Indlela Yokubheka Ekuziqapheleni Ukuhlinzwa
Nakuba kungekho ukwelashwa kwamathambo e-rheumatoid, kukhona ukwanda okuqhubekayo kokwelashwa okukwazi ukunciphisa ubuhlungu nokuvuvukala kwalesi sifo esingavamile sokuvuvukala. Zihlanganisa amakhambi okuzinakekela, ukudla, okungekho emthethweni kanye nokunciphisa ubuhlungu bezinhlawulo, imithi yokwelashwa, kanye nezidakamizwa ezishintsha izifo ezishaya izifo (DMARD). Amacala ahlukumezayo angadinga izinqubo ze-office ezifana ne-arthrocentesis noma ukuhlinzwa ukuze kusetshenziswe noma kulungiswe ukuhlanganiswa okonakalisiwe.
Amakhambi asekhaya kanye nendlela yokuphila
I-arthritis ye-rheumatoid yisifo esingapheli, esiqhubekayo esidinga ukuphathwa njengengxenye yokuphila kwakho. Kunokuba nje ukwelapha lesi sifo ngezidakamizwa, udinga ukuthatha indlela ephelele ehlose ukuthuthukisa impilo yakho yonke kanye nokunciphisa izingozi ezikubeka ngendlela engozini.
Konke mayelana nokwamukela ukuziphatha okunempilo nokushintsha indlela ophendula ngayo ekuhlaselweni okumangalisayo.
Ukudla
Ngisho noma izandla zakho kuphela zithintekile, ukugqithisa ngokweqile noma ukugquma kubangela ukuvuvukala ngenxa yokukhululwa kwamaprotheni okuvuvukala (okuthiwa i- cytokines ) kusuka kuma-fat cells. Lokhu kusebenza kuphela ekukhuliseni izimpawu zesifo samathambo futhi kufaka ukucindezeleka okungadingekile kumalunga emiphahla engezansi.
Nakuba kungekho okunye okudliwayo kubantu abane-arthritis ye-rheumatoid, odokotela abaningi bavumela ukudla okunemedithera yaseMedithera okuhlinzeka ngokulingana okunempilo kwamaprotheni, amafutha, kanye nama-carbohydrate ngenkathi kukhuthazwa ukunwetshwa kwezinhlanzi (ezicebile ama- fatty acids anti-inflammatory) , okusanhlamvu, imifino, izithelo, namafutha anempilo (njengamafutha omnqumo).
Ukuzivocavoca
I-arthritis ye-rheumatoid ibonakala nokuqina ngenxa yomonakalo oqhubekayo wezicubu ezinama-synovial endaweni ehlangene. Ngokuqalisa uhlelo lokuqeqeshwa olwenziwe kahle , ungakwazi ukulahlekelwa isisindo futhi ugcine ububanzi bokuhlanganyela kwesibambisene esithintekile. Ukuphila ngokwemvelo, ngokuphambene, kuvumela izicubu ezihlangene ukuba "zenzeke" -kuzibophezele ngokubambisana njenge-glue-okuholela ekunqandeni okuqhubekayo kokunyakaza.
Ukuzivocavoca kungabuye kuqiniseke ukuthi amathambo akho ahlale eqinile futhi alwa nezibonakaliso ze- osteoporosis ejwayelekile kubantu abane-arthritis ye-rheumatoid.
Ukubhema
Sonke siyazi ukuthi ukubhema akusihle kithi, kodwa kungaba kubi kakhulu uma une-arthritis ye-rheumatoid. Umoyi wesigare wenza izinto ezingcolile emzimbeni wakho, hhayi nje ukudala ukuvuvukala kodwa kubangele ukucindezela kwemithambo yegazi endaweni lapho ukujikeleza kungagqanyiswa khona ngokuphelele ezingxenyeni ezithile zomzimba.
Lokhu kungakhuthaza ukuthuthukiswa kwe- vasculitis ye- rheumatoid , isifo esijwayelekile sesifo esibhekene nokukhathala okungapheli, izilonda zesikhumba kanye neziqhwaga, umkhuhlane, ukulahlekelwa isisindo, nobuhlungu obuyisisindo kanye nomzimba. Ngaphezu kwalokho, ucwaningo lubonise ukuthi ukubhema kungakwandisa ingozi yokuthola isifo samathambo, kwezinye izimo cishe ngamaphesenti angu-300.
Nakuba ukuyeka ugwayi kungaba nzima, izinzuzo zempilo yakho (ehlangene nojwayelekile) ingaba enkulu kakhulu. Khuluma nodokotela wakho ngezinketho zokwelashwa. Izidakamizwa ezifana neZyban (bupropion) ne-Chantix (varenicline) zingasebenza ngabanye ababhemayo futhi ngeke ziphazamise izidakamizwa zakho ze-arthritis ye-rheumatoid.
Izixazululo ze-Over-the-Counter (OTC)
Njengengxenye yohlelo lwakho lokuqala lwezokwelashwa, udokotela wakho uzongcoma ukuthi i-over-the-counter (i-OTC) ye- anti-infermatory anti-inflammatory drugs (NSAID) ukunciphisa ubuhlungu obukhulu kuya kokulinganisela nokuvuvukala.
Lokhu kufaka phakathi izinhlobo ezifana ne-OTC brand njenge-Aleve (naproxen) noma i-Advil (ibuprofen). Ukwengeza kokuba nezakhiwo zokulwa nokuvuvukala, ama-NSAID nawo anama- analgesic ne-antipyretic (okusho ukuthi angakwazi ukukhulula ubuhlungu nomkhuhlane, ngokulandelana).
I-NSAID ayinciphisi ukuqhubeka kwesifo. Uma izimpawu ziba nzima, udokotela wakho angase anikeze ama-NSAID anamandla afana ne- Celebrex (celecoxib) noma i- Voltaren (i-diclofenac) . Imiphumela emibi ye-NSAID ihlanganisa ukucasuka kwesisu, ukucindezela kwegazi eliphezulu, ukukhala ezindlebeni zakho, izilonda zesisu kanye nesibindi sebindi.
Imigomo
Uma uthola ukuthi une-arthritis ye-rheumatoid , udokotela wakho uzovame ukubeka inhlanganisela yemithi, ezinye zazo eziphatha izimpawu nabanye okubhekana ne- autoimmune disorder yangaphakathi .
Lokhu kufaka phakathi i-corticosteroids yomlomo nomjovo, izidakamizwa zokuguqula izifo (i-DMARD), kanye nezidakamizwa ezintsha zezizukulwane ze-biologic.
Corticosteroids
I-Corticosteroids yimithi ephumelelayo kakhulu kepha enamandla enganciphisa ukuvuvukala futhi kusize umsebenzi olinganiselayo wokuzimela. I-Corticosteroids isebenza ngokulingisa i-cortisol, i-hormone ye-adrenal esiza ukulawula ukuvuvukala, ukugaya umzimba, inkumbulo, kanye noshukela wegazi.
Zivame ukushiwo njengengxenye yokwelashwa kwezidakamizwa eziningi futhi zihanjiswa ngomlomo (ifomu lesipilisi), ngomjovo (zibe isikhala semisipha noma esihlangene), noma ngaphakathi (ngaphakathi kwesiguli). I-Prednisone yisidakamizwa esivame ukusetshenziselwa isifo samathambo e-rheumatoid.
I-Corticosteroids inqunyelwe ukusetshenziselwa isikhathi esifushane ngenxa yengozi yokwanda kwemiphumela emibi, kuhlanganise nokuqeda i-osteoporosis, inzuzo yesisindo, ukulimala kalula, i-cataracts, i-glaucoma, nesifo sikashukela. Uma kuthathwa ngomlomo, kunqunywe ngamazinga aphansi futhi ngokuvamile kuthathwa ekuseni. Ama-injection agcinwe ukuhlaselwa okunamandla futhi awasetshenziswanga izikhathi ezintathu noma ezine ngonyaka.
I-DMARD
Izidakamizwa zokuguqula izifo ezithathelwana nezifo (DMARDs) zisebenza ngokulungisa ukuphendula komzimba wonke. Njengesifo esizimele, isifo samathambo esibangelwa yi-rheumatoid arthritis kubangelwa ukungasebenzi kwamasosha omzimba lapho kusetshenzwa khona amaselula okuhlasela. Indima ye-DMARD iwukuvimbela isistimu yomzimba wonke.
Umsebenzi we-DMARD usebenza ngokuphumelelayo uma uthathwa ngokushesha ngangokunokwenzeka ngemuva kokuba lesi sifo sibonwe. Kunezinhlobo eziningi ze-DMARD ezivunyelwe ukwelashwa, okubandakanya izidakamizwa zezizukulwane zakudala ezifana ne- Plaquenil (i-hydroxychloroquine) nezintsha ezifana ne- Arava (i-leflunomide) . Iningi lithathwa ngomlomo.
Ngokude, i-DMARD ejwayelekile kakhulu ebizwa ngokuthi i- methotrexate . I-Methotrexate iye yaba khona iminyaka engaphezu kwengu-50 futhi iyaqhubeka ibe yinkimbinkimbi yokwelashwa kwamathambo e-rheumatoid arthritis. Phakathi kwezinzuzo zayo eziningi, i-methotrexate ingathathwa ngokuphepha isikhathi esiningi, ngokuvamile idinga ukulandelwa kwesonto ngalinye, futhi ingasetshenziswa ngisho nasezinganeni.
Ngokwehla, i-methotrexate ingabangela ubuthi obunobuthi nokucindezelwa komnyoba. Ukuhlolwa kwegazi okudlulayo kuyadingeka ukuze ugweme lezi zinkinga. Ezinye imiphumela emibi zibandakanya ukukhathala, isicanucanu, ukucasuka kwesisu, ukuqhuma, isifo sohudo, izilonda zomlomo, nokulimala kalula. Ukuthatha isisindo se-folic acid nsuku zonke kungasiza ekunciphiseni ezinye zezinto ezihlobene nemiphumela ehlobene nezidakamizwa.
Gwema i-methotrexate uma ukhulelwe noma uzama ukukhulelwa njengoba kungabangela ukukhubazeka kokuzalwa.
Iziguquli ze-Biologic Response Modifiers
Ama-modifiers e-biologic response response are uhlobo olusha lwe-DMARD oluhlose izingxenye ezithile zesistimu yomzimba kunayo yonke. Zibhekwa njenge- biologic ngoba azikwenziwa ngabantu kodwa zitholakala kumaprotheni omuntu noma wezilwane.
Nakuba izidakamizwa eziphilayo ezisetshenziselwa ukwelapha i-rheumatoid arthritis zinezinqubo ezahlukene zesenzo, zonke zivimbela isilwane esithile sokuzivikela nge-immune: noma isifo se-tumor necrosis (i-TNF) (indima yayo ukukhombisa ukuvuvukala), i-interleukin (elawula ukuphendula komzimba), kanye nama- T-amangqamuzana (okuyinto ehlose futhi ehlasela ama-pathogens asolwayo).
Imithi ebizwa ngokuthi i-biologic ejwayelekile ehlanganisa:
- I-Actemra (tocilizumab)
- I-Cimzia (i-certolizumab pegol)
- Enbrel (etanercept)
- Huma (adalimumab)
- I-Kineret (yakinra)
- Orencia (abatacept)
- I-Remicade (i-infliximab)
- I-Rituxan (rituximab)
- I-Simponi (i-golimumab)
I-biologics inikezwa ngomjovo noma nge-intravenously futhi ngokuvamile ibelwe abantu abangazange baphendule kwezinye izifo.
Ngenxa yokuthi i-biologics iphazamisa izinqubo zokuzivikela, abantu abakwelashwa bangase babe nengozini enkulu yokutheleleka. Ngakho-ke, noma yisiphi isinqunjwana, isiguli, noma isibonakaliso sokutheleleka kufanele siphathwe udokotela. Imiphumela emibi evamile ihlanganisa injection site site, izifo zokuphefumula, kanye nezimpawu ezifana nezifo.
I-JAK Inhibitors
I-Janus kinase (JAK) inhibitors yiklasi elisha le-DMARD engeyona i-biologic eyenza ngokuvimbela inqubo yokuvuvukala ngaphakathi kweseli. I-Jafaki (i-ruxolitinib) ne- Xeljanz (tofacitinib) yi-JAK yokuqala ye-inhibitors evunyelwe ukusetshenziswa ku-US Bobabili kuthathwa ngomlomo futhi kunqunyelwe abantu abangazange baphendule ngokwanele ukuze bafinyelele noma bahluleke kwi-biologics.
Ama-JAK inhibitors asetshenziselwa ukuhlanganiswa ne-methotrexate futhi athathwa kabili nsuku zonke. Imiphumela emibi ihlanganisa ikhanda, ukukhathala, ukucasula isisu, izimpawu ezifana nomkhuhlane, isifo sohudo, i-cholesterol ephezulu, kanye nengozi eyengeziwe yokutheleleka.
Ukwelashwa Kwemvelo
Ngaphandle kwemithi, udokotela wakho angakutshela ochwepheshe ovuselelayo ongasebenza nawe ukubuyisela umsebenzi ohlangene nokuhamba. Lezi zihlanganisa abahlinzeki bezitho zomzimba kanye nabahlengikazi bezemisebenzi.
Ukwelapha ngokomzimba kugxila ekwakheni amandla nasekuthuthukiseni ukuhamba. Abantu abane-arthritis enesisindo esiyinkimbinkimbi bavame ukusebenzisana nomhlengikazi wenyama njalo futhi bangabonakalisa amasu ahlukene ahambisana nezimpawu zabo noma ukulinganiselwa.
Izindlela zokwelapha zingafaka:
- Ukuzivocavoca amandla nokuzivocavoca
- Ukwelashwa okushisayo nokubandayo
- I-ultrasound yokwelashwa
- Ukugqugquzela kagesi kagesi
- Hydrotherapy
Imithi yokwelashwa ihlose ukusekela ukuzimela kwakho nokuthuthukisa ikhwalithi yakho yokuphila ngokusiza ukunqoba ukulinganiselwa ngokomzimba, ngokuvamile ngokusetshenziswa kwamathuluzi okusiza namadivayisi.
Izibonelo zifaka:
- Ukufaka amadokhumende amakhulu noma ukuphatha okulula ukuwabamba
- Ukuthola izihlalo ze-ergonomic ezikuvumela ukuba uhlale ungakhululekile
- Ukukhetha amathrekhi, ama-walkers noma amanye amadivaysi okuhamba ahambisana nesidingo sakho
- Ukulungisa kabusha amakhabhinethi namashalofu ukuze izinto zilula ukufinyelela
- Ukushintsha ukushintsha kokukhanya nama-sliders
- Ukusebenzisa umyalo wezwi kunokuba ukulawula kwekhiphedi
Abanye ochwepheshe, kuhlanganise nabasebenzi be-podiatrists, massage therapists, kanye nezengqondo, bangase bafune ukunqoba ezinye izithiyo ngokomzimba nangokomzwelo.
Izinketho zangaphambi kokuhlinzwa
Ukuhlinzwa njalo kubhekwa njengendlela yokugcina uma une-arthritis ye-rheumatoid. Ngaphambi kokucubungula ukuhlinzwa, udokotela wakho angase afune ukuhlola amasu amancane angenawo amandla, ikakhulukazi uma usemusha futhi ngezinye izikhathi ube nempilo enhle.
Phakathi kwezinketho kukhona inqubo eyaziwa ngokuthi i- arthrocentesis lapho i-fluid isuswa khona endaweni ehlangene nenaliti ukuze kunciphise ukucindezelwa. Kuvame ukusetshenziselwa njengento enesifo sokuxilongwa kodwa kungasebenza nakakhulu lapho kwenzeka khona uketshezi oketshezi okwenza ubuhlungu obukhulu.
I-arthrocentesis ingenziwa ngokwayo noma ngaphambi kokudubula i-corticosteroid shot. Ezinye izijocavo ze-intra-articular zihilela ukusetshenziswa kwe- hyaluronic acid ukugcoba isikhala esihlangene noma i -plasma ecebile eplasma (PRP) etholakala egazini lomuntu siqu ukugqugquzela ukukhiqizwa kwe-cartilage emahlanganisweni awonakele kakhulu.
Kodwa-ke, kuzoba nezikhathi lapho i-arthrocentesis ingeke inikeze ukusizwa okulindelekile, futhi ukuhlinzwa yiyona ndlela kuphela.
Ukuhlinzwa
Uma ubuhlungu bakho obuhlangene bube bubekezeleleke, udokotela wakho angancoma ukuhlinzekwa ukuba avuselele ukuhlanganiswa okonakalisiwe noma ukuwuthathe esikhundleni. Ngokuvamile, ukuhlinzekwa kubhekwe kuphela uma zonke ezinye izinketho seziphelile futhi uthathwa njengomuntu ofanelekayo wokufaka isicelo.
Ukulungisa Okuhlangene
Njengoba isifo samathambo siqhubeka, ama-tissue ahlangene angase aphethwe. kuyilapho ukuguguleka kwe-cartilage ne-bone kuzokwenza ukuthi ihlangene ilahlekelwe ukulungiswa nokuma, okwenza kube nokukhubazeka okuhlangene . Ikakhulukazi kumajoyini amancane lapho ukushintshwa akuyona inketho, odokotela abahlinzayo bazosebenzisa amasu ahlukene ukuze basize ukubuyisela ukunyakaza nokunciphisa ubuhlungu.
Phakathi kokukhethwa kokulungisa:
- I-Arthrodesis , eyaziwa nangokuthi i-bone kanye ne-fusion ehlangene, isetshenziselwa ukukhulula ubuhlungu obuhlangene obungathintekayo ngokubuthana amathambo ndawonye ukuvimbela ukunyakaza kwe-intra-articular.
- I-arthroscopy yinkqubo lapho indawo ekhanya khona (ebizwa ngokuthi i-arthroscope) ifakwa endaweni ehlangene ukuze amabhuthi nethambo atholakale futhi asuswe.
- Umhubhe weCarpal ukukhululwa , obizwa nangokuthi ukukhululwa kwe-nerve, kungukuhlinzwa lapho umhubhe we-carpal ligament wesandla uhlukaniswa ukuze wenze isikhala esiningi sezinzwa namathenda.
- I-Synovectomy ihilela ukukhishwa kwegumbi elihlangene, elibizwa ngokuthi i-synovium, uma ligujwa njalo futhi liphazamisa ukuhlanganiswa kokubambisana.
Ukujoyina Okuhlangene
Ukuhlinzwa okuhlanganyelwe okuhlanganyelwe , okuyaziwa nangokuthi i-arthroplasty, sekuye kwaba yinto evame kakhulu kubantu abane-arthritis ye-rheumatoid. Isinqumo sokuhlola ukushintshaniswa okuhlanganyelwe kuzosekelwe ekubuyekezweni kwezimpawu zomzimba, umlando wezokwelapha, nokuthola okuvela ekuhlolweni kwe-imaging.
Ngaphezu kwalokho, iminyaka yakho ingadlala indima enkulu esinqumweni esinikezwe ukuthi izidakamizwa ezihlangene zivame ukuhlala kuphi kusukela eminyakeni engu-15 kuya kwengu-20. Ngakho-ke, odokotela abaningi abahlinzayo bazofuna ukubambezela inqubo isikhathi eside ngangokunokwenzeka, ngokuvamile kuze kube yilapho usendaweni yakho ema-50s.
(Ngalokho kuthiwa, iningi labantu abane-arthritis ye-rheumatoid liye lafakwa esikhundleni salo eminyakeni engama-60 ubudala ngenxa yokusebenza kakhudlwana kwama-DMARD amasha.)
Njengoba i-DMARD isebenza ngokucindezela isimiso somzimba sokuzivikela, kuzodingeka ukuthi uyeke ukwelashwa kahle ngaphambi nangemva kokuhlinzwa ukuze unciphise ingozi yokutheleleka okukhulu kokuthunyelwa komzimba.
Namuhla, ukuguqulwa kwamadolo nokuqhaqhazeka kuye kwaba ngokukhululekile okuphephile futhi okuphumelelayo ngezinga eliphezulu lokuphumelela kwamaphesenti angu-90. Izinkinga zokuthunyelwa komzimba kubantu abane-arthritis ye-rheumatoid zifana kakhulu nakwezinye izinto futhi zingafaka umonakalo wezinzwa, ukutheleleka, ama-blood clots, nokuhlukaniswa okuhlangene.
Imithi yokwelapha ehambisanayo (i-CAM)
Ekubhekaneni nesifo esingapheliyo, impilo yonke, abantu abane-arthritis ye-rheumatoid bavame ukwamukela ukwelashwa okuhambisanayo ukusekela ukwelashwa kwabo wendabuko.
Nakuba izindlela ezinjalo zokwelapha zinikeza izinzuzo, zombili zangempela futhi zibonwa, kubalulekile ukukhuluma nodokotela wakho nganoma yisiphi isisetshenziswa, imifino noma imithi yendabuko ongase uyithathe. Lokhu kungavimbela ukusebenzisana kwezidakamizwa ezingaphazamisa ukwelapha kwakho noma imiphumela emibi kanye nobuthi obunokugula.
Phakathi kwalezi zixazululo ezibhekwa njengezinenzuzo ekwelashweni kwe-rheumatoid arthritis:
- Ukwengeza kwamafutha wezinhlanzi kunamanani amaningi ama-omega-3 fatty acids amabili okusetshenziselwa umzimba ukuncipha ukuvuvukala. Ucwaningo oluningi luye lwabonisa ukuthi i-supplement ezintathu-gram yansukuzonke ingahlinzeka ngokukhululeka kokuhlunguphazeka komzimba we-arthritis nobuhlungu. Kodwa-ke, amafutha okudoba amafutha kufanele agwenywe kubantu abasebenzisa igazi abanomzimba njenge- warfarin ngoba bangandisa ingozi yokuphuma kwegazi.
- I-Borage , i- primrose kusihlwa , namafutha omnyama ama-currant , atholakala ku-gel-cap kanye nama-liquid formulations, imithombo emikhulu ye-omega-6 fatty acids nayo enezindawo eziphikisayo ezizuzisa abantu abane-arthritis ye-rheumatoid. Ukusebenzisa ngokweqile kufanele kugwenywe njengoba borage ingabangela ukulimala kwesibindi kumazinga aphezulu, kuyilapho ubusuku bokuhlwa bungaphazamisa izidakamizwa ze-phenothiazine ezisetshenziselwa ukwelashwa kwengqondo.
Ezinye izidakamizwa ezisebenzisekayo ezisetshenziswa kakhulu ezifana ne-glucosamine, i-chondroitin, i-acupuncture, ne-magnetic therapy azibonwanga ukuthi ziwusizo ngokukhethekile ekwelapheni i-arthritis ye-rheumatoid.
> Imithombo:
> Isikhungo Sikazwelonke seMithi Ephelele Neyomunye. "Umbiko Wokucwaninga: I-Rheumatoid Arthritis kanye Nemithi Ephelele Nezokwelapha." UBethesda, eMaryne; ibuyekeziwe ngoMeyi 4, 2016.
> Nikiphorou, E .; I-Konan, uS .; MacGregor, A. et al. "Ukwelashwa kokuhlinzwa kwesifo samathambo; Isikhathi esisha?" I- Bone Joint J. 2014; 96-B: 1287-9. I-DOI: 10.1302 / 0301-620X.96B.34506.
> Singh, J .; I-Saag, K .; Amabhuloho, uL. et al. "Umhlahlandlela we-American American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis." Ukunakekelwa Kwe-Arthritis Res. 2016: 68 (1); 1-25. I-DOI: 10.1002 / acr.22783.
> Smolen, J .; Aletaha, D .; noMcInnes, I. "I-rheumatoid arthritis. " Lancet. 2017; 388 (10055): 2023-38. I-DOI: 10.1016 / So140-6736 (16) 30173-8.
> Sugiyama, D .; Nishimura, K .; UTamaki, K. et al. "Impikiswano yokubhema kuyisici esiyingozi ekuthuthukiseni i-arthritis ye-rheumatoid: ukuhlaziywa kwemeta yezifundo zokuhlola. "I- Annals Rheum Dis. 2010; 69 (1): 70-81. I-DOI: 10.1136 / ard.2008.096487.