Kwangathi futhi ungafaka isicelo ku-Ankylosing Spondylitis ne-Psoriatic Arthritis
Kuyaziwa ukuthi abantu abane- arthritis ye-rheumatoid (RA) basengozini enkulu yokwehluleka nokufa okuvela ezifweni zenhliziyo-engozini okuthiwa kufaniswa nalokhu kubantu abane-type 2 yesifo sikashukela. Kubantu abane-arthritis ye-rheumatoid, kukhona ingozi eyengeziwe yokwehla kwe-myocardial infarction (ukushaya kwenhliziyo) nokufa okungazelelwe. Ukusabalala kwe-infarction ye-myocardial kungaphezu kwezikhathi ezimbili eziphakeme kubantu abane-arthritis ye-rheumatoid uma kuqhathaniswa nomphakathi jikelele.
Ubuhlobo be-causal phakathi kwesifo senhliziyo nesifo samathambo luyinkimbinkimbi futhi kubonakala sengathi buhlobene nezici eziningana. Izinkinga zempilo yengqondo yemvelo (isb., Ukucindezeleka okukhulu, ukukhuluphala, ukubhema, isifo sikashukela, i-cholesterol ephezulu), kanye nezimbonakaliso zokuqina kwamathambo e-rheumatoid, zifaka isandla.
Ingozi Yezinhliziyo E-Arthritis Ye-Rheumatoid: Okuthi Siyazi
Iminyaka eminingi, abacwaningi bebelokhu befunda inhlangano nokuthi ngabe kunakekelwa okwanele kunezici ezinobungozi ezingqondweni zabantu kubantu abanezinhlungu zokuphefumula kwamathambo . Kuye kwashiwo ukuthi isifo samathambo ngokwawo siyisifo esizimele esiyisifo senhliziyo. Okutholakele abacwaningi kubandakanya:
- Kukhona ingozi enkulu yesifo senhliziyo esenzeka ekuqaleni kwenkinga yesifo se-rheumatoid arthritis, esingaqala ngisho nesandulela ngculazi kuqala.
- Ukuvuvukala kudlala indima ebalulekile ekufweni kwesifo senhliziyo.
- Abantu abane-arthritis ye-rheumatoid bavele bephuthumayo i- atherosclerosis , okuyinto ngokwayo ebhekwa njengesimo sokuvuvukala. Kungenzeka ukuthi inqubo yokuvuvukala kwamathambo e-rheumatoid kanye ne- cytokines engaphezu kwamaprotheni ayinxenye ekwakhekeni kwe-plaque.
- Ukuvuvukala okuzenzakalelayo kwe-arthritis ye-rheumatoid kunomthelela ekwenzeni ukukhubazeka okungapheliyo , ukucindezeleka kwe-oxidative , nokusebenza nokufuduka kwama-leukocyte (amangqamuzana egazi omhlophe) ngaphakathi kwemithwalo yegazi. Ukunamathela kwama-leukocyte kuya ekugcineni kwe-vascular is a isici esihlukanisayo senqubo yokuvuvukala.
- Ukuvuvukala kwesimiso okuhambisana nesifo samathambo esihambisana ne-carthiscular risk factors ezihlobene nendlela yokuphila zingabangela ukugula ngokweqile kwesifo senhliziyo esifubeni se-rheumatoid arthritis.
Kungani Ukuxhumeka Kubaluleke Kakhulu?
Cishe isigamu sabo bonke ukufa kubantu abane-rheumatoid arthritis kuhlotshaniswa nesifo senhliziyo. Ukufa kwenhliziyo kukhuliswa ngamaphesenti angu-50 kanti ingozi yesifo senhliziyo isuke ngamaphesenti angu-48 kulabo abane-arthritis ye-rheumatoid uma kuqhathaniswa nomphakathi jikelele (i-Avina-Zubieta).
Abantu abane-arthritis ye-rheumatoid isikhathi eside, labo abanezibonakaliso ezingaphezulu (okusho ukuthi, kuthinta okungaphezu kwamajoyina kuphela), kanye nalabo abanesifo se-rheumatoid kanye ne-anti-CCP (i-autoantibodies) abanengozi enkulu yokufa kwe-cardiovascular mortality. Ukulawula ingozi kubalulekile.
Izincomo EULAR zokuphatha Ingozi Yenhliziyo E-RA
Ngo-2009, i-EULAR (i-European League Against Rheumatism) yabutha iqembu lokubeka izincomo zokulawula ingozi yezinhliziyo kubantu abane-arthritis ye-rheumatoid. Izincomo zibuyekeziwe ngo-2015/2016.
Kunemigomo emithathu ephezulu ehlinzekwa yi-EULAR-nezincomo ezingu-10 ezinikezwa, enye entsha futhi ayisithupha ishintshiwe kusukela ku-2009 inguqulo.
Izimiso eziphezulu:
1) Odokotela kumele baqaphele ingozi ephezulu yesifo senhliziyo kubantu abane-arthritis ye-rheumatoid uma kuqhathaniswa nomphakathi jikelele.
2) I-rheumatologist kufanele iqinisekise ukuthi ukulawulwa kwezinkinga zesifo senhliziyo isetshenziswa iziguli zesifo samathambo kanye nezinye izifo ezihlangene.
3) Ukusetshenziswa kwama- NSAID (izidakamizwa ezingavumeli ukuvuvukala) kanye nama- corticosteroids kufanele kube ngokuvumelana nezincomo ezithile ezivela ku-EULAR ne-ASAS (Ukuhlolwa kwe-Spondyloarthritis International Society).
Izincomo ezingu-10 Zihlanganisa:
1) Umsebenzi wokugula kufanele ulawulwe kahle ekuguleni kwamathambo, i- ankylosing spondylitis , ne- psoriatic arthritis ukuze unciphise ingozi yesifo senhliziyo.
2) Ukuhlolwa kwesifo sengculazi kunconywa kulabo abane-arthritis ye-rheumatoid, i-ankylosing spondylitis, noma i-psoriatic arthritis okungenani kanye njalo eminyakeni emihlanu futhi mhlawumbe ilandela noma yikuphi ukuguqulwa okukhulu kokwelashwa.
3) Ukulinganisa ingozi yesifo senhliziyo kubantu abanesifo samathambo, i-anondlosing spondylitis, noma i-psoriatic arthritis kufanele kwenziwe ngokwemihlahlandlela kazwelonke, kanye ne-SCORE CVD engozini yokubikezela ingozi uma kungekho mikhombandlela ekhona.
4) Ingqikithi ye- cholesterol kanye ne-high-density lipoprotein cholesterol kufanele isetshenziswe ekuhloleni kwenhliziyo yengculazi ye-rheumatoid arthritis, i-ankylosing spondylitis, ne-psoriatic arthritis ne-lipids kufanele kulinganiswe lapho umsebenzi wesifo uzinzile noma ukhululekile. I-lipids engeyona yokuzila iyamukeleka.
5) Amamodeli okubikezela ingozi yempilo yengqondo kufanele aguqulelwe abantu abane-arthritis ye-rheumatoid ngokuphindaphindiwe ngu-1.5.
6) Ukuhlolisiswa kwamapuletiki angenawo ama-atherosclerotic usebenzisa i-carotid ultrasound ingabhekwa njengengxenye yokuhlolwa kwengozi yezinhliziyo kulabo abane-arthritis ye-rheumatoid.
7) Izincomo zokuphila kufanele kugcizelele ukudla okunempilo, ukuvivinya umzimba njalo nokuyeka ukubhema.
8) Ukulawulwa kwezinhlekelele ze-cardiovascular disease kufanele kwenziwe ngokwemihlahlandlela kazwelonke yesifo se-rheumatoid, i-ankylosing spondylitis, ne-psoriatic arthritis. Ama-anti-hypertensives nama- statins angase asetshenziswe njengabantu basebonke.
9) Ama-NSAID kufanele anqunywe ngokucophelela nge-arthritis ye-rheumatoid kanye ne-psoriatic arthritis, ikakhulukazi kubantu abanesifo senhliziyo esaziwayo noma izici eziyingozi.
10) Ukuze uthole ukwelashwa okwesikhathi eside, umthamo we-corticosteroids kufanele ugcinwe phansi futhi kufanele uphethwe uma ukukhishwa noma umsebenzi wesifo esiphansi kwenzeka. Ukuqhubeka kwe-corticosteroids kufanele kubuyekezwe njalo.
Okutholakele Ucwaningo olwethulwa eMhlanganweni we-ACR wonyaka we-2016
Emhlanganweni waminyaka yonke we-American College of Rheumatology, owabanjelwa ngoNovemba 2016, kwakukhona okungenani izifundo ezintathu ezethulwa ezibhekene nengozi yezinhliziyo emthonjeni we-rheumatoid arthritis. Enye yezifundo (i-ID ye-athikili: 664363 i-ACR Newsroom) iphetha ngokuthi esikhathini esingaphezu kweminyaka engu-15, abantu abane-arthritis ye-rheumatoid babe kabili ingozi yemicimbi ye-cardiovascular njengoba inani labantu-isilinganiso esifana nesifo sikashukela sesi-2.
Esinye isifundo (i-ID yocingo: 663451 ACR Newsroom) ihlola ukuthi ngabe abantu abane-arthritis esebenzayo kodwa abanalo isifo senhliziyo esaziwayo banokufakazela ukuvuvukala kwe-myocardial. Babuye bacabange ukuthi ukuvuvukala kwe-myocardial kwathatha ukwelashwa nge- DMARDs (izidakamizwa eziguqula izifo ezilwa ne-rheumatic) . Abacwaningi baphetha ngokuthi kubonakala sengathi ukuvuvukala kwe-myocardial futhi kubonakale kuthatha ukwelashwa nge-DMARD.
Ucwaningo lwesithathu (i-ID yocingo: 664367 i-ACR Newsroom) igxile ekulawulweni okungaphansi kwesifo senhliziyo kubantu abantu abanezifo ezihlangene ezivuthayo. Kwaqedelwa ukuthi naphezu kokutholakala kwemithi elwa ne-hypertensive kanye ne-lipid-downing, inani elingaphansi kweziguli libekwe izidakamizwa.
Okubalulekile
Sekuyisikhathi eside, ingozi enkulu yezinhliziyo zenhliziyo kubantu abane-arthritis ye-rheumatoid igxila futhi ilawulwa phansi. Ingozi evezwe yi-hypertension, ukukhuluphala, ukubhema, ne-dyslipidemia, kanye nenqubo yokuvuvukala eqhubekayo ku-arthritis ye-rheumatoid, akufanele inganakwa. Kunesidingo sama-rheumatology kanye nodokotela bokunakekelwa okuyinhloko ukusebenza ngokubambisana ukulawula izifo zengozi yengqondo kanye nomsebenzi wesifo ohlobene ne-arthritis ye-rheumatoid.
Ngesikhathi ucwaningo luye lwagxila ekubalukeleni kokulawula ingozi yemithwalo yemvelo ehambisana ne-rheumatoid arthritis, ucwaningo olwengeziwe luyadingeka. Izinhloso zokwelashwa ezichazwe kahle zisalokhu zingekho. Kukhona isidingo sezinkombandlela ezicacile zokunciphisa ngempumelelo ingozi yesifo senhliziyo kubantu abane-arthritis yesifo sofuba noma ezinye izifo ezihlangene zokuvuvukala.
> Imithombo:
> Agca R. et al. Izincomo EULAR zokulawulwa kwezinkinga zesifo senhliziyo ezigulini ezine-arthritis ye-rheumatoid nezinye izinhlobo zezifo ezihambisana nokuvuvukala: 2015/2016 isibuyekezo. Ama-Annal of the Rheumatic Diseases . Okthoba 2016.
> Barber CE et al. Amaphutha Ekubhekaneni Neengozi Ze-Cardiovascular In Arthritis Ye-Rheumatoid: Ukuhlola Ukusebenza Ukusebenzisa Izinkomba Zekhwalithi Zomzimba. Journal of Rheumatology . Novemba 2016.
> USolomoni DH et al. Ukuchaza ingozi yenhliziyo ehambisana ne-arthritis ye-rheumatoid: izici zengozi zendabuko ngokumelene nezimpawu zesifo se-arthritis se-rheumatoid. Ama-Annal of the Rheumatic Diseases . Novemba 2010.
> Tournadre, Anne et al. Ukulawula ingozi ye-cardiovascular in iziguli ezine-arthritis evuthayo: ukucabangela okuwusizo. Ukuthuthukiswa Kwezokwelapha Emzimbeni We-Musculoskeletal . 2016.
> van-Breulelen-van der Stoep DF et al. Ingozi ye-car in arthritis ye-rheumatoid: indlela yokunciphisa ingozi? I-aestrosclerosis . Novemba 2013.