Ukulawula iiNdawo eziManyeneyo kunye neNceba yeArmitis Psoriatic
I-Psoriatic arthritis yinto engapheliyo ye- arthritis evuthayo edibene ne-psoriasis, isifo sokhumba. Iimpawu zokuvuvukala kunye kunye ne-psoriasis kaninzi aziveli ngexesha elinye, nangona kunjalo. Kwizigulane ezininzi ze-psoriatic arthritis, iimpawu ze-psoriasis zikhula phambi kweempawu ze-arthritis. Nangona kunjalo, malunga neepesenti ezingama-15 zeemeko, iimpawu zesifo se-arthritis zikhula phambi kwe-psoriasis.
Kwezinye iipesenti ezili-15 zezigulane, i-psoriatic arthritis ifunyanwe ngexesha elifanayo ne-psoriasis.
Kukho iindidi ezi-5 ze-psoriatic arthritis : i-symmetric, asymmetric, distallangeal ephezulu, i-spondylitis kunye ne-arthritis mutilans. Ukuxilongwa kwangaphambili kunye nokonyango kubalulekile ukwenzela ukunciphisa ingozi yomonakalo ohlanganyelweyo. Unyango lujoliswe ekulawuleni ukuvutha, kunye neenkalo ezidibeneyo kunye nesikhumba sesi sifo, zombini maziqwalaselwe.
Iqela elisebenza kwi-EULAR (i-European League elwa neRheumatism) lenze uhlolo olusisiseko lweencwadi zenzululwazi ukuhlola unyango lwe-pharmacy lwe-psoriatic arthritis. Ekuqaleni, i-EULAR yashicilela iingcebiso ngo-2012. Kodwa ngowama-2015, ukuhlaziywa kwakufunekayo ngenxa yobungqina obutsha kunye nokufumaneka kwamachiza amatsha. Ngo-2012, kukho iindidi ezimbini ze- DMARD ( izidakamizwa eziguqula izidakamizwa ezichasene ne-rheumatic): ii-DMARD eziqhelekileyo zokwenziwa kwee-DMARD (ezifingqiweyo ze-csDMARD), ezibandakanya i- methotrexate , i- Arava (i-leflunomide) , i- Azulfidine (i-sulfasalazine) kunye ne- DMARD ye-biologic (iifrivized bDMARD).
Ngo-2015, ukuhlaziywa kwakubandakanya isigaba sesithathu se-DMARD, esibizwa ngokuba yi-DMARD esicwangcisiweyo (ezifingqiweyo ze-tsDMARD), ezibandakanya i-PDE (i-phosphodiesterase inhibitors) kunye ne-JAK inhibitors (umzekelo, Xeljanz [tofacitinib] ). Izikhokelo ezihlaziyiweyo ezivela kwi-EULAR zibandakanya iingcebiso ezili-10 kunye nemigangatho emibini yokupasa i-psoriatic arthritis.
Imigaqo-siseko
- I-Psoriatic arthritis iyingcipheko (oko kukuthi, iqukethe imiba eyahlukileyo) kunye nezifo ezinokuthi zinokuthi zifune unyango oluninzi.
- Unyango lwe-Psoriatic ye-arthritis kufuneka lujolise ekunyamekelweni okufanelekileyo kwaye kufuneka kusekelwe kwisigqibo esabelana ngaso phakathi kwesigulane kunye nesifo se-rheumatologist , ngokuqwalasela ukusebenza, ukhuseleko kunye neendleko zonyango.
- I-Rheumatologists yiingcali ezimele zikhathalele ngokuyinhloko imiba ye-psoriatic arthritis. Ngenxa yokubandakanyeka kwesikhumba, i-rheumatologist kunye ne-dermatologist kufuneka babambisane ekuxilongweni nasekulawuleni izifo.
- Injongo ephambili ye-psoriatic arthritis unyango kukuba ukwandise umgangatho wobomi obunxulumene nempilo, ufezekiswe ngokulawulwa kweempawu , ukuthintela ukulimala kwesakhiwo, kunye nokugcina umsebenzi oqhelekileyo nokuthatha inxaxheba kwentlalo. Ukunciphisa ukuvuvukala kubalulekile ekufezeni iinjongo.
- Ulawulo lwe-psoriatic arthritis isigulane kufuneka lithathe ingqalelo imbonakalo eyongezelelweyo (oko kukuthi, ngaphandle kwamalungu), isifo se-metabolic, isifo se-cardiovascular kunye nezinye izimo ezixhamlayo .
Iingcebiso
Utyando lwe-psoriatic arthritis kufuneka lujolise ukuxoxwa okanye ukuthotyelwa komsebenzi wesifo ophantsi ophunyezwe ngokujonga rhoqo kunye nokwenza utshintsho kwiyeza njengoko kuyimfuneko.
- I-NSAID (izidakamizwa ezingekho komzimba ezichasayo) zingasetyenziselwa ukukhulula iimpawu kunye neempawu ze-musculoskelet.
- Kwizigulane ezine-arthritis ye-peripheral, ngokukodwa kulabo abanamalungu amaninzi avuvukileyo, umonakalo odibeneyo kunye nokuvuvukala, izinga lokuphakama kwe- sedimentation kunye ne- CRP , kunye / okanye iimbonakaliso ezingaphezulu kwe-csDMARD kufuneka ziqwalaselwe kwangoko, kunye ne-methotrexate ikhetha izigulane ezibandakanyeka kwesikhumba.
- Ijoyileji zengingqi ze-corticosteroids kufuneka zibhekwe njengento echaziweyo (oko kukuthi, eyongezelelweyo) unyango. I- corticosteroids yenkqubo ephantsi kwesazi esebenzayo ingasetyenziswa ngokulumkisa.
- Kwizigulane ezine-arthritis zengxubevange ezineempendulo ezinganeleyo ubuncinane kwi-csDMARD enye, unyango nge-bDMARD kufuneka luqaliswe. I-bDMARD ngokuqhelekileyo i- blocker ye-TNF .
- Kwizigulane ezine-arthritis zengxubevange ezingenazo iimpendulo ezinganeleyo kwi-csDMARD enye ezingenakusebenzisa i-blocker ye-TNF, i-BDMARD ejolise kwi-IL12 / 23 (umzekelo, uStelara [ustekinumab] okanye i-IL17 (umzekelo, secukinumab) inokuqwalaselwa.
- Kwizigulane ezine-arthritis zengxubevange ezineempendulo ezinganeleyo ubuncinane kwi-csDMARD enye kwaye ezingenakusebenzisa i-BDMARD, i-tsDMARD ingaqwalaselwa.
- Kwizigulane ezine- enthesitis esebenzayo kunye / okanye i-dactylitis (ukuvuvukala kwenani elipheleleyo) elineempendulo ezinganeleyo kwi-NSAID okanye ii-corticosteroids zengingqi, i-BDMARD iya kuqwalaselwa. I-blocker ye-TNF ijwayele ukuqala.
- Kwizigulane ezinezifo ezixhamlayo, ezifumana impendulo enganeleyo kwi-NSAID, i-BDMARD iya kuqwalaselwa. I-blocker ye-TNF idlalwa kuqala.
- Kwizigulane ezingaphumeleli ukuphendula kwi-BDMARD, ukutshintshela kwenye i-BDMARD kufuneka kuqwalaselwe. Ukutshintsha phakathi kwee-blockers ezihlukeneyo ze-TNF kunokubhekwa njengefanelekileyo. I-TNF blockers iquka: Enbrel (etanercept) , Remicade (infliximab) , Humira (adalimumab) , Simponi (golimumab) kunye neCimzia (certolizumab pegol) .
Imithombo:
I-European League echasene neRheumatism (EULAR) iingcebiso malunga nolawulo lwe-psoriatic arthritis kunye neyeza zonyango: uhlaziyo luka-2015. Iziganeko zeeRheumatic Diseases. Gossec L. et al. 2016; 75: 499-510 ityala: 10.1136 / annrheumdis-2015-208337
http://ard.bmj.com/content/75/3/499.full
Ulwazi olunomonde: I-Psoriatic arthritis (Ngaphandle kweZiseko). Isemgangathweno. Gladman noRitchlin. Ukuhlaziywa nge- 4/9/15.
http://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics