Yiziphi Izinkinga Zengozi?
Ukulimala okuhlangene okuqhubekayo yilokho odokotela, abacwaningi, neziguli ezine- arthritis nezifo ze-rheumatic zizama ukulawula. Kungumphumela wokuvuvukala okungapheli kwe- synovial . Ukwelashwa kwenzelwa izinhloso ezithile engqondweni-okunye okuwukuphuza ukuqhubekela phambili kwesifo.
Okokuqala futhi okubaluleke kakhulu, kubalulekile ukuqonda ukuthi ukulimala okuhlangene okuqhubekayo, uma kungalawulwa, kungase kuhlotshaniswe nokulinganiselwa okusebenzayo nokukhubazeka.
Yiziphi izici ezibikezela ukubikezela okungalungile ngokulimala okuhlangene okuqhubekayo?
Izinto ezijwayelekile ezihambisana nokulimala okuhlangene okuqhubekayo
Isibonakaliso esinamandla kunazo zonke somonakalo ohlanganyelwe ohlangene e- rheumatoid arthritis kuthiwa yi- seropositivity . Lokho kusho ukuthi, ukushiswa komzimba akuvimbeli umonakalo ohlangene wokuqhubekayo. Ngingafakazela lokho kusuka ekuhlangenwe nakho kwesandla sokuqala.
Ukuqhubeka okusheshayo kokulimala okuhlangene kuhloswe ukuba kuhlotshaniswe nokuba nomthelela kokubili isisindo se-rheumatoid kanye ne-anti-CCP- okungaphezu kwalokho uma kukhona umuntu omuhle kunoma yikuphi, kunokubili kokubili. Izinto ezikhomba ukuthi ukuhlaselwa okuncane okunampofu ngokulimala okuhlangene okubandakanya kubandakanya:
- Ubufakazi be-X-ray noma ubufakazi bomtholampilo wokulimala okuhlangene
- Inombolo eyengeziwe yamajoyina abandakanyeka ne-synovitis esebenzayo, isisa, ukuvuvukala, noma ukuhlangana okuhlangene
- Isilinganiso se-erythrocyte se-sedimentation esilinganisiwe (sed sed) noma iphrotheni esebenzayo e-C (CRP) . Ngokwezinga eliphansi, ukukhuphuka kwe-1 mm / ihora ngalinye kuxhumene namaphesenti angu-2 kwandisa ubungozi bokulimala okuhlangene okuqhubekayo.
- Okuhle kakhulu kwe- anti-CCP
- Okuhle ku- HLA-B27 , HLA-B39, noma i-HLA-DQw3.
- Izinga eliphezulu lokusebenzisa imithi, kuhlanganise ne- corticosteroids , esetshenziselwa ukwelapha ukuvuvukala kumajoyini athintekile
- Ukusabela okunganele ngokwemithi
- Ukunciphisa umsebenzi ohlangene njengoba kunqunywe uMbuzo Wokuhlola Ezempilo
- Ukunciphisa izinga lokuphila
Imigomo Yokwelashwa
Ukugcizelela ukucwaninga kwamathambo amaningi e-rhumum isifo sezifo zakuqala, nokuthi ukuxilongwa kokuqala kanye nokwelapha kungathinta kanjani ukuqhubeka. Ngokomphumela wokucwaninga oshicilelwe ku- Arthritis neRheumatism , phakathi kwamaphesenti angu-60 namaphesenti angu-95 abantu abane-arthritis ye-rheumatoid athuthukisa okungenani ukuvuthwa komzimba okubonakalayo kwe-radiographically (okungukuthi, kuma-ray ray) eminyakeni engaba ngu-3 ukuya kweyisishiyagalombili emva kokuqala kwesifo.
Ngokomphumela owethulwe emhlanganweni waminyaka yonke ka-2012 we-American College of Rheumatology, abacwaningi futhi banquma ukuthi ukulimala okuhlangene okuqhubekayo kusekhona kubantu abaye banesifo samathambo okungenani iminyaka emihlanu. Lokhu kubonakala sengathi kunjalo naphezu kwesigamu seziguli ze-rheumatoid arthritis eziphathwa ngezidakamizwa ze-biologic .
I-FDA iye yaqaphela ukuthi ukuvimbela noma ukunciphisa umonakalo ohlangene we-radiographic kwi-rheumatoid arthritis ngumgomo omkhulu wokwelapha. Izimangalo ze-FDA ezigunyazisiwe zokubhalisa ze- DMARD ezithile (izidakamizwa eziguqula izifo ezilwa no-rheumatic) nezidakamizwa ze-biologic ezisho ukuthi imishanguzo isinciphisa ukuqhuma komonakalo ohlangene we-radiographic.
Umgomo wokuthola ukukhululwa kwamathambo e-rheumatoid isimiso sokumisa umonakalo ohlangene. Kodwa, izindlela ezisungulwe zokuthola ukuxolelwa zisashiya igumbi ukuze kube nokuthuthukiswa kwe-radiographic yomonakalo ohlangene.
Ukuthethelelwa kuchazwa ngemigomo yesifo sesifo njengoba kuhlotshaniswa nokuvuvukala okuhlangene, kunokuba kube nomonakalo ohlangene. Ukulawula ukuvuvukala kubalulekile ekulawuleni umsebenzi wesifo ku-arthritis ye-rheumatoid. Izinqubo zomzimba zihilelekile. Inethiwekhi eyinkimbinkimbi yamaseli omzimba ewumyalo wenethiwekhi ye- cytokines ne-chemokines evuthayo . Yilokho uhlobo lwe-crux yesifo ku-rheumatoid arthritis. Ngesikhathi esifanayo nomsebenzi we-cytokine, kunezinto eziningi ezikhethekile ezivela emkhatsini wamangqamuzana asekhaya, ikakhulukazi ama-fibroblasts, ne-cartilage kanye namathambo esifuba. Lo msebenzi, otholakala emaphethelweni wezingxube ezithintekile, ubangela ukulimala okuhlangene.
Umsebenzi we-synovial wendawo ungenza ngokuzimela futhi ubangele ukubhujiswa kwe-cartilage kanye ne-bone, okuhluke ukuvuvukala okujwayelekile kwe-synovial. Kuyinkimbinkimbi, kodwa okubalulekile ukuthi ukulimala okuhlangene okuqhubekayo kungenzeka naphezu kokuvuvukala okulawulwa kahle.
Izwi elivela
Kukhona abantu abane-arthritis ye-rheumatoid abangenayo izici ezivamile noma izinto eziphilayo zokulimala okuqhubekayo, kodwa namanje banomonakalo ohlangene wokuhlanganyela. Ngibhekisela kulabo abangase bangabi nethonya le-rheumatoid (i-seronegative), ababi ngokumelene ne-anti-CCP, noma abanesilinganiso se-sed noma i-CRP engakhulumi kakhulu. Kuye kwaqunywa ukuthi, ezimweni ezinjalo, kukhona inkulumo nokusebenza kwe-MMP-3 (i-stromolysin-1) ne-MMP-1 (i-collagenase-1) eyenza umonakalo ohlangene wokuqhubeka. I-MMP-3 ne-MMP-1 yi-metalloproteinase yamatriki (ama-enzyme). Izinga le-serum eliphakeme le-MMP-3 kanye ne-MMP-1 lihlotshaniswa kakhulu nomsebenzi wesifo futhi kungase kube ukubikezela kokulimala kokuhlanganyela kwe-radiological nokunciphisa ukusebenza.
> Imithombo:
> Gladman, uRitchlin. Izingozi Zezingozi Zokulimala Okuhlangene Okuqhubekayo. Ukwelashwa kwe-Psoriatic Arthritis. Kusesikhathini. Kubuyekezwe ngo-September 28, 2016.
> Lafeber Floris PJG et al. Ukuthuthukiswa Kwengozi Ehlangene Naphezu kokulawulwa kokuvuvukala ku-Arthritis ye-Rheumatoid: Indima ye-Cartilage Ukulimala okuqhutshwa umsebenzi we-Synovial Fibroblast. Imibiko ye-BMJ. 2012.
> Lillegraven, S et al. Ukulimala Okuhlangene Kwama Radiographic Joint in Rthmatic Rheumatoid Arthritis: Ejwayelekile futhi Enamandla Ngokuhambisana Ne-Seropositivity. Ama-ACR Okushiwo: 2660. Umhlangano Wonyaka we-ACR ka-2012.
> Paulus HE et al. Ukuhlukanisa Umonakalo Ohlanganisiwe Wokwakhiwa Kwamakhemikhali E-Rheumatoid Arthritis Njengenqubekela phambili noma Engenakuqhathaniswa Nokusebenzisa Incazelo Ehlanganisiwe Yezinguquko Zama-Radiographic Joint. I-arthritis ne-Rheumatism. April 2004.
> Al-Bayyoumy SA, et al. Ukulingana Phakathi Kwemvelo Yokulimala Okuqhubekayo Nezinga leSerum le-Matrix Metalloproteinases: MMP-3 kanye neMP-1 ku-Arthritis Yasekuqaleni Ye-Rheumatoid . I-Rheumatology yaseGibhithe nokuvuselelwa. Julayi 2007.