Ukucwaninga ngemishanguzo ye-Arthritis
Imithi ye-arthritis sekuyisikhathi eside ibhekwa njengendlela yokwelapha "yendabuko". Njengoba ukusabela okuhlukile kwezidakamizwa kungashintsha futhi ngenxa yokuthi imiphumela emibi engaba khona kanye nokuphendula okubi kungenxa yokusebenza, ukuthola inhlanganisela ephumelela kakhulu yemithi ye-arthritis kungaba inqubo eyinkimbinkimbi kunokuba ungayilindela. Kumele ube nolwazi ngemithi ehlukahlukene ye-arthritis, ukuze ukwazi ukwenza isinqumo esinolwazi nodokotela wakho.
Ama-NSAID / COX-2 Inhibitors
Ama-NSAID (izidakamizwa ezingezona ukuvuvukala) aziphakathi kwezidakamizwa ezivame ukusetshenziswa futhi ezisetshenziswa kabanzi. Kunezinhlobo ezintathu zama-NSAID: ama-salicylates (kokubili acetylated [isib, aspirin] kanye non-acetylated [isib., Disalcid {salsalate}]), Trilisate (choline magnesium trisalicylate), nePill Pills noma i-Novasal (i-magnesium salicylate); i-NSAID yendabuko; kanye ne-COX-2 inhibitors ekhethiwe.
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Ukusebenzisa Amaseli E-Stem Ukuphulukisa I-Arthritis ne-Cartilage Dommage
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I-JAK Inhibitors: I-Option Treatment ye-Rheumatoid Arthritis
Ama-NSAID asebenza ngokuvimbela umsebenzi we-enzyme, i-cyclooxygenase, eyaziwa nangokuthi i-COX. Ucwaningo lwembula ukuthi kunezinhlobo ezimbili ze-cyclooxygenase, eyaziwa njenge- COX-1 ne-COX-2 . I-NSAID ithinta kokubili amafomu. I-COX-1 ibandakanyekile ekugcineni izicubu ezinempilo, kuyilapho i-COX-2 ibandakanyeka endleleni yokuvuvukala. I-COX-2 inhibitors ekhethiwe yaba yi-subset of NSAIDs-ne- Celebrex (celecoxib) eyokuqala ukuba i-FDA evunyiwe ngasekupheleni kwawo-1990.
Ama-NSAID wendabuko afaka:
- I-ansaid (flurbiprofen)
- I-arthrotec (i-diclofenac / i-misoprostol)
- I-Cataflam (i-diclofenac potassium)
- I-Clinoril (i-sulindac)
- I-Daypro (i-oxaprozin)
- I-Dolobid (i-diflunisal)
- UFeldene (piroxicam)
- Ibuprofen (brand Motrin, Advil)
- Indocin (indomethacin)
- I-Ketoprofen (i-brand Orudis, i-Oruvail)
- I-Lodine (etodolac)
- UMeclomen (meclofenamate)
- I-Mobic (meloxicam)
- I-Nalfon (i-fenoprofen)
- I-Naproxen (uphawu lwe-Naprosyn, i-Aleve)
- I-Ponstel (i-mefenamic acid)
- I-Relafen (nabumetone)
- I-Tolectin (tolmetin)
- I-Vimovo (naproxen-esomeprazole)
- I-Voltaren (i-diclofenac sodium)
I-COX-2 Inhibitors ihlanganisa:
- I-celebrex (i-celecoxib)
Funda: I- NSAID - Okufanele Uyazi
I-DMARD
I-DMARD (izidakamizwa eziguqula izifo eziphikisana nezifo) zibizwa nangokuthi "izidakamizwa ezenza kancane kancane" ngoba ngokuvamile zithatha amasonto noma izinyanga ukusebenza futhi "ama-line-line agents". Ucwaningo luye lwaqinisekisa ukusebenza kwe-DMARD ekwelapheni kwamathambo e- rheumatoid , i- psoriatic arthritis , kanye ne- ankylosing spondylitis kanye nokubaluleka kokwelapha kokuqala, ukuhlukunyezwa okusebenzisa i-DMARD. Umgomo wokuphathwa nge-DMARD ukuvimba ukuqhubeka kwesifo nokunqanda ukulimala okuhlangene.
Ama-DMARD afaka:
- I-Arava (i-leflunomide)
- I-Auranofin (i-brand Ridaura, i-Oral Gold) ne-Myochrysine (I-Gold Injectable)
- I-Azulfidine (i-sulfasalazine)
- CellCept (i-mycophenolate)
- I-Cyclosporine (uphawu lwe-Neoral, iSandimmune)
- I-Cytoxan (i-cyclophosphamide)
- I-Imuran (azathioprin)
- I-Leukeran (i-chlorambucil)
- I-Methotrexate (i-brand Rheumatrex, i-Trexall)
- I-Minocin (i-minocycline)
- I-Penicillamine (i-brand Cuprimine, i-Depen)
- I-Plaquenil (i-hydroxychloroquine)
I-Xeljanz (tofacitinib citrate), i-DMARD yomlomo, ivunyiwe yi-FDA ngomhla kaNovemba 6, 2012, ukuphatha abantu abadala ngokusebenza ngokulinganisela emthonjeni we-rheumatoid we-rheumatoid okhuthele oye waba nempendulo enganele, noma ukungabekezelelani, ukuze kube ne-methotrexate. I-Xeljanz yiyokuqala ekilasini lemithi eyaziwa ngokuthi i-JAK (Janus kinase) inhibitors.
Funda: Amaqiniso Nge-DMARD
I-Corticosteroids (i-Steroids)
I-Corticosteroids noma i-glucocorticoids, evame ukubizwa ngokuthi "i-steroids," yizidakamizwa ezinamandla ezinganciphisa ukuvuvukala nokuvuvukala ngokushesha. Lezi zidakamizwa zihlobene eduze ne-cortisol, i-hormone ekhiqizwa i-cortex yezinhlayiya ze-adrenal. Zibekiwe ngokulinganisa okungafaniyo ngokuya ngesimo kanye nomgomo wokwelapha. Nakuba i-steroids ingasetshenziselwa ukulawula ukuvuvukala kwamalungu kanye nezitho ezifweni zokuvuvukala, njenge-arthritis ye-rheumatoid, i- lupus , i- polymyalgia rheumatica , ne- vasculitis , kuye kwaqunywa ukuthi amathuba okuba nemiphumela emibi yanda ngamanani aphezulu noma ngexesha elide sebenzisa.
Odokotela bangase banikeze ama-steroids angenesikhathi esifushane, ama-steroid ama-intravenous intravenous kwezinye izimo ezithile, noma udokotela wakho angakwazi ukuphatha umjovo we-steroid wendawo endaweni ethile, njenge-Kenalog (triamcinolone), ukukusiza uthole ukukhululeka ebuhlungu nasekuvukeni.
I-Corticosteroids ihlanganisa:
- i-betamethasone (i-brand Celestone)
- i-cortisone (i-brand Cortone)
- dexamethasone (brand Decadron)
- i-hydrocortisone (i-brand Cortef)
- i-methylprednisolone (i-brand Medrol )
- i-prednisolone (i-brand Prelone)
- i-prednisone (i-brand Deltasone)
Funda: I-Corticosteroids (i-Steroids) - Okufanele Ukwazi
Ama-analgesics (Imithi Yezinhlungu)
Ama-analgesics yizidakamizwa zokukhulula ubuhlungu. Ukulawula ubuhlungu kuyingxenye ebalulekile yokuphatha i-arthritis. Nokho, ngokungafani ne-NSAID, imithi ye-analgesic ayinqamuki ukuvuvukala. I-Acetaminophen (iTylenol) yi-analgesic evame ukusetshenziswa kakhulu. Izidakamizwa ezidakayo zengqondo zingase zenziwe futhi ngenxa yobuhlungu obukhulu.
Ama-Narcotics afaka:
- I-Codeine (iTylenol # 3)
- I-Duragesic (i-Fentanyl Skin Patch)
- I-hydromorphone (i-Palladone) - ayisekho emakethe
- I-MS Contin (i-morphine sulfate)
- I-OxyContin (oxycodone)
- I-Percocet (i-oxycodone / i-acetaminophen)
- I-Percodan (i-oxycodone / i-aspirin)
- I-Talwin NX (i-pentazocine / naloxone)
- I-Ultracet (tramadol / i-acetaminophen)
- Ultram (tramadol)
- I-Vicodin (i-hydrocodone / i-acetaminophen)
Funda: Imithi Yokuhlaziywa - Okufanele Ukwazi
I-Biologic Response Modifiers (i-Biologics)
I-Biologic Response Modifiers (BRMs), okuvame ukubizwa ngokuthi yi- biologics , ukugqugquzela noma ukuvuselela amandla omzimba wokuvikela omzimba ukulwa nezifo noma ukutheleleka. I-biologics yizidakamizwa ezithathwe emithonjeni ephilayo ngokuphambene nokusetshenziswa kwamakhemikhali.
I-Enbrel (etanercept) , i- Remicade infliximab) , i- Humira (i-adalimumab) , i- Cimzia (certolizumab pegol) , ne- Simponi (golimumab) i- TNF-alpha, enye ye- cytokines ebaluleke kakhulu ehilelekile ku-rheumatoid arthritis. I-TNF blockers (izidakamizwa ze-biologic ezibophezela ku-TNF-alpha) zenza ukuthi zingasebenzi, ngaleyo ndlela ziphazamise umsebenzi wokuvuvukala futhi ekugcineni zinciphise umonakalo ohlangene.
I-Kineret (anakinra), futhi nomuthi we-biologic, ungumphikisi we-IL-1. I-Kineret yayiyi-blocker yokuqala yokukhetha ye-interleukin-1 (IL-1), iphrotheni etholakala ngokweqile kwabanye abantu abane-arthritis ye-rheumatoid. Ngokuvimbela i-IL-1, i-Kineret inqanda ukuvuvukala nobuhlungu obuhambisana ne-arthritis ye-rheumatoid. I-Kineret ingasetshenziswa yedwa, noma ihlanganiswe namanye ama-DMARD, ngaphandle kwezidakamizwa ezilwa ne-TNF. Ngenkathi i-Kineret iyinhlangano yokukhetha, ayikho into enqunyiwe.
I-Orencia (abatacept) yayiyindlela yokuqala ye-T-cell co-stimulation yokuvunyelwa ukwelashwa kwesifo samathambo.
I-Rituxan (rituximab) , imithi yomdlavuza odayiswa kakhulu kunazo zonke emhlabeni, i-FDA ivunyelwe ngo-Mashi 2006 ukuze isetshenziswe ngokuhlanganiswa ne-methotrexate yokwelapha i-rheumatoid arthritis ngokunciphisa izimpawu nezimpawu kubantu abadala abanesifo samathambo esiyinkimbinkimbi futhi esicindezelekile futhi kwehluleka eyodwa noma ngaphezulu izidakamizwa ze-TNF. I-Rituxan yilona ukwelashwa kokuqala kwe-arthritis ye-rheumatoid ekhetha ngokukhethekile ama-B-cells ase-CD20.
I-Actemra (tocilizumab) i -antibody monoclonal evimbela i-interleukin-6 (IL-6 receptor), ngaleyo ndlela ivimbele i-interleukin-6. I-Actemra yamukelwa yi-FDA ngoJan. 8, 2010 yokwelapha isifo samathambo omdala omdala kubantu abahlulekile ukuvimbela eyodwa noma ngaphezulu kwe-TNF.
Ukwelashwa kwe-Arthritis Arthritis - Izincomo ze-ACR
Izidakamizwa ze-Fibromyalgia
Kuze kube ngu-2007, bekungekho izidakamizwa ezamukelwa yi-FDA yokwelashwa kwe- fibromyalgia . Odokotela baphatha i-fibromyalgia ngezidakamizwa ezihlukahlukene futhi zamukelwa ezinye izinkomba. Ngo-2007, uLyrica (pregabalin) wamukelwa ukwelapha i-fibromyalgia. Ngo-2008, i- Cymbalta (i-duloxetine HCl) yamukelwa i-fibromyalgia. Ngo-2009, i- Savella (i-milnacipran HCl) ivunyelwe lesi simo.
Gout Izidakamizwa
I-Gout ingenye yezinhlobo ezibuhlungu kakhulu ze-arthritis. Ingalawulwa ngemithi, ukudla, kanye nezinguquko zokuphila. Kunezici ezintathu zokuphathwa kwe-gout ngemithi: izidakamizwa, imishanguzo yokulwa nokuvuvukala, nezidakamizwa zokuphatha amazinga we-uric acid nokuhlaselwa kwe-gout .
Izidakamizwa ze-gout zifaka:
- I-Acetaminophen (i-Tylenol), noma amanye ama-painkillers e-analgesic, ukuphumula ubuhlungu
- Ama-NSAID (izidakamizwa ezingavumeli ukuvuvukala), ngokuvamile i-Indocin (i-indomethacin), ngokuvuvukala
- Colchicine , ukuvimbela noma ukukhulula ukuhlasela kwe-gout
- I-Corticosteroids, ngokuphendula okusheshayo okuphikisana nokuvuvukala
- I-Probenecid (Benemid, Probalan), ukunciphisa amazinga wegazi le-uric acid
- I-ColBenemid (i-Col-Probenecid ne-Proben-C) inezakhiwo zokulwa ne-gout
- I-Allopurinol (zyloprim) , ukuze wehlise igazi le-uric acid ngokuvimbela ukukhiqizwa kwe-uric acid
- I-Losartan (Cozaar, i-Hyzaar), hhayi umuthi owenziwe yi-gout, kodwa yisidakamizwa esilwa ne-hypertensive esingasiza ukulawula amazinga we-uric acid
- I-fenofibrate (Tricor), hhayi umuthi othize we-gout, kodwa yisidakamizwa esinciphisa i-lipid esingasiza amazinga we-uric acid
- I-uloric (febuxostat) , ihlisa amazinga we-serum uric acid ngokuvimbela i-xanthine oxidase
- I-Krystexxa (i-pegloticase), isidakamizwa se-biologic esisebenza ngokuphula i-uric acid
I-Osteoporosis Izidakamizwa
I-osteoporosis yisimo esibonakala ngamathambo angenamahloni, anesifo esibuhlungu, esivame kakhulu kubantu asebekhulile, kodwa futhi angase abe nenkinga kubantu abaye bathatha i-corticosteroids (steroids) longterm. Kunezigaba eziningana zokukhethwa kwezidakamizwa ze-osteoporosis: ama-estrogens, ama-hormone aphikisayo, ama-bone form formation, ama-bisphosphonates, nama-molecule we-receptor. Kuye ngokuthi yisiphi isisetshenziswa esisetshenziswayo, unganciphisa ukulahleka kwethambo, ukukhuthaza ukukhula kwethambo, nokunciphisa ingozi yezinsalela.
Izidakamizwa ze-osteoporosis zihlanganisa:
- I-Actonel (i-risedronate)
- I-Boniva (ibandronate)
- I-Didronel (i-etidronate)
- I-Estrogens (i-hormone therapy)
- I-evista (raloxifene)
- I-Forteo (i-teriparatide)
- I-Fosamax (i-alendronate)
- I-Miacalcin (i-calcitonin)
- Ukuqedwa (i-zoledronic acid)
- I-Prolia (i-denosumab)
Izwi elivela
Imigomo eyinhloko yokwelapha isifo samagciwane kanye nezifo zesifo se-rheumatic ngemithi ihlanganisa ukulawula ubuhlungu, ukwehlisa ukuvuvukala, ukunciphisa ukuqhubekela phambili kwesifo, nokulawula imisebenzi yesifo. Kunezinhlobo eziningi ze-arthritis nezidakamizwa eziningi eklasini ngalinye lezidakamizwa. Lokhu kwenza ukhetho lomuthi luyinkimbinkimbi. Ukunquma ukuthi imiphi imithi noma inhlanganisela yemithi ikulungele ukuthi ube yinto enzima. Kungenzeka ukuthi kuzothatha isilingo nesiphambeko-futhi uzoqhubeka uzama uze uzizwe uzuze impendulo eyanele. I-Wellwell iqoqe amaqiniso okudingayo ukwazi ngemithi ye-arthritis. Ulwazi olunikezile luzokusiza ukuthi uqonde ukuthi kungani uthatha imithi oyithathayo futhi kuzokusiza ukuthi uhlele imibuzo kudokotela wakho.
> Umthombo:
> Kelley's Bookbook of Rheumatology. Ingxenye 8. Pharmacology of Izidakamizwa Antirheumatic. Elsevier. Umagazini wesishiyagalolunye. Kufinyelelwe ngo-07/23/16.