko chechirwere. Chiyero chitsva chinonzi Vectra DA chinoyera kuunganidzwa kwezvimwe zvinowedzera ropa. Izvi zveropa zvinobatsira kuongorora immune system kupindura kune chirwere chiitiko.

Vanhu vane rheumatoid arthritis inoshanda (RA) iyo isiri paActemra (tocilizumab Injection) vanowanzove nematanho akakwira e interleukin 6 (IL-6). Ichi chinomaka chiratidzo chiratidzo chakakosha muVectra DA bvunzo.

Actemra inovhara iyo inogamuchira IL-6 yekurapa kuzvimba kweRA. Chiyero cheI IL-6 muropa chinokwira apo inogamuchira IL-6 yakavharwa. Izvi zvinodaro nekuti haisisina kusungwa kune inogamuchira. Yakawedzera IL-6 mazinga haamiriri chiitiko chehosha muvashandisi veActemra. Ivo. Izvo zvinongoratidza kuti munhu akarapwa neActemra.

Rheumatologists havana kugamuchirwa zvakanyanya Vectra DA senzira inoshanda yekuongorora chiitiko chechirwere. Vectra DA kuyedza haina kubatsira pakuongorora mhinduro yako kune Actemra kurapwa. Rheumatologist yako ichafanirwa kuvimba nenzira dzechinyakare kuti uongorore mhinduro yako kuna Actemra.

Mubvunzo: Ndeipi njodzi yekuenda zvachose kunze kwemishonga yese?

Seropositive (zvichireva kuti rheumatoid factor iri positive) rheumatoid arthritis ingangove iri chirwere chisingaperi uye chinofambira mberi chinogona kutungamira mukuremara nekuparadzwa kwekubatana kana chikasarapwa Zvakangodaro, kune kufarira kukuru (kune chikamu chevarwere uye nekurapa vanachiremba) kuti riini uye sei rekudzora uye kunyange kumisa mishonga.

Iko kune kubvumirana kwakawanda kuti kwokutanga rheumatoid arthritis kurapwa kunogadzira yakanakisa murwere mhedzisiro nekudzikiswa kwekuremara kwebasa, kugutsikana kwemurwere uye kudzivirira kwekubatana kuparadzwa. Iko kune kushoma kwekubvumirana pamusoro pekuti sei uye nguva yekudzora kana kumisa mishonga kune varwere vari kuita zvakanaka parizvino kurapwa. Zvirwere zvehosha zvinowanzoitika kana mishonga yakadzikiswa kana kumiswa, kunyanya kana marongero emishonga imwe chete ari kushandiswa uye murwere ave kuita mushe. Vazhinji vanorapa rheumatologists nevarwere vakasununguka kudzikisira uye kubvisa DMARDS (senge methotrexate) apo murwere anga achiita zvakanaka kwenguva yakareba uye ari zvakare pane biologic (semuenzaniso, TNF inhibitor).

Chiitiko chekiriniki chinoratidza kuti varwere vanowanzoita zvakanaka chero bedzi vachigara pane imwe kurapwa asi kazhinji vane mwenje wakakura kana vakamisa mishonga yese. Vazhinji varwere vane seronegative vanoita zvakanaka kumisa mishonga yese, kwenguva yakati rebei, zvichiratidza kuti chikamu chevarwere vanogona kunge vaine chirwere chakasiyana neicho chinonzi seropositive rheumatoid arthritis varwere. Zvakangwara kudzora kana kumisa mishonga yerumatoid chete nechibvumirano uye tarisiro yekurapa kwako rheumatologist.

Mubvunzo: Ndine OA mune chigunwe changu chihombe uye RA mumapfudzi nemabvi. Pane chero nzira yekudzosera kukanganisa kwakatoitwa kare? Uye chii chandingaite kugadzirisa kuneta kwemhasuru?

Osteoarthritis (OA) mune yakakura zvigunwe mubatanidzwa yakajairika zvakanyanya uye inobata anenge munhu wese kune imwe nhanho nezera re60.

Rheumatoid arthritis (RA) inogona kukanganisa kubatana uku zvakare. Kuzvimba kwetambo yemubatanidzwa kunonzi synovitis. Ese maviri mafomu eArthritis anogona kuguma ne synovitis.

Naizvozvo, vanhu vazhinji vane RA vane zvimwe zvinokonzeresa OA mumubatanidzwa uyu vanowana zororo rakakura kubva kuzviratidzo zvine mushonga unoshanda weRA, senge mishonga.

Nekumisa kana kudzikisa iyo synovitis, kukuvara kune shwashwa uye pfupa zvinoderedzwawo. Kuzvimba kusingaperi kunogona kukonzera shanduko yekusingaperi kune chimiro chemapfupa. Aya mapfupa uye shwashwa shanduko akafanana neshanduko dzinokonzerwa neOA. Muzviitiko zvese izvi, shanduko hadzina kunyanya "kudzoserwa" nemishonga iriko nhasi.

Zviratidzo zveOA zvinogona wax uye kuderera, kuwedzera kuipa nekufamba kwenguva, uye kuwedzeredzwa nekushungurudzika. Kurapa kwepanyama, kurapa uye kwemuromo mishonga, uye corticosteroids inogona kubatsira kudzikisira zviratidzo zvakanyanya. Zvisinei, kutora calcium supplements hakuzokanganisa maitiro eOA.

Kuneta kunogona kusanganiswa nemishonga yakasiyana siyana uye mamiriro ekurapa, kusanganisira RA. Chiremba wako anogona kubatsira kududzira zviratidzo zvako uye kukubatsira kuronga kurapwa kwakanyanya.

Mubvunzo: Panguva ipi zvinogamuchirwa kuenda kuE ER yekutambudzika? Ndezvipi zviratidzo zvandinofanira kunge ndichitaura?

Kuenda kuchipatara zvechimbichimbi kamuri kunogona kuve kunodhura, kunodya nguva, uye nekushungurudzika mupfungwa chiitiko. Zvakangodaro, maE ER anodiwa kune vanhu vanorwara zvakanyanya kana vane chirwere chinotyisidzira hupenyu.

RA haawanzo kuva nezviratidzo zvinotyisidzira hupenyu. Kunyangwe kana zviratidzo izvi zviripo, ivo vashoma kwazvo. Zviratidzo zvakakomba zveRA zvakadai seapericarditis, pleurisy, kana scleritis hazviwanzo "kunyanya." Izvi zvinoreva kuti havauyi nekukurumidza (pamusoro penyaya yemaawa) uye zvakanyanya. Pane kudaro, izvi zviratidziro zveRA kazhinji zvinyoro uye zvinouya zvishoma nezvishoma. Izvi zvinokutendera iwe nguva yekuonana nachiremba wako wekutanga kana rheumatologist kune mazano kana kushanyira hofisi.

Yakawanda emergency mune vanhu vane RA inosanganisirwa nemamomorbid mamiriro senge coronary arteri chirwere kana chirwere cheshuga. Zvimwe zvinokanganisa zveRA mishonga iwe yauri kutora - senge yeergoriki reaction - inogona kupa warandi rwendo kune iyo ER. Izvi zvinonyanya kuitika kana kuita kwacho kwakanyanya. Zviratidzo zvinosanganisira kupisa kwakanyanya, kuputika kwakanyanya, kuzvimba kwehuro, kana kunetseka kufema.

Imwe ingangoitika yechimbichimbi kusangana kunotapukira kwechirwere-kugadzirisa uye biologic mishonga. Pneumonia, hutachiona hweitsvo, hutachiona hwepamuviri, uye hutachiona hwehutachiona hwehutachiona mienzaniso yezvirwere zvakanyanya izvo zvinokonzeresa kuongororwa kweEER.

Fivha yakakura inogona kunge iri chiratidzo chehutachiona uye chikonzero chekudaidza chiremba wako. Kuenda zvakananga kune ER kuchenjera kana paine zvimwe zviratidzo, senge kushaya simba, kunetseka kufema, uye kurwadziwa pachipfuva kuripo nefivhiri yakakura. Kazhinji zano rakanaka kushevedza chiremba wako kuti akubatsire mazano usati waenda kune ER, asi kana usina chokwadi, zviri nani enda kuE ER kuti uongorore nekukurumidza.

Mubvunzo: Rheumatologist yangu yakati mahormone haakanganise zviratidzo, asi mwedzi wega wega ma flare-ups anoenderana nekuenda kwangu kumwedzi. Ndeupi maonero ako pane izvi?

Mahormone echikadzi anogona kukanganisa zvirwere zvine chekuita nemota, kusanganisira RA. Iyo yekurapa nharaunda haisati yanyatsonzwisisa kudyidzana uku. Asi isu tinoziva kuti zviratidzo zvinowanzo wanda usati waenda kumwedzi. RA kuregererwa panguva yekuzvitakura uye kupisa-mushure mushure mekuzvitakura zvakare kunowanzoonekwa kwese.

Zvidzidzo zvekare zvakaratidza kuderera kweRA kuitika kune vakadzi vakatora mapiritsi ekudzivirira kubereka. Zvisinei, kutsvagurudza kwazvino hakuna kuwana humbowo hunogutsa hwekuti hormone kutsiva kurapa kunogona kudzivirira RA. Zvimwe zvidzidzo zvakaratidza kuti zvingave zvakaoma kusiyanisa pakati pezvakajairwa pre-kuenda kumwedzi zviratidzo uye RA flare-up. Asi kushamwaridzana nemoto nekuenda kwako kumwedzi kungangopfuura kungoitika. Vamwe vanhu vanoona kuti zvinobatsira kuwedzera yavo pfupi-inoshanda mishonga, senge nonsteroidal anti-kupisa mishonga, mukutarisira iyo flare-up.

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