Option Ephumelelayo Ukwelapha Abanye Abantu
Inhlanganisela ehlukene ye- DMARD (izifo ezishintsha izifo ezilwa nokulwa nezifo) zingabhalwa ukuphatha i- arthritis ye-rheumatoid ngokungafani ne-DMARD eyodwa. Ukwelapha kathathu, okuphakathi kwezinketho zokwelashwa, kubhekisela ekusetshenzisweni kwe-DMARD emithathu ehlukene; ngezinye izikhathi kungabhekisela kuma-DMARD amabili ahlukene kanye nomthamo owodwa we- glucocorticoid .
Kuyini Ukwelashwa Okuthathu?
Inhlanganisela evamile ye-DMARD esetshenziselwa ukwelashwa kathathu ngesifo samathambo esibizwa ngokuthi i-rheumatoid arthritis ihlanganisa methotrexate , sulfasalazine (igama elibizwa ngegama elithi Azulfidine), ne- hydroxychloroquine (Plaquenil).
Ngokujwayelekile, i-DMARD eyodwa (i-monotherapy) izohlolwa kuqala, kodwa uma impendulo inganele, udokotela nesiguli babezocabangela ezinye izindlela zokwelashwa.
Ubani Okufanele Acabange Ukwelashwa Okuyisithathu?
Ngo-2012, iziqondiso zokwelashwa ezivela e-American College of Rheumatology, kanye neCanada Rheumatology Association, zincoma ukusetshenziswa kwe-combination ofrapy ne-DMARD-kuhlanganise nokwelapha kathathu-kubantu abane-arthritis yokuqala, okuyizinto ezilingana nezifo ezimbi, kanye nabampofu ukubikezela. Ukwelashwa kathathu kungacatshangwa ngendlela efanele kulabo abaye basabela ngendlela engafanele kwi-DMARD eyodwa.
Izincomo ze-European League Against Rheumatism (EULAR) zokwelashwa kwesifo samathambo ngo-2013 zazingacacile futhi zisho nje ukuthi iziguli ezingakaze zibekwe i-DMARD, i-monotherapy noma i-combination combination itholakala. Uma iqhinga lokuqala le-DMARD lihluleka, ukushintshela kwi-DMARD ehlukile kungacatshangwa.
I-New American College of Rheumatology iziqondiso eziphathelene nesifo sofuba se-rheumatoid arthritis esifundazweni sokuqala, uma isifo sesifo sezinhlungu singasese silinganiselwe ukuphakama ne-DMARD monotherapy (ngaphandle noma i-glucocorticoid), inhlanganisela ye-DMARD noma i- TNF inhibitor noma i- biologic ngaphandle kwe-TNF i-inhibitor (ngaphandle kokuthandana nomyalelo, futhi nge-orthotrexate noma ngaphandle) kufanele icatshangelwe kunokuba iqhubeke ne-monotherapy.
(Qaphela: I-oda lokuthandayo ayitholakali ngoba izihloko zezidakamizwa zezinhloko zezihloko azikho. Iziqondiso zesikhathi esizayo zingase zibheke leso sici.)
Yini Eyayifundwa Ngokwelashwa Okuyisithathu?
Izifundo zokuqala eziveze ukuthi inzuzo yokwelashwa kathathu kuqhathaniswa ne-monotherapy ibonakala ezincwadini zesayensi eminyakeni yama-1990. Ucwaningo olwenziwa ngo-1999 luhlolisise ukuphumelela nokubekezeleliswa kwemithi emithathu (methotrexate, sulfasalazine, kanye ne-plaquenil) kanye ne-dose prednisone ephansi uma kuqhathaniswa ne-monotherapy noma ngaphandle kwe-oral prednisone kubantu abane-arthritis yokuqala noma esebenzayo. Kwakunqunywe ukuthi ukwelashwa kathathu kwaba nokuphumelela kangcono ngaphandle kokuphepheka kancane kune-monotherapy uma ucabangela ikhono layo lokukhipha ukuxolelwa .
Ucwaningo olwanyatheliswa ngo-2002 lwaphetha ngokuthi kubantu abane-arthritis ye-rheumatoid, ukwelapha kathathu ne-methotrexate, sulfasalazine, ne-plaquenil kwakunakekelwa kahle futhi kuphumelela kakhulu kunokwelapha okuhlanganiswa ne-methotrexate ne-sulfasalazine. Ukwelapha kathathu "kwakungcono kakhulu" kuya kwe-methotrexate ne-hydroxychloroquine.
Ngo-2010, ukubuyekezwa okuhleliwe kweCyrus ne-meta-analysis, okubheka ukuthi i-methotrexate i-monotherapy ne-combination combination, isiphetho sokuthi bekukhona umehluko omkhulu phakathi kwamacebo.
Ngokuvamile, abantu abangu-9 kwabangu-100 bayeka ukuthatha methotrexate ngenxa yemiphumela emibi, kuyilapho abangu-14 kwabangu-100 bayeka ukumisa methotrexate ngokubambisana nelinye i-DMARD.
Imiphumela eyethulwa emhlanganweni wesayense wonyaka we-2013 we-American College of Rheumatology yembula ukuthi amaphesenti aphezulu abantu abane-arthritis ye-rheumatoid ayinqatshelwa ukwelashwa kathathu ngemva kweminyaka eyodwa noma emibili. Ukuhlunga ukuthi kungani kunezinga eliphezulu lokuyeka ukulula, akusikho okulula, kodwa esinye sezizathu kungenzeka ukuthi abantu bakhetha amaphilisi ambalwa ukuthatha, hhayi amaphilisi amaningi.
Ingabe Ukwelapha Okuthathu Okuvamile Kubhalwe?
Naphezu kokuphepha nokuphumelela kwayo, ukwelapha kathathu akuvamile ukuhamba ukwelashwa emtholampilo uma i-methotrexate yedwa inganele.
Kubikwa ukuthi i-Sparks JA et al., Kusukela ngo-2009 kuya ku-2014, amaphesenti angu-0.7 ama-arthritis angaba ngu-25 000 we-rheumatoid arthritis athuthele ekwelapheni kathathu kusukela ohlelweni lwabo lwasekuqaleni lwe-DMARD. Ngokuqhathanisa, amaphesenti angu-11.1 weziguli adane nomuthi we-biologic ngaphezu kwe-DMARD yabo. Yilokho-ke, nakuba imiphumela yocwaningo ibonise ukuthi ukwelashwa kathathu kuphumelela njenge-biologics ye-rheumatoid arthritis-futhi ngokuqinisekile kubiza kakhulu.
Ukwelapha kathathu (methotrexate, sulfasalazine, plaquenil) kuyabiza kakhulu kunokuhlanganiswa kwe-methotrexate ne- Enbrel (etanercept) -izinkulungwane ezingaphansi kwesiguli ngesiguli ngonyaka. Kuye kwaphakanyiswa ukuthi ukwelashwa kathathu kufanele kuvivinywa ngaphambi kokuba i-biologic, njenge-Enbrel, ngenxa yokubiza izindleko. Isinyathelo sokufika ku-Enbrel singenziwa kamuva, kwiziguli ezineempendulo ezinganele ngokwelapha kathathu.
Naphezu kwezindleko zokwelashwa kathathu, ekusebenzeni kwemitholampilo, i-TNF inhibitor yiyona ndlela yokukhetha yokwelashwa okhethwayo uma i-methotrexate yedwa inganele. Ngokuthakazelisayo, ngokuthuthukiswa kwesigaba semithi esisha, eyaziwa ngokuthi yizinto eziphilayo , okungase kushintshe futhi. I-biosimilar ngumkhiqizo wezinto eziphilayo ezifana kakhulu nesisetshenziswa se-biological reference reference se-US. Kuthiwa, lokhu kufanele kwenziwe ukwelashwa okukhona okuphumelelayo njengezidakamizwa ze-biologic ngentengo ephansi. Mhlawumbe ama-biosimilars angase abe indlela ekhethwayo uma i-methotrexate yedwa ihluleka.
> Imithombo:
> Katchamart, W et al. Ukubuyekezwa kwe-Cochrane. I-Methotrexate yodwa ngokumelene ne-methotrexate ngokuhambisana neminye imithi ye-rheumatoid arthritis. Ngo-Ephreli 14, 2010.
> Mottonen, TT et al. Ukuhlanganiswa Kwama-DMARD Therapy Kuhlanganisa ne-Corticosteroids ku-Arthritis Yasekuqaleni Ye-Rheumatoid. I-Rheumatology yezokwelapha kanye nokuhlola. 1999.
> O'Dell, JR, et al. Imithi ye-Active Rheumatoid Arthritis Ngemuva kokuhluleka kwe-Methotrexate. I-New England Journal of Medicine. Julayi 25, 2013.
> O'Dell, JR, et al. Ukwelashwa kwamathambo e-rheumatoid nge methotrexate ne-hydroxychloroquine, methotrexate ne-sulfasalazine, noma ukuhlanganiswa kwemithi emithathu. Imiphumela yenkathi yokulawulwa kwe-placebo eneminyaka emibili, engahleliwe, kabili-yimpumputhe. I-Arthritis & I-Rheumatology 46: 1164-1170. 2002.
> Sparks, JA, et al. Umbiko omfushane: Ukuqiniswa kokwelashwa kathathu Emva kokulashwa nge-Nonbiologic Disease-Ukuguqula izidakamizwa ze-Antirheumatic ye-Rheumatoid Arthritis e-United States Kusukela ngo-2009 kuya ku-2014. I-arthritis ne-Rheumatology. NgoJuni 24, 2016.