I-arthritis ye-rheumatoid isifo esingapheli, sokuvuvukala esibonakaliswe umonakalo ohlangene ohlangene, ukulinganiselwa ngokomzimba , nokukhubazeka okusebenzayo . Ngesikhathi ngithola ukuthi ngine-arthritis ye-rheumatoid (ngo-1974 ngineminyaka engu-19) futhi ekuqaleni ngafunda ngezinketho zami zokwelashwa, umgomo waba ngokushesha-ukulawula ukuvuvukala, ukuphuza kwesifo sokuphuza, nokunciphisa ubuhlungu nezinye izimpawu zesifo samathambo e-rheumatoid .
Izwakala njengecebo elifanele kimi. Njengomuthi we-arthritis we-newbie, ngangizimisele ukuqala ukwelashwa nokuyeka inqubo yesifo.
Ngafunda ukuthi kwakukhona amathuba okukhululwa, futhi, okwangenza ngazizwa ngikhuthazwa nakakhulu. Engangingazi ngokugcwele ngaleso sikhathi ukuthi ngisho nangokwelashwa, i-arthritis ingaqhubeka ikhula kakhulu. Umonakalo ohlangene ungadala. Yebo, kuyiqiniso. Ngisho noma isiguli sisesekuxoxweni, njengoba kuchaziwe ngemigomo ebekiwe, singakwazi ukukhombisa ukuthuthukiswa kwe-radiographic (okungukuthi, ubufakazi be-x of umonakalo wokubambisana kakhulu).
Ukwelashwa Okubhekiswe Ekulawuleni Ukuvuvukala
Kwaphela amashumi eminyaka, izidakamizwa zokuguqula izifo ezibulala izifo (DMARD), ezifana ne- methotrexate , i- Plaquenil , ne- sulfasalazine , zisetshenziselwa ukunciphisa noma ukunciphisa umsebenzi wesifo ohambisana nesifo samathambo. Ngokutholakala kwezidakamizwa ze- biologic (i- Enbrel [etanercept] kwaba ngowokuqala ngo-1998), izinhloso zaba ngaphezulu nakakhulu ezingxenyeni zamangqamuzana.
Futhi manje, kukhona isu elisha elizovela, elibhekwa ngokuthi yi- Treat-to-Target therapy .
Izikhonkwane zokuThatha kuya ku-Target phansi isu lokulashwa esekelwe izinga lomuntu ngamunye wesifo sesenzo. Umgomo ukufezekisa izinga eliphansi lomsebenzi wesifo noma ukuxoxwa esikhathini esithile esithile - kanti uhlelo ngalunye luhlukile.
Ukuyibeka emibhalweni elula kunazo zonke, izinguquko zokwelapha zenziwa uma imigomo yomsebenzi wesifo ingahlangatshezwanga. Yeka ukuthi i-Treat-to-Target kahle iyovikela kanjani umonakalo ohlanganyelwe okunye okuzobonakala. Imithi yokwelashwa yenzalo (okusho, imithi elwa nokuvuvukala) ayinayo ukuvinjelwa komonakalo ohlangene ezinyaweni zayo. Kuye kwaphakanyiswa ukuthi ngisho nangemva kokuba ukuvuvukala kulawulwa, umsebenzi we-synovial wezishukela ezigulini ze-rheumatoid arthritis ungaphakamisela ukubhujiswa kwe- cartilage neyethambo. Ukuze siqonde kangcono, ake sibheke kakhulu ukuthi umonakalo ohlangene uqala kanjani futhi uyaqhubeka.
Ukuqonda Indlela Ukulimala Okuhlangene Kwenzeka Kanjani
Umonakalo ohlangene ungabonwa phakathi nezinyanga zokuqala kwamathambo e-rheumatoid arthritis. Ukulahlekelwa kwe-cartilage yasekuseni kanye ne-bone impumulo kuhlotshaniswa nokuqoqwa kwamangqamuzana evuvukala emlonyeni we- synovial kanye nokuthuthukiswa kwe- pannus (izicubu ezinama-synovial ezingenele ezingakwazi ukuhlasela ithambo). Kukhona isendlalelo esincinci se-synovial esinezibalo eziningana zamangqamuzana ama-macrophages, amaseli e-T, amaseli e-B, amaseli e-dendritic, ne-polymorphonic leukocytes, kanye ne-layer synovial lining layer equkethe ama-macrophages nama-synoviocytes (fibroblast-like synoviocytes).
Kunabantu abaningi abasebenzisa ama-macrophage nama-synoviocytes angakwazi ukuvikela ama-enzyme (amaprotheniase) ahilelekile ekusebenziseni ukuchithwa kwezicubu.
Ukuqonda umsebenzi we-synovial, ikakhulukazi izindlela kanye nezindlela ezihilelekile ezingeni lapho kukhona ukucinwa kwe-enzymes ehlambalaza, kubalulekile uma umonakalo ohlangene kufanele ulawulwe noma uvinjelwe. Ngokwesibonelo, ezingeni lemangqamuzana, yini eyenza i-fibroblasts ibe nobudlova futhi inonakalise?
Ngokusho kukaKelley's Textbook of Rheumatology , ama-proteinase avela emithonjeni emithathu ayabulalisa i-cartilage e-arthritis ye-rheumatoid: iziqephu ze-articular cartilage zibhujiswa ngamaprotheniase avela ku-synovial fluid; ngokuxhumana okuqondile phakathi kwe-articular cartilage ne-proteolytic (okungukuthi, ekwazi ukwephula amaprotheni) i-synovium noma i-pannus tissue noma kokubili; noma ukubhujiswa kwangaphakathi (okungukuthi, ukubhujiswa okuvela ngaphakathi) ngamaprotheniase atholakala kuma-chondrocytes.
Njengoba abacwaningi basebenza ukuze bathole izimpendulo, sisondelene kakhulu futhi siseduze nemithi engcono - ngethemba lokugcina indlela yokuvimbela umonakalo ohlangene. Ngesikhathi se-arthritis ye-rheumatoid, umonakalo ohlangene ungaqhubeka kancane kancane futhi njalo. Ekupheleni kwesikhathi noma isifo samathambo esiphuthumayo, ukulungiswa okuqinile kukhona phakathi kobufakazi be-x-ray bokulimala okuhlangene nokukhubazeka. Ukunciphisa umonakalo ohlangene kuzosiza ukulondoloza umsebenzi ohlangene.
Inqubo yomonakalo ohlangene e-osteoarthritis ihlukile kancane. Umcimbi owenziwe ngomsebenzi (isb., Ukulimala noma ukugqoka nokudiliza) kuvame ukuhlotshaniswa nenqubo yokuqothulwa kwe-cartilage. Ukuvuvukala kwenzeka, kepha kuyesibili ezimweni eziningi ze-osteoarthritis. I-IL-1 (interleukin-1), i- cytokine , ingadlala indima ebalulekile ekuqandeni kwe-cartilage ehlobene ne-osteoarthritis. Ama-Chondrocytes (amaseli atholakala ku-cartilage) akhiqiza inani elikhulu le-IL-1 nokuvuvukala kwe-synovial kwengeza emsebenzini we-IL-1. Nakuba kungekho izinguquko eziphawulekayo zokuvuvukala ngokuvamile ezenzeka ku-synovium ekuqaleni kwe-osteoarthritis, ukukhiqizwa kwama-enzyme okwandiswa yi-chondrocytes okufaka isandla ekubhujisweni kwe-cartilage. Kodwa-ke, kubonakala sengathi i-phenotype ethize ye-osteoarthritis ekhona futhi, uhlobo oluthile oluthile lwe-osteoarthritis , olubhekiswe ekubhujisweni okuhlangene okuqhutshwa ngokuyinhloko ngokuvuvukala.
Imithombo:
Ukuqhubeka komonakalo ohlangene naphezu kokulawula ukuvuvukala kwesifo samathambo: indima yomonakalo we-cartilage oqhutshwa umsebenzi we-synovial fibroblast. Floris PJG Lafeber, Willemijn H Van der Laan. Ama-Annal of the Rheumatic Diseases 2012; 71: 793-795 i-doi: 10.1136 / ngonyaka-2011-200950
http://ard.bmj.com/content/71/6/793.full
I-Pathogenesis yomonakalo ohlangene ku-rheumatoid arthritis. Bresnihan B. Journal of Rheumatology. 1999.
http://www.ncbi.nlm.nih.gov/pubmed/10090189
Izixhumanisi phakathi kokulimala kokuhlanganyela nokukhubazeka ku-arthritis ye-rheumatoid. I-rheumatology. 2000.
http://rheumatology.oxfordjournals.org/content/39/2/122.abstract
I-Kelley's Bookbook of Rheumatology. Umagazini wesishiyagalolunye. Umqulu I. Amakhasi 111-113.