Kuvame ukushiwo ukuthi i-Methotrexate ayinakunaki
I-Arava (i-leflunomide) ibhekwa njengesidakamizwa sokulwa nesifo (DMARD) eshintsha isifo . Isidakamizwa, esavunywe yi-US FDA ngoSeptemba 11, 1998, sisetshenziselwa ukuphatha ngokulinganisela ukuya ku- arthritis esebenzayo yokuhlukunyezwa kwamathambo kubantu abadala. Isetshenziselwa ukunciphisa izimpawu nezibonakaliso zesifo samathambo, ukuvimbela ukulimala kwesakhiwo (isb., Ubufakazi be-x-ray bokukhulelwa kanye nendawo ehlangene yokunciphisa), nokuthuthukisa umsebenzi womzimba.
I-Arava ivame ukushiwo uma amanye ama-DMARD, ikakhulukazi i- methotrexate , engakwazi ukubekezelela noma ukukhiqiza impendulo enganele (ie, ukuhluleka ukulawula izimpawu).
Ukutholakala kanye nokuzibophezela
I-Arava itholakala ku-10 mg no-20 mg amaphilisi aphethwe amafilimu (amabhodlela wokubala angu-30). I-Arava itholakala futhi ku-100 mg 3-count count blister pack. Ngenxa yokuphila kwengxenye ende ye-Arava eziguli ze-rheumatoid arthritis kanye nekhefu eliphakanyisiwe lamahora angu-24 wokulinda, kunconywa ukuthi i-Arava iqale ngomthamo wokulayisha we-tablet eyodwa ye-100 mg ngosuku ngezinsuku ezingu-3. Ngemuva kokuthi umthamo wokulayisha uphelelwe, umthamo wansuku zonke we-20 mg Arava unconywa ukwelashwa kwesifo samathambo. Ithebhulethi engu-10 mg iyatholakala kulabo abadinga isilinganiso esincane ngenxa yemiphumela emibi ehlangene nomthamo ophakeme. Kungathatha amasonto ambalwa ngaphambi kokuthuthukiswa okuphawulekayo ebuhlungu obuhlangene noma ukuvuvukala okuhlangene. Izinzuzo ezigcwele angeke zifinyeleleke kuze kufike amasonto ayisithupha kuya kwangu-12 emva kwe-Arava.
Indlela Esebenza ngayo
I-Arava iyi-agent e-isoxazole e-immunomodulatory evimbela i-dihydroorotate dehydrogenase, i-enzyme ehilelekile ekuhlanganisweni kwe-pyrimidine. I-pyrimidines yakha izakhi ze-nucleic acid. I-Arava ihlotshaniswa nomsebenzi wokuvimbela (okusho ukuthi kuvimbela ukusabalalisa kwamaseli) futhi ekuvivinyweni, kuboniswe imiphumela ephikisana nokuvuvukala.
Ivimbela ukwakheka kwe-DNA okudingekayo ekwakheni amangqamuzana, njengamasosha omzimba omzimba. Ngokwenza kanjalo, kuphazamisa isimiso somzimba sokuzivikela . Indlela okusebenza ngayo ngokuqondile ukulawula isifo samathambo akuqondwa ngokugcwele.
Imiphumela emibi nokuphendula okubi
Ukusabela okubi okuvame kakhulu okuhlobene no-Arava kufaka phakathi isifo sohudo, isifo sokukhwehlela, isifo sokukhanda, ukutheleleka kokuphefumula, ama-enzyme ephakeme yesibindi (i-ALT ne-AST), i-alopecia, ne-rash. Ukuphakama kwama-enzyme yesibindi ngokuvamile kuthinta ngaphansi kwezingu-10% zeziguli ezithatha i-Arava, kodwa ngoba zingabangela ukulimala kwesibindi, ikakhulukazi ngokusetshenziswa kotshwala noma ngezinye izidakamizwa, ukuhlolwa kwegazi njalo kufanele kwenziwe ukuze kuqaphe isibindi.
Izenzakalo eziningi ezimbi zabikwa ukuthi zithinta u-1% ukuya ngaphansi kuka-3% weziguli zesifo se-rheumatoid arthritis ezithintekile ekuhlolweni kwe-Arava. Izinkinga zokugoba, kuhlanganise nokukhwehlela noma ukuphefumula, kubhekwa njengemiphumela emibi engavamile. Iziguli kufanele ziqaphele izimpawu zokuqala zezifo zamaphaphu futhi zibike lezo zimpawu uma zikhona.
Uhudo, umphumela ovame kakhulu, uthinta ama-20% weziguli eziphathwa nge-Arava. Uhudo ngenxa yokusetshenziswa kwe-Arava kuvame ukuthuthukisa ngesikhathi noma ngokuthatha imithi yokuvimbela isifo sohudo.
Kwezinye izimo, umthamo we-Arava ungadinga ukwehla.
Izixwayiso nezinkomba
I-Arava akufanele isetshenziswe ngabesifazane abakhulelwe noma ngabesifazane abangakhulelwa futhi basebenzisanga izisu. Ukukhulelwa kufanele kugwenywe ngenkathi ukwelashwa ne-Arava kanye nangaphambi kokuqedwa kwenqubo yokuqeda izidakamizwa ngemuva kokwelashwa ne-Arava.
Ukulimala okukhulu kwesibindi, kuhlanganise nokuhluleka kwesibindi esibulalayo, kubikiwe kwezinye iziguli ezaphathwa nge-Arava. Iziguli ezinezifo zesibindi esivela zikhona noma ezingapheli akufanele ziphathwe nge-Arava.
I-Arava ayikhuthazwa iziguli ezine-immunodeficiency ejulile, i-bone marrow dysplasia, noma izifo ezinzima noma ezingalawuleki.
Imibiko ejwayelekile ye-pancytopenia, i-agranulocytosis, ne-thrombocytoplenia ibike. Ukubala kwegazi kufanele kwenziwe njalo ukubuka izinto ezingavamile.
Amacala ajwayelekile ka-Stevens-Johnson syndrome kanye necrostysi ye-epidermal necrolysis, kanye ne-DRESS (ukusabela kwezidakamizwa nge-eosinophilia nezimpawu zesistimu kuye kwabikwa kuziguli eziphathwe nge-Arava. Uma lokhu kwenzeka, i-Arava kufanele imiswe futhi inqubo yokuqeda izidakamizwa ingaqaliswa.
I-peripheral neuropathy ibike kwezinye iziguli ezithatha i-Arava. Ngenkathi ezimweni eziningi, izimpawu zinikezwa ukuyeka ukusebenza kwe-Arava, ezinye iziguli zinezimpawu eziqhubekayo.
Imithombo:
Arava Tablets. Ukubeka imininingwane. I-Sanofi-Aventis US ebuyekeziwe ngoNovemba 2014.
Leflunomide (Arava). I-American College of Rheumatology. Kubuyekezwe uMeyi 2015.