I-vasculitis ye-rheumatoid iyinkimbinkimbi engavamile, eyinkimbinkimbi ye- arthritis ye- rheumatoid engase isongele impilo. Nge-vasculitis ye-rheumatoid, ukuvuvukala kwanda emithanjeni yegazi encane noma ephakathi emzimbeni. Ngokuvame ukubandakanya imithanguzo, kodwa imithanjeni ingaba njalo. Izindwangu ezinkulu zegazi azibandakanyeki neze.
Izindonga zemithambo yegazi evuthayo ziyancipha futhi njengoba isibonakaliso sesitsha esithintekayo segazi sincane, singase sivinjelwe.
Igazi elinikezwa isitho lingase lihlehliswe, uma lingavinjelwe. I-vasculitis ye-rheumatoid ingase ihlanganise izitho eziningi, kufaka isikhumba, amehlo, izinzwa, inhliziyo, amaphaphu, ubuchopho, izinso noma isisu somzimba. Kodwa, kunezindaba ezinhle kanye. Iziguli ezimbalwa ze-rheumatoid arthritis zihlakulela i-vasculitis ye-rheumatoid, cishe ngenxa yezidakamizwa ezisebenzayo ezakhiwe futhi zithengiswa eminyakeni eyishumi edlule noma ngaphezulu (okungukuthi, izidakamizwa ze-biologic ).
Ukuvama Nengozi Ye-Rheumatoid Vasculitis
Nakuba ukubonakala kwesifo se-rheumatoid vasculitis kubonakala sengathi sinciphisa, kulinganiselwa ukuthi inani elingaphansi kwesisodwa kuya kwezingu-5 zesiguli se-rheumatoid arthritis siphuthukisa i-vasculitis ye-rheumatoid. Noma kunjalo, izifundo ze-autopsy ziye zabika ngo-15-31%. Amazinga omzimba kanye nokufa okuhambisana nesifo se-rheumatoid vasculitis sibalulekile ngokufa kwabantu abaneminyaka emi-5 ku-30-50% ngamanani amaningi kakhulu okubhekene nezifo ezibangelwa izifo noma ukwelashwa ngokweqile.
Izici ezilandelayo zandisa ingozi yokuthuthukisa i-vasculitis ye-rheumatoid:
- Isici se-rheumatoid factor
- Okuhle kakhulu kwe- anti-CCP
- Abesilisa (1 kwabangu-9 abesilisa abane-arthritis ye-rheumatoid bakhula i-vasculitis ye-rheumatoid)
- Ukubhema
- Ukutholakala kwama- nodules we- rheumatoid
- Isikhulile ekukhuleni kwesifo noma isikhathi eside sesifo samathambo (iminyaka engaphezu kwengu-10)
Izimpawu nokubonakaliswa kwe-Rheumatoid Vasculitis
Noma yimuphi umzimba womzimba ungathinteka yi-vasculitis yesifo sofuba. Isikhumba kanye nezinzwa zomzimba zivame ukuzibandakanya. Nakuba ukubandakanya komzimba omkhulu kubhekwa njengento engavamile, kuhlotshaniswa nokuhlukunyezwa nokufa okuphawulekayo.
Ukubandakanya isikhumba kungabandakanya i-purpura, ama-nodules, izilonda, ne-necrosis yamadijithali, ikakhulukazi ama-fingertips. U-Livedo reticularis uyinto ejwayelekile yokuthola. Ukubandakanya isikhumba kudinga ukuphenywa okunye kokubandakanyeka komzimba. I-scleritis , i- pleuritis , noma i- pericarditis yizibonelo zalokho okungase kuthuthuke. Uma isikhumba sihilelekile ngaphandle kokubandakanyeka kwesistimu, ukubikezela kungcono.
Ngesimiso sezinzwa ze-peripheral, i- peripheral neuropathies ingase ikhule, njenge-distal symmetric sensory polyneuropathy, i-distal motor noma i-neuropathy ehlangene, noma i-multiplex i-mononeuritis. Uma i-vasculitis ilimaza izinzwa. kungaba khona ukunganaki, ukukhipha, ukulahlekelwa ukuzwa, ubuthakathaka, nokulahlekelwa umsebenzi ezandleni nasezinyaweni. Izimpawu eziningi ezenziwe ngokujwayelekile zingase zenzeke, ezifana nomkhuhlane, ukulahlekelwa isisindo, ukulahlekelwa ukudla, nokulahlekelwa amandla.
Ukuxilongwa kwe-Rheumatoid Vasculitis
Ngenkathi i-pattern yezimpawu zingabangela udokotela ukuba asolise i-vasculitis ye-rheumatoid kanye nokuhlolwa kwe-laboratory kunganikeza ubufakazi obusekelayo bokuthola ukuxilongwa okunokwenzeka, i-biopsy iyadingeka ukuze kutholakale ukuxilongwa okucacile.
Isikhumba esithintekayo singase sibe ne-biopsied, kanye nesisipha noma isisindo ngaphakathi kwesifunda esithintekile, noma isici esithintekile.
Ngesikhathi ukuhlolwa kwegazi ngenxa yesifo se-rheumatoid kanye ne-anti-CCP ngokuvamile kuphakanyisiwe kwi-vasculitis ye-rheumatoid, imiphumela ayiyona ecacile. Ama-antibodies amabili nawo ayenziwa kakhulu ku-arthritis ye-rheumatoid ngaphandle kwe-vasculitis. Ama-antibodies anti-neutrophil cytoplasmic (i-ANCA) kanye nama-anti-myeloperoxidase kanye nama-anti-proteinase-3 antibodies ngokuvamile awanayo i-vasculitis ye-rheumatoid.
Ukwelashwa kwe-Rheumatoid Vasculitis
Ukwelashwa kwe-vasculitis ye-rheumatoid ngokuyinhloko kunqunywa yiziphi izitho ezihilelekile.
Futhi, i-arthritis ye-rheumatoid kufanele iphathwe ngokuphumelelayo ngokusebenzisa i- DMARD noma izidakamizwa ze-biologic, njenge- block block ye-TNF . Ukulawula ukuvuvukala kokubili amalunga nasemithanjeni yegazi kubalulekile.
Umzila wokuqala wokulashwa kwe-rheumatoid vasculitis kuhilela ukusetshenziswa kwe- corticosteroids (ngokuvamile i- prednisone ). I-Prednisone ingahlanganiswa ne- methotrexate noma i-azathioprin. Ngezimpawu ezithuthukisiwe nokubandakanyeka okukhulu komzimba, umzamo okhudlwana wokuzivivinya umzimba ungabandakanya i-cyclophosphamide kanye namazinga aphezulu e-prednisone. I-Rituxan (rituximab) ivela njengendlela yokwelapha yokuqala ye-vasculitis ye-rheumatoid. Ngokusho kombiko we-Arthritis Care and Research (2012), ukuhlaziywa kwedatha kusukela ku-Autoimmunity and Rituximab registry kwembula ukuthi ukuxolelwa kwafinyeleleka ku-12 kwezingu-17 ze-vasculitis iziguli eziphathwe kabi nge-rituximab. Iziguli nazo zakwazi ukwehlisa umthamo wazo we-prednisone.
Imithombo:
I-rheumatoid Vasculitis. Johns Hopkins Vasculitis Center.
http://www.hopkinsvasculitis.org/types-vasculitis/rheumatoid-vasculitis/
I-rheumatoid Vasculitis. Umtholampilo waseCleveland.
http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-rheumatoid-vasculitis
I-rheumatoid Vasculitis. I-Vasculitis Foundation. September 2012.
http://www.vasculitisfoundation.org/education/forms/rheumatoid-vasculitis/
I-Vasculitis Ye-Rheumatoid: Ukulahlekelwa Inhlekelele noma Ukubhekela Izinyathelo Ezintsha Zokwelapha? I-Bartels namabhuloho. Imibiko Yamanje Ye-Rheumatology. Disemba 2010.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950222/
I-Rituximab therapy ye-vasculitis ehleliwe ehambisana ne-arthritis ye-rheumatoid: Imiphumela evela ku-Autoimmunity and Rituximab Registry. I-Puechal X et al. Ukunakekelwa Kwe-Arthritis Nokucwaninga. Mashi 2012.
http://www.ncbi.nlm.nih.gov/pubmed/22076726