Ukuphatha Izinto Ezihlangene Nezikhumba ze-Psoriatic Arthritis
I-arthritis ye-Psoriatic iyinhlobo engapheliyo ye- arthritis evuthayo ehlobene ne-psoriasis, isifo sesikhumba. Izimpawu zokuvuvukala okuhlangene kanye ne-psoriasis ngokuvamile azikwenzeka ngesikhathi esifanayo, noma kunjalo. Kulezi ziguli eziningi ze-psoriatic arthritis, izimpawu ze-psoriasis zithuthuka ngaphambi kwezimpawu ze-arthritis. Nokho, cishe ngamaphesenti angaba ngu-15, izimpawu zesifo samathambo zikhula ngaphambi kokuba i-psoriasis ivele.
Kwezinye iziguli ezingu-15, i-psoriatic arthritis iyatholakala ngesikhathi esisodwa njenge-psoriasis.
Kunezinhlobo ezinhlanu ze-arthritis ye-psoriatic : i-symmetric, asymmetric, distal interphalangeal predominant, spondylitis ne-arthritis mutilans. Ukuxilongwa kokuqala kanye nokwelashwa kubalulekile ukuze kunciphise ingozi yokulimala okuhlanganyelwe okuhlala njalo. Ukwelashwa kuhloswe ekulawuleni ukuvuvukala, futhi ngezici ezihlangene nezikhumba zesifo, zombili kufanele zibhekiswe.
Iqembu elisebenza nge-EULAR (i-European League Against Rheumatism) lenza ukubuyekezwa okuhlelekile kwezincwadi zesayensi ukuhlola ukwelashwa kwemithi ye-arthritis ye-psoriatic. Ekuqaleni, i-EULAR yashicilela izincomo ngo-2012. Kodwa ngo-2015, ukubuyekezwa kwakudingeka kakade ngenxa yobufakazi obusha nokutholakala kwezidakamizwa ezintsha. Ngo-2012, kwakukhona izigaba ezimbili ze- DMARD (izidakamizwa eziguqula izidakamizwa ezilwa nesifo): izidakamizwa ezivamile ezihambisana nama-DMARD (ezifingqiwe csDMARD), ezihlanganisa methotrexate , i- Arava (leflunomide) , i- Azulfidine (sulfasalazine) kanye ne- biologic DMARDs (izifinyezo ze-BDMARD).
Ngo-2015, lesi sibuyekezo sihlanganisa isigaba sesithathu se-DMARD, esibizwa ngokuthi i-DMARD esetshenzisiwe ehlosiwe (okufingqiwe yi-tsDMARD), efaka i-PDE (phosphodiesterase inhibitors) kanye ne-JAK inhibitors (isib. Xeljanz [tofacitinib] ). Imihlahlandlela ebuyekeziwe evela ku-EULAR ihlanganisa izincomo ezingu-10 kanye nemigomo eyinhloko engaphezu kwe-5 yokwelapha i-psoriatic arthritis.
Izimiso Eziphezulu
- I-arthritis ye-Psoriatic i-heterogeneous (okungukuthi, iqukethe izici ezihlukene) nezifo ezinamandla ezingase zidinge ukwelashwa okuhlukahlukene.
- Ukwelashwa kwe-Psoriatic arthritis kufanele kuhlose ukunakekelwa okungcono futhi kufanele kususelwe kwisinqumo esabiwe phakathi kwesiguli nesifo se-rheumatologist , sicabangela ukusebenza kahle, ukuphepha, kanye nezindleko zokwelapha.
- I-Rheumatologists yizintatheli okufanele ngokuyinhloko zikhathalele izici ze- musculoskelet ze-psoriatic arthritis. Uma kukhona ukubandakanya isikhumba, i-rheumatologist kanye ne-dermatologist kufanele bahlanganyele ekuxilongweni nasekulawuleni izifo.
- Umgomo oyinhloko wokwelapha i-psoriatic arthritis ukukhulisa izinga lempilo elihlobene nempilo, elifeziwe ngokulawula izimpawu , ukuvimbela ukulimala kwesakhiwo, kanye nokugcina umsebenzi ovamile nokuhlanganyela komphakathi. Ukunciphisa ukuvuvukala kubalulekile ekufinyeleleni imigomo.
- Ukuphathwa kwesiguli se-psoriatic arthritis kumele kucabangele ukubonakaliswa okungaphezulu kwe-articular (okungukuthi, ngaphandle kwamalungu), i-syndrome ye-metabolic, isifo senhliziyo kanye nezinye izimo ze-comorbid .
Izincomo
Ukwelashwa kwe-arthritis ye-psoriatic kufanele kuhloswe ukukhululwa noma okuncane kakhulu kumsebenzi we-TB ophansi otholakala ngokuqapha okujwayelekile futhi wenze ukwenziwa kwemishanguzo njengoba kudingeka.
- Ama-NSAID (izidakamizwa ezingezona ukuvuvukala) ezingasetshenziselwa ukukhulula izimpawu nezimpawu ze-musculoskeletal.
- Kulezi ziguli ezine-arthritis ye-peripheral, ikakhulukazi kulabo abanamalungu amaningi avuvukala, ukulimala okuhlangene nokuvuvukala, izinga lokuphakama kwe- sedimentation kanye ne- CRP , kanye / noma ukubonakaliswa okunye okubonakalayo csDMARD kufanele kucatshangelwe ngesikhathi sokuqala, ne-methotrexate ekhethwe iziguli ezinokubandakanya isikhumba.
- Ukujova kwendawo ye-corticosteroids kumele kubhekwe njengendlela yokwelashwa (okuwukuthi, eyengeziwe). I- corticosteroids yesistimu emthamo ophansi kakhulu ungasetshenziswa ngokuqapha.
- Kulezi ziguli ezine-arthritis ye-peripheral ezinempendulo engenele okungenani eyodwa csDMARD, ukwelashwa nge-bDMARD kufanele kuqaliswe. I-bDMARD ivame ukuvimba i- TNF .
- Kulezi ziguli ezine-arthritis ye-peripheral ezinempendulo engenele okungenani eyodwa csDMARD engakwazi ukusebenzisa i-blocker ye-TNF, i-BDMARD ekhomba i-IL12 / 23 (isib., Stelara [ustekinumab] ) noma i-IL17 (isb., Secukinumab) ingacatshangwa.
- Kulezi ziguli ezine-arthritis yophiko lwangasese ezingaphenduli kahle okungenani eyodwa csDMARD futhi ezingakwazi ukusebenzisa i-bDMARD, i-tsDMARD ingacatshangwa.
- Ezigulini ezine- enthesitis esebenzayo kanye / noma i-dactylitis (ukuvuvukala kwedijithi yonke) enokungeneli okwanele kuma-NSAID noma izilonda zendawo ye-corticosteroids, i-bDMARD kufanele icatshangelwe. Isivimbela se-TNF ngokuvamile sizame kuqala.
- Ezigulini ezinezifo ezisebenzayo ze-axial, ezinokuphendula okungafanelekile kuma-NSAID, i-bDMARD kufanele icatshangelwe. I-block ye-TNF ivame ukuhlolwa kuqala.
- Ezigulini ezihluleka ukuphendula ku-bDMARD, ukushintshela kwenye i-bDMARD kufanele kucatshangelwe. Ukushintsha phakathi kwama-blocker ahlukene e-TNF kungabhekwa njengokufanele. I-TNF blockers ihlanganisa: Enbrel (etanercept) , Remicade (infliximab) , i- Humira (adalimumab) , i- Simponi (golimumab) ne- Cimzia (certolizumab pegol) .
Imithombo:
Izincomo ze-European League Against Rheumatism (EULAR) zokuphatha i-psoriatic arthritis nemithi yokwelashwa: isibuyekezo se-2015. Ama-Annal of the Rheumatic Diseases. UGossec L. et al. 2016; 75: 499-510 i-doi: 10.1136 / ngonyaka-2015-208337
http://ard.bmj.com/content/75/3/499.full
Ukwaziswa kwesineke: I-Psoriatic arthritis (Ngaphandle Kwezinto Eziyisisekelo). Kusesikhathini. UGladman noRitchlin. Kubuyekezwe 4/9/15.
http://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics