Uchishandisa Methotrexate Kurapa Psoriatic Arthritis

Zvemukati

• Iyo methotrexate inoshanda se kurapwa kwe psoriatic arthritis
• Kubatsirwa kwemethotrexate ye psoriatic arthritis
• Zvimwe zvinokanganisa methotrexate ye psoriatic arthritis
• Kukura kwe fetus
• Kukuvara kwechiropa
• Mimwe mhedzisiro
• Kubatana kwezvinodhaka
• Chipimo chemethotrexate inoshandiswa ku psoriatic arthritis
• Dzimwe nzira dzemethotrexate yekurapa kweporioriatic arthritis
• Mamwe maDMARD akajairwa
• Biologics
• Kutora

Mhedziso

Methotrexate (MTX) mushonga wakashandiswa kurapa psoriatic arthritis kweanopfuura. Iwe wega kana wakasanganiswa nemamwe marapirwo, MTX inoonekwa seyakatanga-kurapwa kurapwa kwepakati kusvika kune yakaoma psoriatic arthritis (PsA). Nhasi, inowanzo shandiswa pamwe chete nemishonga mitsva yebiologic yePsA.

MTX ine inogona kuve yakakomba mhedzisiro. Padivi rekuwedzera, MTX:

• isingadhuri
• inobatsira kudzikisa kuzvimba
• inobvisa zviratidzo zveganda

Asi MTX haidziviriri kuparadzwa kwekubatana painoshandiswa yega.

Kurukura nachiremba wako kuti MTX ndega here kana kuti pamwe chete nemimwe mishonga ingava mushonga wakanaka kwauri.

Iyo methotrexate inoshanda se kurapwa kwe psoriatic arthritis

MTX imushonga weantimetabolite, zvinoreva kuti inopesana neyakajairika mashandiro emasero, ichiamisa kubva pakupatsanuka. Inonzi chirwere-chinogadzirisa antirheumatic drug (DMARD) nekuti inoderedza kuzvimba kwemajoini.

Kushandiswa kwayo kwekutanga, kwakatangira kunopera kwema1940, kwaive muzvikamu zvepamusoro zvekurapa hura hweleukemia. Mumadosi mashoma, MTX inodzvinyirira immune system uye inodzivirira kugadzirwa kweturu lymphoid inobatanidzwa muPsA.

MTX yakatenderwa neU.S.Food and Drug Administration (FDA) muna1972 kuti ishandiswe neakanyanya psoriasis (iyo inowanzoenderana ne psoriatic arthritis), asi zvakare yakashandiswa zvakanyanya "off label" yePsA. "Off label" zvinoreva kuti chiremba wako anogona kukunyorera kuzvirwere kunze kweiyo FDA-inogamuchirwa.

Kubudirira kweMTX yePsA hakuna kumbobvunzwa mumatanho makuru emakiriniki, maererano neAmerican Academy yeDermatology (AAD). Panzvimbo iyoyo, iyo AAD kurudziro yeMTX yakavakirwa pane yakareba-nguva chiitiko uye mhedzisiro yevanachiremba vakazvinyorera iyo PsA.

Chinyorwa che2016 chekuongorora chinoratidza kuti hapana yakangoerekana yadzorwa yekuongorora yakaratidza MTX yekubatana kwekuvandudza pamusoro peiyo placebo. Mwedzi mitanhatu 2012 inodzorwa kutongwa kwevanhu mazana maviri negumi nevaviri pamusoro pemwedzi mitanhatu haina kuwana humbowo hwekuti kurapwa kweMTX chete kwakavandudza kuzvimba kwekubatana (synovitis) muPsA.

Asi pane yakakosha yekuwedzera mhedzisiro. Chidzidzo che2012 chakawana kuti kurapwa kweMTX akaita zvakanyanya kuvandudza kuongororwa kwese kwezviratidzo navanachiremba uye nevanhu vane PsA vanobatanidzwa mukudzidza. Zvakare, zviratidzo zveganda zvakagadziridzwa neMTX.

Chimwe chidzidzo, chakataurwa muna2008, chakawana kuti kana vanhu vane PsA vakarapwa pakutanga kwechirwere pachiyero chakawedzerwa cheMTX, vakave nezvibereko zvirinani. Pakati pevanhu makumi mashanu nevapfumbamwe vari muchidzidzo:

• 68 muzana yakanga iine makumi mana muzana muzana mukuderera kwakazara kupisa kwemajoini kuverenga
• 66 muzana yaive ne40 muzana kuderera kwekuzvimba kwemajoini kuverenga
• 57 muzana yaive neyakavandudzwa Psoriasis Nzvimbo uye Severity Index (PASI)

Uku kutsvagisa kwa2008 kwakaitwa pakiriniki yeToronto uko kudzidza kwakapfuura kwainge kwawana mukana wekurapa kweMTX yekubatana kwekuzvimba.

Kubatsirwa kwemethotrexate ye psoriatic arthritis

MTX inoshanda senge inorwisa-kupisa uye inogona kubatsira pachayo kune akapfava kesi dzePSA.

Chidzidzo chegore ra2015 chakawana kuti makumi maviri neshanu muzana yevanhu vane PsA vaibatwa chete neMTX vakawana mashoma chirwere chiitiko.

MTX inoshanda mukuchenesa kubatanidzwa kweganda. Nechikonzero ichi, chiremba wako anogona kutanga kurapwa kwako neMTX. Izvo zvakachipa kupfuura iyo mitsva biologic zvinodhaka zvakagadzirwa mukutanga 2000s.

Asi MTX haidziviriri kuparadza pamwe muPsA. Saka kana iwe uri panjodzi yekuparadzwa kwemapfupa, chiremba wako anogona kuwedzera mune imwe yeiyo biologics. Iyi mishonga inodzivisa kugadzirwa kwethumba necrosis factor (TNF), chinhu chinokonzera kuzvimba muropa.

Zvimwe zvinokanganisa methotrexate ye psoriatic arthritis

Iyo mhedzisiro mhedzisiro yekushandisa kweMTX kune vanhu vane PsA inogona kuve yakakosha. Izvo zvinofungidzirwa kuti genetics inogona mune yega maitiro kune MTX.

Kukura kwe fetus

MTX inozivikanwa kuva inokuvadza mukukura kwechi "fetus". Kana iwe uri kuyedza kuve nepamuviri, kana kana iwe uri nepamuviri, gara kure MTX.

Kukuvara kwechiropa

Ngozi huru kukuvara kwechiropa. Vanenge 1 mu200 vanhu vanotora MTX vane kukuvara kwechiropa. Asi kukuvara kunogadziriswa paunomisa MTX. Sekureva kweNational Psoriasis Foundation, njodzi inotanga mushure mekunge iwe wasvika paupenyu kuunganidzwa kwe 1.5 gramu eMTX.

Chiremba wako anoongorora chako chiropa chinoshanda paunenge uchitora MTX.

Ngozi yekukuvara kwechiropa inowedzera kana iwe:

• kunwa doro
• vakafutisa
• vane chirwere cheshuga
• vane itsvo isingaite

Mimwe mhedzisiro

Mimwe mhedzisiro inogona kuve mhedzisiro haina kukomba, ingori isina kugadzikana uye kazhinji inogoneka. Izvi zvinosanganisira:

• kusvotwa kana kurutsa
• kuneta
• maronda emuromo
• manyoka
• kurasikirwa nevhudzi
• dzungu
• musoro
• chills
• kuwedzera njodzi yehutachiona
• kunzwisiswa nechiedza chezuva
• kunzwa kupisa mumaronda eganda

Kubatana kwezvinodhaka

Mimwe inodzvinyirira-the-counter inorwadza zvinodhaka senge aspirin (Bufferin) kana ibuprofen (Advil) inogona kuwedzera mhedzisiro yeMTX. Mimwe mishonga inorwisa mabhakitiriya inogona kupindirana kuti ideredze kushanda kweMTX kana inogona kukuvadza. Taura nachiremba wako nezvemishonga yako uye nekugona kudyidzana neMTX.

Chipimo chemethotrexate inoshandiswa ku psoriatic arthritis

Mutero wekutanga weMTX wePS ndeye 5 kusvika 10 milligrams (mg) pavhiki yevhiki yekutanga kana maviri. Zvichienderana nemhinduro yako, chiremba anowedzera zvishoma nezvishoma kuti asvike gumi nemashanu kusvika makumi maviri nemashanu pavhiki, inoonekwa seyakanyanya kurapwa.

MTX inotorwa kamwe pasvondo, nemuromo kana jekiseni. Iyo yemuromo MTX inogona kunge iri mupiritsi kana fomu remvura. Vamwe vanhu vanogona kupaza iyo dosi muzvikamu zvitatu pazuva ravanoitora kuti vabatsire nemhedzisiro.

Chiremba wako anogona zvakare kunyorera folic acid yekuwedzera, nekuti MTX inozivikanwa yekudzora akakosha mafaturu mazinga.

Dzimwe nzira dzemethotrexate yekurapa kweporioriatic arthritis

Kune mamwe marapirwo emishonga ePsA kune vanhu vasingakwanise kana vasingade kutora MTX.

Kana iwe uine nyoro kwazvo PsA, unogona kukwanisa kubvisa zviratidzo nema nonsteroidal anti-anogumbura zvinodhaka (NSAIDs) wega. Asi NSAIDS ine maronda eganda. Izvi zvakafananawo nemajekiseni emuno ecorticosteroids, ayo anogona kubatsira nezvimwe zviratidzo.

Mamwe maDMARD akajairwa

Yakajairwa DMARD muboka rimwe seMTX ndeaya:

• sulfasalazine (Azulfidine), iyo inovandudza arthritic zviratidzo asi haimise kubatana kwekubatana
• leflunomide (Arava), iyo inovandudza zvese zviratidzo zvekubatana uye zveganda
• cyclosporine (Neoral) uye tacrolimus (Prograf), iyo inoshanda nekudzivirira calcineurin uye T-lymphocyte chiitiko

Aya maDMARD anomboshandiswa mukubatana nemamwe madhiragi.

Biologics

Mishonga mitsva yakawanda iripo, asi iyi inodhura. Kutsvagurudza kuri kuenderera, uye zvingangoita kuti kumwe kurapa kutsva kunogona kuwanikwa mune ramangwana.

Biologics inodzivisa TNF uye inoderedza kukuvara kwemajoini muPSA inosanganisira idzi TNF alpha-blockers:

• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)

Biologics inotarisa interleukin mapuroteni (cytokines) anogona kudzora kuzvimba uye kugadzirisa zvimwe zviratidzo. Aya ndiwo FDA-anotenderwa ekurapa PsA. Zvinosanganisira:

• ustekinumab (Stelara), monoclonal antibody inotarisa interleukin-12 uye interleukin-23
• secukinamab (Cosentyx), inovavarira interleukin-17A

Imwe nzira yekurapa ndeye apremilast yemushonga (Otezla), iyo inovavarira mamorekuru mukati memasero ekudzivirira ane chekuita nekuzvimba. Inomisa iyo enzyme phosphodiesterase 4, kana PDE4. Apremilast inoderedza kuzvimba uye kubatana kuzvimba.

Yese mishonga yekurapa PsA ine mhedzisiro, saka zvakakosha kuti uongorore zvakanakira uye mhedzisiro pamwe nachiremba wako.

Kutora

MTX inogona kuve kurapwa kunobatsira kwePSA nekuti inoderedza kuzvimba uye inobatsira zviratidzo zvacho. Izvo zvakare zvinogona kuve nemhedzisiro mhedzisiro, saka iwe unozofanirwa kuongororwa nguva dzose.

Kana paine zvinopfuura chimwe chemajoini ako chinobatanidzwa, kusanganisa MTX ne biologic DMARD kunogona kubatsira mukumisa kuparadzwa kwekubatana. Kurukurai nezvese nzira dzekurapa nachiremba wako, uye ongorora chirongwa chekurapa nguva dzose. Zvichida kuti kuenderera mberi kwekutsvaga mumishonga yePSA kunouya mune ramangwana.

Iwe unogona zvakare kuona zvichibatsira kutaura ne "murwere anofambisa ngarava" kuNational Psoriasis Foundation, kana kujoina rimwe remapoka ayo ekukurukura psoriasis.