Isinyathelo sokubambisana esivela ku-ACR no-EULAR
Iziqondiso zokuphathwa kwe- polymyalgia rheumatica (PMR) zakhishwa ngo-September 2015, njengengxenye yomzamo wokusebenzisana phakathi kwe-American College of Rheumatology (ACR) ne-European League Against Rheumatism (EULAR). Imikhombandlela iyisethi yokuqala yezincomo zomhlaba jikelele zokwelashwa nokuphathwa kweziguli ezine-polymyalgia rheumatica.
Yini i-Polymyalgia Rheumatica?
Kulinganiselwa ukuthi abantu abangaba ngu-711 000 baseMelika banepolymyalgia rheumatica - isimo esivame ukukhula kancane kancane. Nakuba izimpawu zingathuthuka ngokuzumayo, lokho akuyona into ejwayelekile ye-polymyalgia rheumatica. Izimpawu zihlanganisa ukuqina komfutho we-musculoskeletal, ngeziqhwa namahlombe ngokuvamile ahilelekile, kanye nezingalo ezingaphezulu, intamo, futhi ephansi. Ngokujwayelekile akukho ukuvuvukala kwamajoyina. Kungenzeka ukuba ne-polymyalgia rheumatica kanye nesinye isifo se-rheumatic . Kuye kwahlukahluka kakhulu ekwelapheni kwe-polymyalgia rheumatica, njengokungathi ukusebenzisa i- glucocorticoids noma izidakamizwa zokuguqula izifo eziphikisayo (DMARDs) nokuthi kungakanani.
Izimiso nezincomo zokuphatha i-PMR
Imikhombandlela ka-2015 ekhishwe yi-ACR ne-EULAR ifaka izimiso ezisezingeni eliphezulu nezincomo ezithile eziphathelene nokufinyelela ukunakekelwa kwezokwelapha, ukuhanjelwa kubachwepheshe, ukulandelwa kweziguli, kanye namasu okuphatha okhethekile.
Izincomo ezicacisiwe zahlukaniswa ngokuthi:
- "Kunconywa ngokuqinile" uma ubufakazi bubhekisela enzuzweni enkulu ngaphandle kokungabi nengozi
- "okunemibandela" uma kwakungenabufakazi obunesizotha bokuthi inzuzo noma uma ukuzuza akuzange kube ngaphezu kwezingozi
Izimiso eziphezulu zihlanganisa:
- Ukwamukelwa kwendlela yokuthola i-polymalgia rheumatica, ngokuhlolwa komtholampilo kuhloswe ukuthi kungabandakanyi izimo ezilinganisa i-polymyalgia rheumatica.
- Ngaphambi kokubeka ukwelashwa, zonke izigameko kufanele zibe nemiqulu yokuhlola ye-laboratory.
- Kuye ngezibonakaliso nezimpawu, ukuhlolwa okwengeziwe kufanele kulandelwe ukuba kungabandakanyi izimo zokulingisa. Ukunciphisa kufanele kutholakale. Izingozi zokubuyela emuva noma ukwelashwa isikhathi eside kufanele zicatshangelwe.
- Ukucatshangelwa kufanele kunikelwe ukuhanjiswa kochwepheshe.
- Izinqumo zokwelapha kufanele zabiwe isiguli nodokotela.
- Iziguli kufanele zibe nesiphakamiso sokwelapha ngokwezifiso se-polymyalgia rheumatica.
- Iziguli kufanele zifinyelele emfundweni mayelana nokwelapha kanye nokuphathwa kwe-polymyalgia rheumatica.
- Wonke isiguli esiphathwa nge-polymyalgia rheumatica kufanele ihlolwe ngokusebenzisa ukuhlolwa okuqondile. Ngonyaka wokuqala, iziguli kufanele zibonwe njalo emavikini amane kuya kwangu-8. Ngonyaka wesibili, ukuhambela kufanele kuhlelwe njalo emavikini angu-8-12. Ukuqapha kufanele kube okudingekayo ukuze kuvuselelwe noma kusetshenziswe i- prednisone tapering.
- Iziguli kufanele zibe nokufinyelela okuqondile kumakhono abo okunakekelwa kwezempilo ukuze zibike izinguquko, njengezishaya noma izenzakalo ezimbi.
Izincomo eziqondile zokuphathwa kwe-polymyalgia rheumatica zihlanganisa:
- Kunconywa okunamandla kokusetshenziswa kwe-glucocorticoids esikhundleni se- NSAID (izidakamizwa ezingekho emzimbeni ezingekho ukuvuvukala), ngaphandle kwesifundo esifushane se-NSAID noma ama- analgesics ezigulini ezinezinhlungu ezihlobene nezinye izimo.
- Isiphakamiso esinamandla sokusebenza okungenani okuyimpumelelo yomuntu ngamunye we-glucocorticoid therapy (okungukuthi, sebenzisa lesi sidakamizwa isikhathi esifushane esidingekayo ukuze uthole impendulo ephumelelayo).
- Ukuncoma okunemibandela yesilinganiso esincane sokuqala sokusebenza kwe-glucocorticoids esiphakathi kwe-12.5 no-25 mg i-prednisone elinganayo nsuku zonke. I-dose ephakeme ingacatshangelwa kulabo abasengozini enkulu yokubuyela emuva futhi ingozi engaphansi yezenzakalo ezimbi. Umthamo ophansi ungacatshangelwa kulabo abanezidakamizwa noma izinto ezibeka ingozi kwimiphumela emibi ehlobene nokusetshenziswa kwe-glucocorticoids. Isilinganiso sokuqala esingu-7.5 mg / ngosuku sasidangele ngokomzimba, kanti ukukala kokuqala kuka-30 mg / ngosuku kwakudangele kakhulu.
- Kunconywa okunamandla kumashejuli okuthinta abantu ngabanye nokuqapha okuvamile. Uhlelo oluphakanyisiwe lokuqothula kokuqala ukufaka umthamo womlomo we-10 mg we-prednisone elilinganayo ngosuku ngalunye phakathi kwamasonto amane kuya kwangu-8. Ukuze uphinde uphinde ukwelashwa, i-prednisone yomlomo kufanele inyuke kumthamo isiguli esithatha ngaphambi kokuphindaphinda futhi wehle kancane kancane ngaphezu kwamasonto amane kuya kwangu-8 kuya kumthamo lapho ubuya khona khona. Uma ukuxoxwa kutholakala, i-prednisone yomlomo yansuku zonke ingafakwa nge-1 mg njalo amasonto amane noma ngo-1.25 mg isebenzise uhlelo oluthile lwezinsuku kuze kube yilapho i-prednisone ishiywe, ukuhlinzeka ukuthi ukuxolelwa akuphazanyiswa.
- Ukuncoma okunemibandela yokusetshenziswa kwe-methylprednisolone ye-intramuscular instead of or glucocorticoids yomlomo.
- Kunconywa okunemibandela ngomthamo owodwa kunokuba uhlukaniswe umthamo wansuku zonke we-glucocorticoids yomlomo.
- Ukuncoma okunemibandela yokusetshenziswa kokuqala kwe- methotrexate ngaphezu kwe-glucocorticoids, ikakhulukazi iziguli ezithile.
- Izincomo ezinamandla ngokumelene nokusetshenziswa kwe- block block TNF .
- Ukuncoma okunemibandela yohlelo lokuzivocavoca komuntu ngamunye ukugcina ubunzima bomzimba kanye nomsebenzi, kanye nokunciphisa ingozi yokuwa .
- Izincomo ezinamandla ngokumelene nokusetshenziswa kwamalungiselelo ama-Chinese we-herbal Yanghe noBiqi.
Imithombo:
Izincomo zika-2015 zokuphathwa kwe-Polymyalgia Rheumatica. Dejaco C. et al. I-arthritis ne-Rheumatology Vol. 67 No. 10. Okthoba 2015.
http://www.rheumatology.org/Portals/0/Files/2015%20PMR%20guidelines.pdf
I-Polymyalgia Rheumatica. I-American College of Rheumatology. Kubuyekezwe ngo-Juni 2015.
http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Polymyalgia-Rheumatica