Ukukhumbuza nokusebenza ngokukhawuleza. Bobabini bachaza indlela iklasi yeziyobisi, ezibizwa ngokuqhelekileyo njenge-DMARD (izifo eziguqula izidakamizwa zesifo se-antirheumatic), zisetyenziselwa ukuphatha i- arthritis ye-rheumatoid emva kokuba iziyobisi ezingekho ngaphantsi zibonakala zingasebenzi. I-DMARD isetyenziselwa ukuphatha izimo ezivuthayo ezinjenge- spondylitis , i- psoriatic arthritis , i-lupus.
Ezi zi yobisi zibhekwa zilahla ngenxa yokuba zinokunciphisa inkqubo yesifo, nangona ingaqhelanga ukuba kukho ukuxolelwa ngokupheleleyo.
Ekubeni kungathabatha iinyanga ezi-6 ukuya kwezi-8 ukuba izidakamizwa zikhuphe impendulo, zibhekwa njengeziyobisi ezihamba ngokukhawuleza kwaye zikhethwa njengendlela yokwenza unyango lwe sibini emva kokuba i- aspirin kunye ne- NSAID (izidakamizwa ezichasene ne-anti-inflammatory drugs) zehluleka.
Akuqondwa kakuhle ukuba i-DMARD isebenza njani. I-DMARD ibonakala iyancipha ukutshabalala nangona ingahlulwa njengezidakamizwa ezichasayo. Ayifani ne-NSAID njengoko inganciphisi ukuvelisa i-prostaglandin, musa ukukhupha ngokukhawuleza intlungu, okanye ukunciphisa umkhuhlane. Ngokwenyani, i-DMARD iyancipha inkqubo yesifo ngokuguqula umzimba wokuzivikela ngandlela-thile.
Ukusebenza, ukhuseleko, umphumo, kunye nobude bokusetyenziswa kwe-DMARD bubuzwe ngabaguli abachaphazelekayo. Izifundo kwiminyaka yonke zibonise i-DMARD ukuba izidakamizwa ezisemgangathweni, kunye nemiphumo emibi engabonakaliyo. Ukubeka iliso rhoqo kwibhubhoratri kunceda ukulawula umngcipheko weempembelelo. Xa ucinga ukuba yonyango lwexesha elifutshane, i-DMARD ngoku ibonwa njengesisombululo sesikhathi eside sokulawula iimpawu kunye nokunciphisa ukunyuka kwesifo.
IGold for Arthritis
Efunyanwe ngengozi ngudokotela waseFransi, iisarts zegolide ziye zasetyenziselwa unyango lwe-arthritis iminyaka engaphezu kwama-50. I-Jacques I-Forrestier ijojiswe isalathisi segolide kwisigulana sesifo sofuba ukuze siphathwe intsholongwane. Isigulane sasine-arthritis kwaye emva kweenyanga ezininzi unyango ngegolide, i-arthritis yaphucula.
Igolide sele isetyenziselwa ukunyanga i-arthritis ukususela ngelo xesha.
Indlela yokwenza umsebenzi wegolide ungabonakali kakuhle kodwa ngokubonakalayo iphazamisa imisebenzi yamaseli egazi amhlophe enoxanduva lokulimala kunye kunye nokuvuvukala . Nangona igolide inganciphisa intshabalalo, ayikwazi ukulungisa ukutshabalalisa okukhoyo.
Igolide beyifumaneka okokuqala nje ngeziyobisi ezingenayo. Ukunikezelwa kwishedyuli yokuqhubekayo yesondlo, kufuna ukuba uvavanyo lwegazi kunye neemvhamo zilawulwe rhoqo. Ngomnyaka we-1986, igolide yafumaneka kwifom yomlomo ngegama loRhwebo. Iziphumo eziqhelekileyo ezichaphazelekayo ezijongene negolide egwenywe yi-intlanzi ephazamisayo emacaleni angaphantsi kunye nezilonda zomlomo ezidla ngokunyamalala xa unyango lugqityiwe. Igolide ye-Oral ineempembelelo ezimbalwa kodwa zingabangela ukuhanjiswa kwexesha lokudlulela okanye ukuhamba kwezilwanyana. I-Gold ibonakala isebenza kakuhle kakhulu kwiipesenti ezili-10 zezigulane kwaye zilungele ezinye iipesenti ezingama-30-40. Iipesenti ezingamashumi amahlanu ezigulane ziyeke ukusetyenziswa ngenxa yemiphumo emibi okanye ukungasebenzi.
Ukusetyenziswa kwegolide kuye kwancipha kakhulu, ngokukodwa ngokuphuhliswa kweziyobisi ze- biologic . I-biologic yokuqala, i-Enbrel, yafumaneka ngo-1998.
Penicillamine
I-Penicillamine, isihlobo esikude se-penicillin, safumaneka kwi-1970.
I-penicillamine yaziwa ngokuba yi-chelator kuba inokubopha isinyithi esinzima emzimbeni. Indlela yayo yokusebenza kwisifo se-rheumatoid arthritis ayengaziwa kodwa kucatshangelwa ukutshintsha umsebenzi weeseli ezimhlophe zegazi ezijongene nomonakalo odibeneyo. Ingaba yasebenza ngakumbi xa idibanisa nobhedu obuqhelekileyo emzimbeni.
I-penicillamine inikezwa ngomlomo, ngokuqala ngeqondo eliphantsi, ngoko ngokunyuka kwandisa umthamo. Kuthathwa kwisisu esingenalutho ubuncinane kwiyure enye ngaphambi okanye emva kokutya. Ukuba ngaba isigulane sifanele sihlale kule nkampu yonyango ngonaphakade. Imiphumo emibi ifana nezo zidibene negolide - izikhumba zesikhumba, izilonda zomlomo, ukulahleka kwentliziyo kunye nokunyanyiswa kwesisu.
Iiprotheyini kumchamo zingabonakalisa okokuqala ukulimala kwezintso.
I-Penicillamine ingasetyenziswa kunye ne-NSAID, nangona i-NSAID ifanele ithathwe ngexesha lokutya. Izigulane ezithintekayo kwi-penicillin zisenokuthatha i-penicillamine. Isebenza ngokumalunga ne-30% yezigulane.
Plaquenil (Hydroxychloroquine)
I-Plaquenil ifumaneka iminyaka emininzi kwaye yayisetyenziselwa ukuphatha i-malaria. Ilula ukuyisebenzisa, ineempembelelo ezimbalwa, kwaye ayifuni ukubeka iliso ngeemvavanyo zegazi. I-Plaquenil isetyenziswe kwizigulane ezine-arthritis ye-rheumatoid ezingaphenduli kakuhle kwi-NSAID. Kubonakala kusebenzayo malunga ne-30% yezigulane. Isetyenziswe kwakhona kwizigulane nge-systemic lupus.
I-Plaquenil ibonakala iphazamise ukusebenza komzimba we-immune. Isilwayo sinikwe ngomlomo, iipilisi enye okanye ezimbini ngosuku. Esinye isiphumo esiqabileyo esingathandekiyo sesigxina sesigxina se-retina esinokukhubazeka okubonakalayo. Uvavanyo lwe-ophthalmology lukhuthazwa njalo emva kweenyanga ezintandathu. I-NSAID zingathathwa kunye ne-Plaquenil kwaye zihlala zihleliwe kunye.
Methotrexate (iRheumatrex)
I-Methotrexate , ifumaneka ngaphezu kweminyaka engama-40, iyasetyenziswa ngokubanzi ukuphatha i-psoriasis kwaye isetyenziselwa ukunyanga umdlavuza. Ngama-1970, i-methotrexate ye-dose ephantsi yayinqunywe yi-rheumatologists ezininzi ukunyanga i-rheumatoid arthritis xa i-NSAID ihlulekile. I-Methotrexate isebenza ngokukhawuleza kunezinye izidakamizwa zokuhambisa izixhobo, ngokuqhelekileyo zivelise ukuphucula kwiiveki kunangeenyanga.
I-Methotrexate yi-antimetabolite, iphazamise ukusetyenziswa kwe-folic acid. Kucatshangelwa ukuba kuvimbele umsebenzi we-immune system kwaye unciphise ukuvuvukala. Kwakhona kunokunciphisa ukukhula ngokukhawuleza kweeseli kumbrane we synovial ohambisa imigxina.
I-Methotrexate inokunikezwa ngomlomo okanye njengesicirisi esisinyanzelo ngokubhekiselele kwishedyuli esisetyenzisiweyo. Kanye kunye neziphumo eziqhelekileyo zecala, ukusetyenziswa kwexesha elide le-methotrexate kungabangela ukulimala kwesibindi. Iimvavanyo zentsholongwane zentsholongwane zifunekayo.
I-Methotrexate ingathathwa kunye ne-NSAID. Izigulane ezithatha i-methotrexate ziyaxwayiswa ukuba ziphephe utywala.
Sulfasalazine
I-Sulfasalazine yinkonzo ye-salicylate kunye neyeza-antibiotic. Kuye kwaqala ukususela ngo-1940, okokuqala ukuphatha izigulane ezinezifo zesifo. Ngesinye isikhathi, yayisetyenziselwa ukuphatha i-rheumatoid arthritis kodwa ukusetyenziswa kwayo kwakuncitshiswa ngenxa yokukhathazeka ngemiphumo emibi. Kwakusetyenziswe kwakhona kwizilingo zeklinikhi njengenye enye yegolide. Kwakukho ixesha lokuvuselela umdla ekusebenziseni njenge-agent ehambisa ngaphandle kweengxaki zezobisi zegolide kunye ne-penicillamine.
Indlela yokwenza i-sulfasalazine ayifumanekanga nangona iyenzo zenzo ezinokubakho, ukuvimba ukuvuvukala nokukhubaza ukukhula kweebhaktheriya. I-Sulfasalazine ifumaneka kwifomathi yefomathi kunye neyombane. Kufuneka kugwenywe ngabantu abanezinyameko kwiidakamizwa ze-sulfa kunye / okanye i-aspirin nezinye i-salicylates. Iziphumo eziqhelekileyo zeziphumo ziquka ukuncwina, uhudo, ukuhlanza nokulahlekelwa yidlo. Iziphumo ezibi kakhulu ziyimingcipheko yomchamo, izifo zegazi kunye neempembelelo ezinzima.
Xa ukhetha naziphi na izidakamizwa ukulwa nesifo sesifo samathambo, wena kunye nogqirha wakho kufuneka ulinganisise izibonelelo kunye neengozi zonyango.
> Umthombo:
> I-Duke University Medical Centre ye-Arthritis, uDavid S. Pisetsky, MD