Nakuba kungekho ukwelashwa kwe-anondlosing spondylitis (AS), umuthi wokwelashwa oqukethe ukwelashwa ngokomzimba kanye nemithi ingenza ngcono izimpawu zomuntu zokuhlukunyezwa, ukuqina, nokuvuvukala, futhi nokuthuthukisa ukusebenza kwansuku zonke.
Ngo-2015, i-American College of Rheumatology (ACR) yakha imihlahlandlela yokwelapha i-spondylitis e-ankylosing.
Le mihlahlandlela yayihloselwe ukusiza odokotela ukuba banakekele iziguli zabo nge-AS ngendlela ehlelekile, ngokusekelwe kwizifundo zocwaningo.
Njengomuntu one-AS (noma uma unomuntu othandekayo ne-AS), ulwazi mayelana nemihlahlandlela yokwelashwa kuzokusiza ukuthi ufunde lesi sifo esiyinkimbinkimbi nesiguli ngokuqiniseka nangokuqiniseka.
Ukwelapha Okungahambi I-Steroidal Anti-Inflammatory (NSAID)
Ukwelashwa okuyisisekelo kwe-ankylosing spondylitis yi-non-steroidal anti-inflammatory (NSAID). I-NSAID iye yahlala isikhathi eside futhi isebenza kakhulu ekunciphiseni ukuvuvukala emzimbeni. Zisebenza ngokuvimbela ama-enzyme okuthiwa i-cyclooxygenase enzymes (i-COX enzymes).
Ngokuvimbela la ma-enzyme, amazinga e-prostaglandin ancipha emzimbeni. Njengoba i-prostaglandin idlala indima ebalulekile ekuvuvukeni, ngokuncipha, izimpawu zokuvuvukala njengobuhlungu nokuvuvukala kuncishisiwe.
Ukuphazamiseka kwama-NSAID ukuthi akukwazi ukuthathwa yilowo nalowo, ngenxa yokukwazi ukulimala.
Yingakho kubaluleke kakhulu ukuthatha i-NSAID kuphela ngaphansi kokuqondiswa kukadokotela wakho.
Isibonelo, enye eyingozi eyaziwayo engaba khona yokwelashwa kwe-NSAID yukuthi ingabangela ukulimala kwesisu, izilonda, nokuphuma kwamanzi. Ama-NSAID angakwandisa ingozi yokuhlaselwa yinhliziyo, ukwehluleka kwenhliziyo, noma ukushaya isifo. Bangase bakhulise umfutho wegazi lomuntu futhi babangele izinkinga zezinso noma zibe zimbi nakakhulu.
Ngaphezu kwalezi zimo ezimbi, ama-NSAID angase ahlanganyele neminye imithi yakho. Yingakho kubalulekile ukutshela udokotela wakho yonke imithi oyithathayo, kuhlanganise nemifino, amavithamini, noma ama-supplements.
Izibonelo zama-NSAID
Kunezinhlobo eziningi ze-NSAID ezitholakalayo zokwelapha i-AS, kufaka phakathi ama-NSAID angaphezu kwe-counter and NSAIDs. Izibonelo zifaka:
- Ama-NSAID angaphezu kwe-counter: Advil noma i-Motrin (ibuprofen) ne-Aleve (naproxen)
- I-NSAID yesiguli: I-Voltaren (i-diclofenac), i-Mobic (meloxicam), noma i-Indocin (i-indomethacin).
Ama-NSAID angaphezu kwamakhompiyutha afana ne-ibuprofen nawo atholakalayo ngemithi ephezulu.
Olunye uhlobo lwe-NSAID oluvame ukushiwo ukwelapha i-AS yi- Celebrex (celecoxib) , engasiza ekuvimbeleni izinkinga zesisu nesisu somzimba. I-Celebrex iyi-selective-NSAID ngoba ivimbela i-COX-2 enzyme kuphela (amanye ama-NSAID avimba i-COX-1 ne-COX-2 enzymes). Ngokulondoloza umsebenzi we-COX-1 futhi uvimbela kuphela i-COX-2, ukulimala kwesisu nangomzimba kuncishisiwe. Lokhu kungenxa yokuthi i-COX-1 isiza ukugcina ubuningi bomzimba.
I-Tumor Necrosis Factor Inhibitors (TNFi)
Uma umuntu one-AS engakwazi ukuthatha i-NSAID, noma uma izimpawu zabo ezinjengobunzima nokuqina zingathuthukiswa nge-NSAID yokwelapha, kunconywa i- blocker ye-TNF .
I-tumor necrosis factor (TNF) yiprotheni ehilelekile kwinqubo yokuvuvukala, ngakho ngokuvimbela ukukhiqizwa kwayo, ukuvuvukala emzimbeni kuncishisiwe.
Izindaba ezinhle nge-block block ye-TNF kukhona ubufakazi obuningi bezesayensi bokusekela inzuzo yabo ekunciphiseni umsebenzi wezifo ku-ankylosing spondylitis-ngamanye amazwi, ukuphoqa ukuvuvukala emzimbeni. Noma kunjalo, ama-block block e-TNF awawona ama-treaty treatments. Zinezingozi, futhi lokhu kumele kulinganiswe ngomuntu ngamunye.
Ngenxa yokuthi ama-TNF abamba ukuvimbela amasosha omzimba omuntu (naphezu kokungasebenzi ngokweqile kumacala alabo abane-ankylosing spondylitis), bangandisa ingozi yomuntu kokubili ukutheleleka okuncane nokutheleleka okukhulu.
Isibonelo sokutheleleka okuncane kungumkhuhlane ovamile. Ngakolunye uhlangothi, ukutheleleka okunzulu okwenziwa odokotela ngokukhethekile uma umuntu ethatha i-TNF inhibitor yisifo sofuba. Ngenxa yengozi yokubuyiselwa kwesifo sofuba, ukuhlolwa kwe-TB kuyadingeka ngaphambi kokuqala ukwelashwa kwe-TNF yokuvimba. Ngokuvamile, ama-block block e-TNF ahlanganiswe nethuba elandayo lokuthuthukisa ezinye ze-khansa.
Kubuye kubalulekile ukwazi ukuthi abantu abathile abangekho ukhetho lokuthatha abavimba be-TNF njengabo abane:
- I-Multiple Sclerosis (i-TNF blockers ayifuni neze ukulahlekelwa i-myelin ebuchosheni nasemgqeni womgogodla)
- Ukuhluleka kwenhliziyo
- Ukutheleleka okusebenzayo njenge-pneumonia
Abesifazane abakhulelwe noma abancancisayo nabo abangekhe bangakhanjelwa ukwelashwa kwe-TNF.
Izibonelo ze-TNF Blockers
Ngo-2010, ukuhlolwa kweSpondyloArthritis International Society (ASAS) kwanyathelisa isethi yemihlahlandlela yokusebenzisa izivimbela ze-TNF kuziguli ezine-spondylitis e-ankylosing. Le mihlahlandlela isiza odokotela ukuba banqume ukuthi ubani omele ukhetho lokuvimbela i-TNF.
Isibonelo, ngokwemigomo ye-ASAS, umuntu kufanele acatshangelwe ukuvimba kwe-TNF uma isifo sakhe singathuthuki okungenani izinhlobo ezimbili ezahlukene zama-NSAID (ezingeni eliphezulu elibekezelelwe).
Ama-block block we-TNF asetshenziselwa ukwelapha i-spondylitis e-ankylosing yilezi:
- Enbrel (etanercept)
- I-Remicade ne-Renflexis (i-infliximab)
- Huma (adalimumab)
- I-Simponi (i-golimumab)
- I-Cimzia (certolizumab)
I-Remicade ne-Renflexis (i-infliximab) inikezwa njenge-infusion ngaphakathi kwe-vein ngenkathi i-Enbrel (etanercept), i-Humira (adalimumab), i-Simponi (golimumab), ne-Cimzia (certolizumab) inikezwa njenge-subcutaneous (emathisini amafutha).
I-Cosentyx (i-Secukinumab)
Uma umuntu engaphenduli kahle ku-TNFi, udokotela wabo angabheka i-Cosentyx (secukinumab). I-Cosentyx yamukelwa yi-US Food and Drug Administration (FDA) ngo-2016 ukuphatha i-spondylitis e-ankylosing esebenzayo.
Isebenza ngokuvimbela i-IL-17A, okuyinto i- cytokine engenawo amandla (isithunywa se-molecule esenza impendulo evuthayo emzimbeni). I-IL-17A yaziwa ngokudlala indima enkulu ekuthuthukiseni i-AS.
I-Cosentyx inikezwa kancane kancane ngeviki amasonto amane, bese kuthi emva kwamasonto amane emva kwalokho. Ucwaningo lubonisa ukuthi lubekezeleleke kahle, nomphumela omubi kakhulu oba yizimpawu ezibandayo, njengephunga eligijimayo kanye nomphimbo obabayo.
Ucwaningo luyaqhubeka ku-Cosentyx. Noma kunjalo, kuyathakazelisa ukuthi manje kunenketho kubantu abagula ngesifo se-TNF noma abangakwazi ukuthatha i-TNF inhibitor.
Ukwelashwa Kwemvelo
Ngaphandle kwemithi, i-American College of Rheumatology incoma ukwelashwa ngokomzimba kubantu abane-AS esebenzayo (okusho izimpawu zokuvuvukala njengokubuhlungu okuhlanganyelwe nokuqina). Lesi sincomo sisekelwe eziningana zezifundo ezitholile ukwelashwa ngokomzimba ukuze kuzuze ukunciphisa ubuhlungu nokuthuthukisa ukuhamba komgogodla, ukuma, ukuguquguquka, ukusebenza ngokomzimba, nenhlalakahle.
Izindaba ezinhle kukhona ukulimala okuncane okuhlobene nokwelapha ngokomzimba. Futhi, umuntu angahlanganyela ekuzivocavoca futhi welule ekhaya noma ngaphakathi kokuhlelwa kweqembu. Lokho kusho ukuthi ucwaningo lubonisa ukuthi ukwelashwa kweqembu elibhekiwe kungasiza kakhulu kunezivivinyo zasekhaya.
Okungaba okukhangayo nakakhulu (futhi okunethezeka) kulabo abane-AS uhlobo lokwelapha okuthiwa i-spa-practice therapy. Lolu hlobo lwezokwelapha luhlanganisa nokusebenzisa amanzi afudumele, ukuququgquzela ama-jet hydrotherapy, nokuphumula endaweni yokudla. Eqinisweni, ucwaningo luye lwathola ukuthi ukwelashwa kwe-spa okuhlangene ne-group treatment therapy kungcono kunokwelashwa kweqembu kuphela.
Ukuhlinzwa
Ezimweni ezingavamile, kudingeka ukuhlinzwa ukuze uphathe i-spondylitis e-ankylosing. Lokhu kuvame ukugcinwa kubantu abanomonakalo omkhulu we-hip kanye nobuhlungu. Kulezi zimo, ukushintshwa kwe-hip esiphelele kuvame ukuphakanyiswa ngaphezu kokuhlinzwa. Ukuhlinzekwa kwe-Riskier njengalabo okubandakanya umgogodla kungavamile kakhulu futhi kwenziwa uma kunesifo esibucayi esiphambanweni somgogodla ("ukugujwa kokuzingela").
Izwi elivela
I-ankylosing spondylitis yisifo esingelapheki, futhi akukho ukwelashwa okwamanje. Kodwa zikhona izindlela zokuzilawula. Ngenkathi yokwelapha efanele (okuzodinga ukuguqulwa ngokuhamba kwesikhathi ngaphansi kwesiqondiso sikadokotela wakho), ungahlala kahle nge-AS.
> Imithombo:
> Blair Ha, Dhillon S. Secukinumab: Ukubuyekezwa ku-spondylitis e-ankylosing. Izidakamizwa . 2016 Jul; 76 (10): 1023-30.
> Callhoff J et al. Ukusebenza kwe-TNFα ukuvimbela iziguli ezine-ankylosing spondylitis ne-non-radiographic spondyloarthritis: ukuhlaziywa kwe-meta. I-Ann Rheum Dis . 2015 Jun; 74 (6): 1241-8.
> Dagfinrud H, Kvien TK, Hagen KB. Ukwelashwa kwe-Physiotherapy kwe-anondlosing spondylitis. I-Cochrane Database Syst Rev. 2008 Jan 23; (1): CD002822.
> van der Heijde D et al. 2010 Ukubuyekezwa kwezincomo ze-ASAS zomhlaba jikelele zokusetshenziswa kwamagciwane aphikisana ne-TNF kuziguli ezine-spacious spondyloarthritis. I-Ann Rheum Dis . 2011 Jun; 70 (6): 905-8.
> Ward MM et al. I-American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network 2015 Izincomo zokwelashwa kwe-Ankylosing Spondylitis ne-Nonradiographic Axial Spondyloarthritis. I-Arthritis Rheumatol . 2016 Feb; 68 (2): 282-98.