Ukuthi Isifo Sokugula Nesifo Siyakunqunywa kanjani
I-arthritis ye-rheumatoid ihluke kwi-osteoarthritis ("ukugqoka nokubhuka" isifo samathambo) ngokuthi yisifo esizimele esisodwa lapho amasosha omzimba ahlasela ngokungaqondile amangqamuzana namathenda akhe, ngokuyinhloko lawo majoyina. Ngenxa yalokho, lesi sifo asikwazi ukuxilonga ngezimpawu zodwa. Esikhundleni salokho, udinga ukusebenzisa inhlanganisela yezivivinyo-kuhlanganise ukuhlola ngokomzimba, ukuhlolwa kwezingqondo, nokuhlolwa kwegazi-ukuthola ukuthi imiphumela ihlangabezana nencazelo yomtholampilo yesifo.
Ukwenza kanjalo akugcini nje kuphela ukuqinisekisa ukuthi ukuxilongwa kulungile, kuyasiza ukunquma inkambo efanele yokwelashwa.
Ukuhlolwa Kwemvelo
Enye yezinto zokuqala zokuxilongwa ukuhlolwa ngokomzimba. Inhloso yokuhlola, ngokwengxenye, ukucacisa izici zobuhlungu obuhlangene nokuvuvukala ukuze kuhlukaniswe kangcono umsolwa osolwa kakhulu, i- osteoarthritis .
Phakathi kokungafani okubalulekile:
- I-arthritis ye-rheumatoid ivame ukuthinta amalunga amaningi (i- polyarthritis ). I-osteoarthritis ivame ukuthinta izandla, izinyawo, namadolo futhi izikhathi eziningi zibandakanya ihlangene elilodwa (i- monoarthritis ).
- I-arthritis ye-rheumatoid ijwayele ukulinganisa, okusho ukuthi izimpawu ezihlangene ngakolunye uhlangothi lomzimba zizovame ukuboniswa ngakolunye uhlangothi lomzimba. I-osteoarthritis ivame ukuhlangana ngokungafani (noma i-asymmetrical uma kuhlangene ngaphezulu kokuhlanganyela okukodwa).
- Ngoba i-arthritis ye-rheumatoid ibangela ukuguqulwa komzimba (umzimba wonke) ukuvuvukala, ukukhathala , i-malaise, ngisho ne-fever low-grade. I-osteoarthritis, okungesiyo isifo sokuvuvukala, ngokuvamile ngeke ihambisane nalezi zimpawu.
- Ukuqina kosuku lokusabalala kujwayelekile ngesifo samathambo kodwa sivame ukugcina imizuzu engu-30 kuphela futhi uthuthuke ngokunyakaza okuncane. Njengoba i-osteoarthritis ihilela ukulimala okuhlangene okuhleliwe, ukuqina kwesimanje kuzohlala isikhathi eside kakhulu.
Ngaphezu kokuhlola izimpawu zakho zomzimba, udokotela uzobuyekeza umlando womndeni wakho.
I-arthritis ye-rheumatoid ingase isebenze emindenini, iphindaphinda kabili ingozi yesifo uma isihlobo sesibili esineziqu futhi sinokubeka kathathu ingozi uma ilunga lomndeni lithintekile.
Izivivinyo ze-Lab
Ukuhlolwa kwelabhu kusetshenziselwa izinhloso ezimbili eziyinhloko ekutholeni i-arthritis ye-rheumatoid: ukuhlukanisa i- serostatus yakho nokukala nokuqapha izinga lokuvuvukala emzimbeni wakho.
Serostatus
I-Serostatus (ngokuhunyushwa ngokuhunyushwa ngokuthi "isimo segazi") ibhekisela ezihlwini eziyisihluthulelo zesifo egazini lakho. Uma lezi zinhlanganisela zitholakala ekuhlolweni kwegazi, kuthiwa unesisindo. Uma zingatholakali, uzobekwa njenge-seronegative. Imiphumela enomthelela enhle ingahle ibekwe njengento ephansi, ehlelekile, noma ephezulu / enamandla.
Kukhona ukuhlolwa okubili okusetshenziselwa ukusungula i-serostatus yakho:
- Isisindo se-rheumatoid (RF) uhlobo lwama-autoantibody olutholakala kuma-80 amaphesenti abantu abaphila nesifo. Ama-autoantibodies ngamaprotheni akhiqizwa ngumzimba ohlasela amangqamuzana anempilo. Nakuba amazinga aphezulu e-RF aphakamisa ngokuqinile isifo samathambo, angase avele nezinye izifo ezizimele njenge-lupus noma izifo ezingezona ezizenzakalelayo ezifana nomdlavuza nezifo ezingapheliyo.
- I-peptide Anti-cyclic citrullinated (anti-CCP) enye uhlobo lwe-autoantibody etholakala kuningi labantu abane-arthritis ye-rheumatoid. Ukucaca okuphezulu kwe-test-ikhono layo lokubona kahle i-anti-CCP-yilokho kungaba njalo ukukhomba amalungu omndeni engozini yesifo ngisho noma engenazo izimpawu.
Lapho ukuhlolwa kokubili kufinyelela khona kuzwela kwabo, ngokuvamile okuyizansi ezingamaphesenti angu-80. Lokho kusho ukuthi ukuhlolwa, kuyilapho kuyigugu ekwenzeni ukuxilongwa, kutholakala emiphumeleni engalungile noma engamanga . Kungenxa yalesi sizathu ukuthi asetshenziselwa njengengxenye yenqubo yokuxilonga kunokuba kube izinkomba zodwa.
Amakhwala okuvuthayo
Ukuvuvukala yisici esichazayo se-arthritis ye-rheumatoid. Ukuhlolwa kwenziwa ekuhloleni izinga lokuvuvukala ngokubheka amakaki abalulekile egazini. Lezi zimpawu azisizi nje ukuthi siqinisekisa ukuhlolwa kokuqala kodwa zisetshenziswa kulo lonke lesi sifo ukuhlola impendulo yethu ekwelapheni .
Kulokhu, odokotela bazosebenzisa izinyathelo ezimbili eziyinhloko:
- Isilinganiso se-erythrocyte sedimentation (ESR) yisivivinyo esilinganisela izinga lapho amangqamuzana egazi abomvu ahlala khona phansi kweshubhu elide elide, elibizwa ngokuthi i-Westergren tube, ngehora. Uma kukhona ukuvuvukala, amangqamuzana egazi abomvu azobamba ndawonye bese ehla ngokushesha. Kuyisilinganiso esingezona esithile sokuvuvukala kodwa esisodwa esinganikeza ulwazi olubaluleke kakhulu ekutholeni ukuxilongwa.
- Iprotheyini esebenzayo e-C (i-CRP) uhlobo lweprotheni elikhiqizwa yisibindi ngokuphendula ukuvuvukala. Ngenkathi futhi engeyona ecacile, kuyisilinganiso esilandelayo sempendulo yokuvuvukala.
I-ESR ne-CRP ingasetshenziselwa ukuxilonga ukuxoxwa kwe-arthritis , isimo sezinto eziphansi zesifo lapho ukuvuvukala kungaphezulu kwesheke.
Ukuhlolwa kwezilingo
Indima yokucubungula ukuhlolwa kwesifo samathambo ukukhomba izimpawu zomonakalo ohlangene, kufaka phakathi ukuguguleka kwamathambo ne-cartilage kanye nokwehlukaniswa kwezikhala ezihlangene. Bangasiza futhi ukulandelela ukuqhubekela phambili kwesifo futhi basebenzise lapho kudingeka khona ukuhlinzwa .
Isivivinyo ngasinye singanikeza ukuqonda okuhlukile nokuqondile:
- I-X-ray iyasiza kakhulu ekuboneni ukuguguleka kwamathambo nokulimala okuhlangene. Nakuba i-X-ray ibhekwa njengethuluzi eliyisisekelo lokugaya i-arthritis, akuzona eziwusizo ezinyathelweni zakuqala zesifo lapho izinguquko ezinamathanteni nezinambuzane ezinama-synovial zingabonakali .
- Ukucabangela kwe-Magnetic resonance (MRI) ikwazi ukubuka ngaphesheya kwezinguquko kanye namathambo ezindaweni ezixhumeneyo futhi ngisho nokubona ukuvuvukala okuhlangene ngezifo zakuqala.
- Ama-Ultrasound nawo angcono ekuboneni ukuguguleka okuhlangene kokuqala futhi angabonisa izindawo ezithile zokuvuvukala okuhlangene. Lesi yisici esibalulekile esinikezwe ukuthi ukuvuvukala ngezinye izikhathi kungaqhubeka kungabonakali nakuba i-ESR ne-CRP isitshela ukuthi lowo muntu usekuxoxweni. Esimweni esinjalo, ukwelashwa kuzoqhubeka kuze kube yilapho isikhathi sokukhululwa kweqiniso kufezwa.
Izigaba zokuhlukaniswa
Ngo-2010, i-American College of Rheumatology (ACR) ivuselele izindlela zayo zokudala izifo zesifo sofuba. Ukubuyekezwa kwakushukunyiswa, ngokwengxenye, ngokuthuthukiswa kwezobuchwepheshe bokuxilonga. Nakuba ukuhlukaniswa kuhloswe ngenhloso yokucwaninga ngemitholampilo, kusetshenziselwa ukwenza umtholampilo ukunikeza ukuqinisekiswa okukhulu kokuxilongwa.
I-2010 ACR / EULAR Classification Criteria ibheka izinyathelo ezine ezihlukene zemitholampilo bese zilinganisa ngesilinganiso se-0 kuya ku-5. Amaphuzu okubalwa aphakathi kuka-6 kuya ku-10 anganikeza izinga eliphakeme lokuqiniseka ukuthi empeleni unesifo samathambo.
| Imigomo | Inani | Amaphuzu |
| Ubude bezimpawu | Ngaphansi kwamasonto ayisithupha | 0 |
| Amasonto angaphezu kwesithupha | 1 | |
| Ukubandakanya okuhlangene | Omunye ohlangene omkhulu | 0 |
| Amalungu amakhulu amabili kuya kwangu-10 | 1 | |
| Amalungu amancane kuya kwamathathu (ngaphandle kokubandakanyeka kwamalungu amakhulu) | 2 | |
| Amalungu amancane amane kuya kwangu-10 (ngaphandle kokubandakanya amalunga amakhulu) | 3 | |
| Amalungu angaphezu kuka-10 (okungenani okuhlanganisiwe okuncane) | 5 | |
| Serostatus | I-RF ne-anti-CCP ayinayo | 0 |
| I-RF ephansi ne-anti-CCP ephansi | 2 | |
| I-RF ephezulu kanye ne-anti-CCP ephezulu | 3 | |
| Amakhamuzi okuvuvukala | I-ESR evamile ne-CRP | 0 |
| I-ESR engavamile ne-CRP | 1 |
Ukuthola Ukukhululwa
Ukubona ukuxolelwa kwesifo akuyona inqubo eqondile. Akudingi kuphela ukuhlolwa kokuhlola kodwa ukuhlolwa okuzithobayo kokuthi wena, njengesiguli, uzizwa kanjani ngesimo sakho. Ukuhlonza ngokufanele ukuxoxwa kubalulekile ngoba kunquma ukuthi imithi ethile ingamiswa noma uma ukwenza kanjalo kungahle kusheshe futhi kubangele ukubuyela emuva .
Kulokhu, i-ACR isungule lokho okubizwa ngokuthi i-DAS28, enamanyathelo amane ahlukene. "I-DAS" isichazamazwi sokuthi "isigaba somsebenzi wesifo," kuyilapho u-28 ubhekisela enombolweni yamalungu ahlolwe ekuhlolweni.
I-DAS ibheka lokhu okulandelayo:
- Inombolo yamalungu amathenda udokotela wakho athola (ngaphandle kuka-28)
- Inani lamalungu avuvukala udokotela wakho athola (ngaphandle kuka-28)
- Imiphumela yakho ye-ESR ne-CRP (evamile ngokungajwayelekile)
- Indlela ozizwa ngayo impilo yakho yonke ngokumaka isimo sakho kumgqa wamamitha angu-10 lapho umkhawulo owodwa "uhle kakhulu" kanti omunye "kubi kakhulu"
Le miphumela isetshenziselwa ifomula eyinkimbinkimbi yezibalo ukubala amaphuzu akho jikelele. I-DAS28 engaphezu kuka-5.1 ibonisa izifo ezisebenzayo, ngaphansi kuka-3.2 kuphakamisa imisebenzi ephansi yesifo, futhi ngaphansi kuka-2.6 kubhekwa ukuxolelwa.
Ukuhlonza okuhlukile
Ngendlela efanayo ukuthi izivivinyo zingasiza ukuhlukanisa phakathi kwesifo samathambo nesifo se-osteoarthritis, abanye bangalawulwa ukuthi baqiniseke uma kunezinye izimbangela zezimpawu zakho. Lokhu kuyiqiniso ikakhulukazi uma imiphumela yakho yokuhlolwa kwamathambo e-rheumatoid ingabonakali, ingaqondakali, noma ingalungile.
Lezi zingase zihlanganise izifo ezizenzekelayo, izifo ezixhumene nezicubu, nezifo ezingapheli ezivuvukala njenge:
- I-Fibromyalgia
- Isifo se-Lyme
- Ama-syndromes aseMyelodysplastic
- I-paraneoplastic syndromes
- I-polymyalgia rheumatica
- I-arthritis yengqondo
- I-Sarcoidosis
- I-Sjogren syndrome
- I-systemic lupus erythematosus (lupus)
> Imithombo:
> Aletaha, D .; I-Neogi, T .; USilman, A. et al. "Isibalo sokuhlukanisa izifo ze-Arthritis sika-2010: I-American College of Rheumatology / i-European League ngokumelene neRheumatism Collaborative Initiativ e." I-Arthritis Rheum. 2010: 62 (9): 2565-81 I-DOI: 10.1002 / ubuciko.27584.
> Anderson, J .; I-Caplan, L .; Yazdany, J. et al. "I- Arthritis Care Arthritis Disease Imisebenzi Yokusebenza: Ikhomishana YaseMelika Ye-Rheumatology Izincomo Zokusetshenziswa Emtholampilo Yokuzivocavoca." I- Arthritis Care Res. 2012; 64 (5): 6. I-DOI: 10.1002 / acr.21649.
> Bykerk, V. kanye noMasarotti, E. "I-ACR / EULAR yokukhipha imigomo entsha: inhloso yokuthuthukisa izindlela ezintsha zokuxolelwa." I- Rheumatology . 2012; 51: vi16vi20. I-DOI: 10.1093 / rheumatology / kes281.
> Smolen, J .; Aletaha, D .; noMcInnes, I. "I-rheumatoid arthritis. " Lancet. 2017; 388 (10055): 2023-38. I-DOI: 10.1016 / So140-6736 (16) 30173-8.