Izincomo zokusetshenziswa kwe-DMARD kanye ne-Biologic Drugs
Ngo-2012, i-American College of Rheumatology (ACR) ivuselele izincomo zokwelashwa kwesifo se- rheumatoid arthritis . Izincomo ze-ACR zika-2012 zokusetshenziswa kwezidakamizwa eziphikisana nezifo (anti-rheumatic drugs ) (DMARD) nezidakamizwa ze-biologic zesifo samathambo yisifo sokubuyekezwa kweziphakamiso zika-2008.
Izibuyekezo ze-2012 ezibhekiswe kuzo:
- izinkomba zokuqala noma ukushintsha izidakamizwa ze-DMARD nezidakamizwa
- ukusetshenziswa kwezidakamizwa ezigulini ezinobungozi obukhulu, kuhlanganise nalabo abane-hepatitis, ukwehluleka kwenhliziyo ukuhluleka, nokulimala
- ukuhlolwa kwesifo sofuba ukuqala kweziguli noma ukuthatha izidakamizwa ze-biologic okwamanje
- ukugoma ezigulini eziqala noma okwamanje kuthatha i-DMARD noma izidakamizwa ze-biologic
Izincomo zisekelwe ekusetshenzisweni kwezincwadi ze-PubMed kanye ne-Cochrane Database yezibuyekezo ezihleliwe, ukuhlolwa kwesimo somtholampilo, nombono wochwepheshe. Lezi zincwadi zafunwa ama-DMARD angu-8: i- azathioprin (Imuran), i- cyclosporine , i- hydroxychloroquine (i-Plaquenil), i- leflunomide (i-Arava), i- methotrexate , i-minocycline (i-Minocin), igolide ne- sulfasalazine (i-Azulfidine) nezidakamizwa ezingu-9 ze-biologic: i- abatacept (i-Orencia) , i- adalimumab (i-Huma), i- anakinra (i-Kineret), isi-certolizumab pegol (iCimzia), i- etanercept (i-Enbrel), i- golimumab (i-Simponi), i- infliximab (i-Remicade), i-rituxab (i-Rituxan), ne -cilizumab (i-Actemra). Ngenxa yokusetshenziswa okungajwayelekile kwezidakamizwa nokuntuleka kwedatha entsha etholakala ekusesha, i-azathioprine, i-cyclosporine, igolide, ne-anakinra ayifakiwe kulezi zincomo.
Orencia, Rituxan, Kineret, ne-Actemra yizidakamizwa ezingekho ze-TNF ze-biologic. I-Enbrel, Remicade, i-Humira, i-Simponi, ne-Cimzia yi-block block ye-TNF.
Kulezi ziguli ezine-arthritis zakuqala (ezichazwa ngokuthi zine-arthritis ye-rheumatoid ezinyangeni ezingaphansi kwezingu-6) kanye neziguli ezine-arthritis ezisemthethweni eziphathwayo ziphathwa nganoma yikuphi i-DMARD noma izidakamizwa ze-biologic, umgomo wokwelashwa ngumsebenzi ophansi wezifo noma ukuxolelwa.
Ukuqala noma Ukuguqula i-DMARD ne-Biologic Drugs
- I-DMARD monotherapy (ukwelashwa ngesidakamizwa esisodwa) yanconywa iziguli zakuqala zesifo se-rheumatoid ezinezinkinga eziphansi zezifo noma ezenzelwe isifo esiphathelene nesifo esiphakeme lapho kungekho khona izimo zokubikezela ezimbi (okuyizimo ezingekho esimweni esibi selesi sifo).
- I-DMARD yokwelashwa kokuncintisana yanconywa iziguli zakudala ze-rheumatoid arthritis ezisebenza ngokulinganisela noma eziphezulu kanye nezici ezimbi zokubikezela.
- Ukusetshenziswa kwe- blocker ye- TNF noma ngaphandle kwe-methotrexate kunconywa iziguli zakudala zengqondo ye-rheumatoid ezinezinkinga eziphezulu zezifo kanye nezici ezimbi zokubikezela. Uma i-blocker ye-TNF i-infliximab (Remicade), noma kunjalo, kufanele isetshenziswe nge- methotrexate.
- Kulezi ziguli ezine-arthritis ezisungulwe yi-rheumatoid, uma emva kwezinyanga ezingu-3 ze-DMARD monotherapy isiguli sinqamuka kusuka emsebenzini ophansi wezifo ukuya emisebenzini yesilinganiso noma isifo esiphakeme, i-methotrexate, i-hydroxychloroquine, noma i-leflunomide (i-Arava) kufanele ifakwe.
- Ngemuva kwezinyanga ezingu-3 ze-methotrexate noma i-methotrexate / i-DMARD yokwelashwa okuhlanganisiwe, engeza enye i-non-methotrexate DMARD noma ushintshele kwenye i-non-methotrexate DMARD uma isiguli esisungulwe sisenomsebenzi ohambelana nesifo esiphakeme - noma engeza noma ushintshela ku-blocker ye-TNF, i-abatacept ( Orencia), noma i-rituximab (i-Rituxan).
- Ngemuva kwezinyanga ezintathu zokwelapha nge-blocker ye-TNF, uma isiguli sinomsebenzi olinganiselayo / ophezulu wesifo ohlobene nokungabi nampendulo noma ukulahlekelwa inzuzo emithini yokwelashwa, ukushintshela kwenye i-blocker ye-TNF noma i-non-TNF biologic kunconywa.
- Uma kunesifo esilinganiselwe / esiphakeme emva kwezinyanga ezingu-6 zokwelapha nge-non-TNF biologic ngenxa yokungabi nampendulo noma ukulahlekelwa inzuzo, isiguli kufanele sitshintshelwe ku-different-non-TNF biologic noma ku-blocker ye-TNF.
- Uma isiguli sinomsebenzi ophezulu wesifo futhi sihluleka i-blocker ye-TNF ngenxa yesenzakalo esibi esibi, ukushintshwa ku-non-TNF biologic kunconywa.
- Uma isiguli sinomsebenzi wesifo olinganiselayo / esiphakeme futhi sihluleka i-blocker ye-TNF ngenxa yesenzakalo esingathí sina esingathí sina, ukushintshela kwenye i-blocker ye-TNF noma i-non-TNF biologic kunconywa.
- Uma isiguli sinomsebenzi wesifo olinganiselayo / esiphakeme ngemuva kokuhluleka okungezona i-TNF biologic ngenxa yesenzakalo esibi, ukushintshela kwesinye isikhombi se-non-TNF noma ukuvinjwa kwe-TNF kunconywa.
Ukusetshenziswa kwezinto eziphilayo ze-Rheumatoid Arthritis Iziguli ezine-Hepatitis, i-Malignancy, noma i-Congestive Heart Failure
- I-Etanercept (Enbrel) Kunconywa iziguli zesifo se-rheumatoid isifo se-hepatitis C.
- Izidakamizwa ze-biologic azikhuthazwa iziguli zesifo sengculazi esingenasifo esiphethwe yi-hepatitis B esingapheli noma ezinye iziguli ezithathelwanayo eziphethwe yi-hepatitis B.
- Ukuqala noma ukuvuselela ukwelashwa kwe-biologic kunconywa iziguli eziphathwe izidakamizwa eziqinile iminyaka engaphezu kwengu-5 eyedlule noma iziguli eziye zelashwa ngomdlavuza wesikhumba ongenayo i-nonmelanoma ngaphezu kweminyaka emihlanu eyedlule.
- I-TNF blockers ayinconywa iziguli zesifo se-rheumatoid arthritis esinezinga elilinganiselayo noma elikhulu lokuncipha kwenhliziyo.
Isifo sofuba (TB) Ukuhlola
- Ukuhlolwa kwesifo sofuba esifinyelele kunconywa ukuthi iziguli ze-arthritis ze-rheumatoid zibheke ukwelashwa kwe-biologic.
- Kungakhathaliseki ukuthi kunezifo ezingezinhle zokutheleleka kwe-TB, ukuhlolwa kwesifo se-tuberculin noma i-interferon-gamma-release-assay kufanele kwenziwe kumagciwane asekulungele ukuqala ukwelashwa kwe-biologic.
Imishanguzo yeziguli Ukuqala noma ukuthola ama-DMARD noma i-Biologic Drugs
- Imishanguzo ebulawe (i-pneumococcal, i-influenza, ne-hepatitis B), i-recombinant (i-papillomavirus yabantu), nokugoma imithi yokugoma (herpes zoster) kufanele inikezwe ngaphambi kokuqala i-DMARD noma i-biologic drug.
- Uma kungakenziwa kakade, imishanguzo ebulawe noma ephindaphindiwe kufanele inikezwe iziguli ezithathele i-DMARD noma izidakamizwa ze-biologic.
- Umuthi wokugoma we-herpes zoster unganikezwa kulabo asebevele bathatha i-DMARD.
IMINININGWANE YAMAKHAYA - 2015 ACR Yokuphatha I-Rheumatoid Arthritis
Imihlahlandlela iphinde ishicilelwe ngo-2015 njengesibuyekezo emihlahlandlela ka-2012. Isiqondiso sika-2015 sihlanganisa ukusetshenziswa kwezidakamizwa ezivamile zesifo-ukuguqula izidakamizwa ze-antirheumatic (i-DMARD), ama-biologic agents, i- Xeljanz (tofacitinib) , ne-glucocorticoids ekuqaleni (ezinyangeni ezingaphansi kwengu-6) futhi yasungulwa (izinyanga ezingu-6 noma ngaphezulu) isifo samathambo. Okunye okuhlinzekwe ku-isiqondiso sika-2015 yizincomo zokusebenzisa izindlela zokuphatha , ukuphazamisa nokuyeka, kanye nokusetshenziswa kwama agent we-biologic kanye ne-DMARD kuziguli ezine-hepatitis, ukwehluleka kwenhliziyo, ukulimala kanye nezifo ezimbi.
Isiqondiso sibhekisela ekusetshenzisweni kwemigomo ezigulini zokuqala noma zokwamukela izidakamizwa ze-DMARD noma izidakamizwa ze-biologic, ukuhlolwa kwesifo sofuba ezigulini eziqala noma zokwamukela ama-biologic agents noma i -facitinib, nokuqapha i-laboratory ye-DMARD yendabuko. Lesi siqondiso sihlanganisa izincomo ezingu-74 okuyi-23% ezibhekwa njengeziqinile futhi 77% zinemibandela. Ungayithola lapha: I-American College of Rheumatology Guideline ye-American College of Treatment of Rheumatoid Arthritis.
Umthombo:
Ukuvuselelwa kweziphakamiso ze-ACR zika-2008 zokusetshenziswa kwe-DMARD kanye ne-Biologics ku-Treatment of Rheumatoid Arthritis. Ukunakekelwa kwe-Arthritis Nokucwaninga. iphe. 625-639. Singh JA et al. Meyi 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract
Umhlahlandlela we-American American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis Singh JA et al. Ukunakekela i-Arthritis & Ucwaningo DOI 10.1002 / acr.22783
http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf