Ucwaningo lungase luthole impendulo
Izidakamizwa ezingekho-steroidal anti-inflammatory ( NSAIDs ) zingenye yezindlela ezibalulekile zokwelapha ze- osteoarthritis ezinqulwini namadolo. Ama-NSAID asebenza ngokuvimbela i-molecule, ebizwa ngokuthi i-cyclooxygenase eyovimbela ukukhiqizwa kwamanqamuzana amaningi okuthiwa i-prostaglandins. I-Prostaglandin inomthwalo wemisebenzi eminingi emzimbeni wethu, enye yazo ukuvuvukala.
Ngokuvimbela ukuhlanganiswa kwe-prostaglandins ama-NSAID ancipha ukuvuvukala emzimbeni wethu, futhi lokho kuhamba ngokunciphisa okukhulu ebuhlungu.
I-Prostaglandins nayo ibhekene neminye imisebenzi eminingana emzimbeni njenge-up-keeping of the stining lining, ngakho-ke ezinye imiphumela emibi ye-NSAID zivela ekuvimbeleni leyo mi sebenzi kanye; I-NSAID ngokukhethekile ingaba nzima esiswini, futhi ukusetshenziswa kwesikhathi eside kwama-NSAID kungabangela isisu noma i-duodenal (amathumbu amancane emathumbu). Lezi zidakamizwa ziye zafundwa kahle futhi zivame ukubakwe kubantu abane-osteoarthritis. Ukusetshenziswa kwama-NSAID kulezi zilungiselelo kungenye yezincomo ezimbalwa eziqinile ezinamandla ezenziwa yi-American Academy of Orthopedic Surgeons (AAOS) emihlahlandlela yazo yokwelashwa kwe-knee osteoarthritis.
Odokotela bavame ukuphakamisa ama-NSAID njengokwelashwa kokuqala kwe-OA. Kunezinhlobo zezidakamizwa ngaphansi kwalesi sigaba semithi ethandwa kakhulu yi-aspirin, ibuprofen (Advil), ne-naproxen (Aleve).
I-Acetaminophen eyaziwa nangokuthi i-paracetamol noma i-Tylenol iyisidakamizwa esiseduze kakhulu nesigaba se-NSAID, isetshenziswa njalo ngezinhloso ezifanayo, kodwa ayinayo impahla eqinile yokuvuvukala ngakho ngokuvamile ayithathwa njengengxenye yeklasi le-NSAID.
Ngenkathi sinesidingo esiningi esisekela ukusetshenziswa kwe-NSAD esimweni se-OA, sinemininingwane encane kakhulu ongasitshela yona, yi-NSAID ephumelela kakhulu kunezinye.
Kuze kube ukubuyekezwa kwamuva okufike eLancet kulo Mashi. Ngaphambi kokuba siqhubekele phambili, hlala ukhulume kafushane ngomthombo walolu cwaningo. I-Lancet yincwadi yezokwelapha esekelwe e-United Kingdom eye yaba khona kusukela ngo-1820s, ingenye yezincwadi ezihlonishwa kakhulu, futhi yayisiyisiteji somthelela omkhulu kunazo zonke ezithinta izihloko zomlando emlandweni wezokwelapha.
Njengesibonelo sezinye izihloko eziphulwa phansi ezishicilelwe kuqala eLancet zincwadi kaLister ngo-1870 mayelana nomphumela wamasu oyinyumba emiphumeleni yokuhlinzwa eyayiyi-ncwadi yokuqala eyabenza odokotela abahlinzayo ukubethela izandla zabo nawo wonke amathuluzi ngaphambi kokuhlinzwa . I-lancet nayo uRonald Ross ishicilela ukuthi u-mosquito usakaza i-malaria, uMcBride ushicilela ukuthi i-thalidomide (eyake isetshenziswa imithi ebizwa ngokuthi i-antinausea imithi esetshenziselwa ukukhulelwa) ibangelwa ukukhubazeka okukhulu kokuzalwa.
I-Lancet ishicilela izihloko zekhwalithi eziphezulu futhi emlandweni wabo wamuva nje zenze umsebenzi wokushicilela ukubuyekezwa kwekhwalithi ephakeme lapho zihlanganisa khona idatha kusuka ezifundweni eziningi ukuze uzame ukuphendula umbuzo obalulekile emtholampilo. Emkhakheni wabo wokugcina, iphephandaba lizama ukuphendula umbuzo othi "Yiyiphi i-NSAID engcono kakhulu ekuphulukiseni ubuhlungu obuhlobene ne-osteoarthritis yamadolo nesikhumba?"
Masihambe lapha ngomzuzwana owodwa futhi senze isimemezelo esibaluleke kakhulu. Lesi sifundo asizange sihlole ukuphepha. Ngakho akekho kulolu datha olubhekisela emaphrofayeleni omphumela ohlangothini noma ukuthi kuyingozi kangakanani le mithi, babheka kuphela ukuphumelela kosizo lwezinhlungu.
Ucwaningo lwathola imibiko engu-8 973, okuyi-74 eyayihlolwe ngezikhathi ezingahleleki ngokuqhathaniswa nama-NSAID ayisikhombisa ahlukene no-Tylenol. Lokhu yibufakazi obuningi obuphezulu obuzoqoqwa esihlokweni. Phakathi kwazo zonke lezi zivivinyo kwakukhona abantu ababalelwa ku-60 000 abaphathwa ngezindlela ezihlukahlukene ze-NSAID kanye nokulinganisa okuhlukahlukene ngenxa yobuhlungu. Bese benza ukuhlaziywa kwe-meta, okuhlanganisa wonke lawa maguli abe yiqembu elilodwa ukubona ukuthi yiziphi ze-NSAID kanye nemingcele esetshenzisiwe eyasebenza kakhulu ekuthuthukiseni ubuhlungu.
Ngenkathi lokhu kungaphezu kokulula kwezindlela zabo, imininingwane yendlela ingekho ngaphezu kwalesi sihloko.
Ngaphandle kokuhlanganiswa kwama-drug-dose angu-22, ku-5 akuzange kwenziwe okungcono kune-placebo (i-pill-pilill). Lezo zingu-5 zaziyi-Tylenol ezingaphansi kuka-2 amagremu futhi ngaphansi kuka-3 amagremu ukuhlolwa kwansuku zonke, i-diclofenac (i-Voltaren) ngo-70mg ngosuku, iNaproxen ngo-750mg ngosuku, ne-ibuprofen ngo-1200mg ngosuku. Kubalulekile ukuphawula ukuthi lezi yimiphumela ethize ye-dose, futhi amanani aphezulu ala mithi kwezinye izimo aphumelele. Ukuphazamiseka okuyisithupha kwabonakala kuhle kakhulu: i-diclofenac (aka Voltaren) 150 mg / usuku, etoricoxib (aka Arcoxia) 30 mg / usuku, 60 mg / usuku, 90 mg / usuku, ne-rofecoxib (i-Vioxx) 25 mg / usuku kanye no-50 mg / usuku.
Ukuhlola okuningi okunamathekisthi kubonisa ukuthi i-diclofenac 150 mg / day kanye ne-etoricoxib 60 mg / ngosuku yenza okuhle ngokukhululeka kobuhlungu lapho kuqhathaniswa nazo zonke ezinye izidakamizwa nemithi. Uma kuqhathaniswa nama-NSAID ahlukene ngokwemiphumela yawo ekuthuthukiseni umsebenzi, kubonakala sengathi i-diclofenac (i-Voltaren) 150mg / usuku ne-rofecoxib (i-Vioxx) 25mg / ngosuku.
Ngaphambi kokuba siqhubekele phambili kufanele sigxile kakhulu ku-Vioxx (rofecoxib). Ngesikhathi kulesi sivivinyo kwaboniswa ukuthi kuyisidakamizwa esiphumelelayo sokuphumula ubuhlungu nokuthuthukiswa komsebenzi, i-Vioxx akuyona imithi ephephile. I-FDA isisusile emakethe ngenxa yokukhathazeka kwengozi eyengeziwe yokuhlaselwa kwenhliziyo nokushaywa okuhambisana nokusetshenziswa kwesikhathi eside. Kuphumelela njengoba ukuhlenga ubuhlungu akusizi ngalutho ngenxa yemiphumela yaso emibi. Akufanele kubhekwe njengendlela yokusebenza.
Ngakho kusho ukuthini lokho? Lena yonke imininingwane yedatha ukuze uhlele futhi ahumushe. Ngombono wami kunamaphuzu ambalwa athatha amaphuzu asekhaya kusukela kulolu cwaningo oluphezulu kakhulu lwe-meta-analysis. Okokuqala, i-paracetamol (eyaziwa nangokuthi i-acetaminophen noma i-Tylenol) ingase ingasebenzi kahle ekulawuleni ubuhlungu kunalokho esikucabangayo. Manje kubalulekile ukuqaphela ukuthi lolu cwaningo luqondile osteoarthritis we-hip namadolo. Ngakho mhlawumbe iTylenol inkulu ekulawuleni ubuhlungu kwezinye izilungiselelo, njengekhanda, lolu cwaningo alukhulumi lokho. Kuze kufike i-OA emaceleni nasemadolweni, kubonakala sengathi iTylenol iyisinqumo esibi. I-Diclofenac ku-150mg / ngosuku yayiwuphumelela kakhulu ekulawuleni ubuhlungu nokusebenza ngcono.
Lokhu kubheka imiphumela mayelana nezikhathi ezincane neziphakathi nesikhathi-sesikhathi ezinyangeni ezingaba ngu-3 ngokwesilinganiso. Ingabe lezi zidakamizwa zaziyobe zenziwa ngokwehlukile ngokweqile isikhathi eside njengeminyaka eminingi? Mhlawumbe, sidinga izifundo eziningi zesikhathi eside ukuze sisho ngokuqinisekile. Into eyinkimbinkimbi ngokuhumusha le datha ukuthi ayikwazi ukubhekana nephrofayli yokuphepha yale mithi. Ama-NSAID aboniswe ukwandisa ingozi yokugaya amathumbu (isisu nesisu samathumbu amancane), kanye nokwandisa ingozi yokuhlaselwa yinhliziyo. Futhi izinga lapho i-NSAID ngayinye, kanye nokuhlolwa kwe-NSAID ngayinye, iphakamisa lezo zingozi zingase zihluke. Isinqumo sokuqala imithi emisha yokwelapha i-OA ye-hip namadolo kufanele ixoxwe ngokucophelela nodokotela wakho, ukuze nonke nisindise ubuhle kanye nokudla komuthi ngamunye bese ukhetha isixazululo esifanele kuwe .