Ukukhumbuza nokusebenza kancane. Bobabili bachaza ukuthi isigaba sezidakamizwa, esivame ukubizwa ngokuthi i-DMARDs (izidakamizwa zokuguqula isifo sofuba), zisetshenziselwa ukwelapha isifo samathambo emva kokuba izidakamizwa ezinamandla zingabhekwa. Ama-DMARD asetshenziselwa ukuphatha izimo ezivuthayo ezivuthayo, njenge- ankylosing spondylitis , i- psoriatic arthritis , i-lupus.
Lezi zidakamizwa zibhekwa njengezikhumbuza ngoba zinganciphisa inqubo yesifo, nakuba kungajwayelekile ukuholela ekuxoxweni okuphelele.
Njengoba kungathatha izinyanga ezingu-6 kuya kwezingu-8 ukuze izidakamizwa ziphakamise impendulo, zibhekwa njengezidakamizwa ezenza kancane futhi zikhethwa njengendlela yokwelapha emgqeni wesibili emva kwe- aspirin ne- NSAID (izidakamizwa ezingezona ukuvuvukala) ezingaphumeleli.
Akuqondi kahle ukuthi i-DMARD isebenza kanjani. Ama-DMARD avela ekunciphiseni ukuvuvukala nakuba engabalwa ngezidakamizwa eziphikisayo. Abafani nama-NSAID njengoba benganciphisi ukukhiqizwa kwe-prostaglandin, musa ukukhulula ngqo ubuhlungu, noma ukunciphisa umkhuhlane. Empeleni, i-DMARD iyanciphisa inqubo yesifo ngokushintsha isimiso somzimba ngokuzivikela .
Ukusebenza, ukuphepha, imiphumela emibi, nokusetshenziswa kwesikhathi kwe-DMARD kuye kwabuzwa iziguli ezikhathazekile. Ucwaningo lweminyaka yonke lubonise i-DMARD ukuthi ibe yimithi ephumelela kakhulu, nemiphumela emibi engabonakali kakhulu. Ukuqapha okuqhubekayo kwama-laboratory kusiza ukulawula ingozi yemiphumela emibi. Uma ucatshangwa ukuthi ukwelashwa okwesikhashana, ama-DMARD manje abhekwa njengesixazululo sesikhathi eside sokulawula izimpawu nokunciphisa ukuqhubeka kwesifo.
Igolide le-Arthritis
Kutholakale ngengozi udokotela waseFrance, usawoti wegolide usetshenziselwe ukwelashwa kwe-arthritis iminyaka engaphezu kwengu-50. UJacques Forrestier wajova i-salts egolide ngesifo sofuba ukuze aphathe isifo. Isigulane sasine-arthritis futhi emva kwezinyanga eziningi zokwelashwa ngegolide, i-arthritis yathuthuka.
Igolide lisetshenziselwe ukwelapha i-arthritis kusukela ngaleso sikhathi.
Indlela yokusebenza kwegolide ayicacile kodwa ngokusobala iphazamisa imisebenzi yamaseli amhlophe egazi aphethwe ukulimala okuhlangene nokuvuvukala . Yize igolide lingashesha ukubhujiswa, ayikwazi ukulungisa ukukhubazeka okukhona okukhona.
Igolide ekuqaleni kwakutholakala kuphela njengesidakamizwa esijova. Njengoba kunikezwe isimiso sokulondoloza okuqhubekayo, kudinga ukuhlolwa okuvamile kwesiguli negazi. Ngo-1986, igolide latholakala ngefomu lomlomo ngegama elithi Trade Ridaura. Imiphumela emibi kakhulu ehambisana negolide engenayo i-rash yokushisa emaphethelweni aphansi kanye nezilonda zomlomo ngokuvamile eziyophela uma imithi ivaliwe. Igolide le-Oral inezimbangela ezimbalwa kodwa zingabangela ukuhuda kwesisu noma ukunyakaza okungekho emzimbeni. Igolide libonakala lisebenza kahle kakhulu ngamaphesenti angu-10 eziguli futhi kahle kakhulu kwamanye amaphesenti angu-30-40. Amaphesenti angu-50 weziguli azishiye ukusetshenziswa ngenxa yemiphumela emibi noma ukungasebenzi.
Ukusetshenziswa kwegolide kuye kwehle kakhulu, ikakhulukazi ngokuthuthukiswa kwezidakamizwa ze- biologic . I-biologic yokuqala, i-Enbrel, yatholakala ngo-1998.
I-Penicillamine
I-penicillamine, isihlobo esivelele se-penicillin, satholakala ngawo-1970.
I-penicillamine yaziwa ngokuthi i-chelator ngoba ingafaka izinsimbi ezinzima emzimbeni. Indlela yayo yokusebenza ngesifo samathambo asikwaziwa kodwa kucatshangwa ukuthi iguqula ukusebenza kwamaseli amhlophe egazi aphethwe umonakalo ohlangene. Kungaba lula kakhulu uma ihlanganisa nethusi ekhona ngokwemvelo emzimbeni.
I-penicillamine inikezwa ngomlomo, ngokuqala ngomthamo ophansi, bese ngokukhuphula kancane kancane umthamo. Kuthathwa ngesisu esingenalutho okungenani ihora elilodwa ngaphambi noma emva kokudla. Uma ngabe isiguli kufanele siphume kule nkambo yokwelapha ngokungapheli. Imiphumela emibi ifana nalabo abahlotshaniswa negolide - izikhumba zesikhumba, izilonda zomlomo, ukulahlekelwa ukunambitheka nokunciphisa kwamathumbu.
Amaphrotheni emcimbini angase abe uphawu lokuqala lokulimala kwezinso.
I-penicillamine ingasetshenziswa kanye nama-NSAID, nakuba i-NSAID ingathathwa ngesikhathi sokudla. Iziguli eziphikisana ne-penicillin zisakwazi ukuthatha i-penicillamine. Iphumelela kuma-30% weziguli.
I-Plaquenil (i-Hydroxychloroquine)
I-plaquenil itholakale iminyaka eminingi futhi isetshenziswe ekuqaleni ukuphatha malava. Kulula ukusebenzisa, kunemiphumela emibi embalwa, futhi ayidingi ukuqapha ngegazi. I-Plaquenil isetshenziselwa iziguli ezine-arthritis ye-rheumatoid ezingaphenduli kahle kuma-NSAID. Kubonakala sengathi isebenza kahle ngeziguli ezingaba ngu-30%. Ibuye isetshenziselwe iziguli ezine-systemic lupus.
I-plaquenil ibonakala iphazamisa ukusebenza komzimba wamasosha omzimba. Isidakamizwa sinikezwa ngomlomo, amaphilisi owodwa noma amabili ngosuku. Omunye umphumela ongathà sina ovuthiwe yi-deposit yesidakamizwa ku-retina enekhono lokukhubazeka okubukwayo. Ukuhlolwa kwe-ophthalmology kunconywa njalo ezinyangeni eziyisithupha. Ama-NSAID angathathwa nge-Plaquenil futhi avame ukuhlelwa ndawonye.
I-Methotrexate (i-Rheumatrex)
I-Methotrexate , etholakalayo iminyaka engaphezu kwengu-40, isetshenziselwa kakhulu ukuphatha i-psoriasis futhi isetshenziselwa ukwelapha umdlavuza. Ngama-1970, i-methotrexate ye-dose ephansi yayinqunywe yizibalo eziningi ze-rheumatologists zokwelapha i-rheumatoid arthritis lapho ama-NSAID ehluleka. I-Methotrexate isebenza ngokushesha kunezinye izidakamizwa eziholayo, ngokuvamile ziletha ngcono emasontweni kunezinyanga.
I-Methotrexate i-antimetabolite, ephazamisa ukusetshenziswa kwe-folic acid. Kucatshangwa ukuthi kuvimbela umsebenzi wesistimu omzimba nokuncipha ukuvuvukala. Futhi kunganciphisa ukukhula okusheshayo kwamangqamuzana enkundleni ye-synovial efaka ukujoyina.
I-Methotrexate inganikezwa ngomlomo noma njengesidakamizwa esijova ngokwemigomo eqinile yokulinganisa. Kanye nemiphumela emibi engavamile yocansi, ukusebenzisa i-methotrexate yesikhathi eside kungabangela ukulimala kwesibindi. Ukuhlolwa komsebenzi wesibindi njalo kuyadingeka.
I-Methotrexate ingathathwa kanye nama-NSAID. Iziguli ezithatha methotrexate ziyaxwayiswa ukuba zigweme utshwala.
Sulfasalazine
I-Sulfasalazine iyi-salicylate ne-antibiotic enhlanganisela. Sekulokhu kusukela ngo-1940, ekuqaleni ukuphatha iziguli ezinezifo zesifo sofuba. Ngesinye isikhathi, yayisetshenziselwa ukwelapha isifo samathambo kodwa isisetshenziswa sayo sinciphise ngenxa yokukhathazeka ngemiphumela emibi. Yayisetshenziselwa ukuhlolwa kwemitholampilo njengenye indlela eya kwegolide. Kwakukhona isikhathi senzuzo evuselelwe ekusetshenzisweni kwayo njenge-agent ekulungisa ngaphandle kwezinkinga zokuqapha igolide ne-penicillamine.
Imishini ye-sulfasalazine ayiziwa nakuba inemisebenzi emibili engaba khona, ivimba ukuvuvukala nokuvimbela ukukhula kwama-bacteria. I-Sulfasalazine itholakala kwifomu yethebhulethi neyomuthi. Kumelwe kugwenywe ngabantu abanezinyosi ezidakamizwa nezidakamizwa ze-sulfa kanye / noma i-aspirin namanye ama-salicylates. Imiphumela emibi evamile ihlanganisa ukucwenga, ukuhuda, ukuhlanza nokulahlekelwa ukudla. Imiphumela emibi engaphezulu kakhulu yinkinga ye-urine, izifo zegazi, nokuphendula okukhulu kwe-allergenic.
Uma ukhetha noma yikuphi ukuphathwa kwezidakamizwa, wena nodokotela wakho kufanele nilinganise izinzuzo nezingozi zokwelapha.
> Umthombo:
> I-Duke University Medical Center Book of Arthritis, uDavid S. Pisetsky, MD