Ngamana unokufaka isicelo kwi-Ankylosing Spondylitis ne-Psoriatic Arthritis
Kuyaziwa ukuba abantu abane- rheumatoid arthritis (RA) banomngcipheko ophezulu wokubandezeleka nokufa kwabantu abavela kwisifo senhliziyo-engozini ekuthiwa iyafana naleyo kubantu abanesifo seswekile. Kubantu abane-arthritis ye-rheumatoid, kukho ingozi eyongeziweyo yokutshatyalaliswa kwe-myocardial infarction (intliziyo yesifo) kunye nokufa ngokukhawuleza. Ukusabalalisa kwe-infyoction ye-myocardial kunezihlandlo ezibini eziphakamileyo kubantu abane-arthritis ye-rheumatoid uma kuqhathaniswa noluntu jikelele.
Ulwalamano lwe-causal phakathi kwesifo se-cardiovascular and rheumatoid arthritis luyinkimbinkimbi kwaye lubonakala luhambelana nezinto ezininzi. Izinto ezinobungozi bomzimba (umz., Uxinzelelo lwexinzelelo, ukukhuluphala, ukutshaya, isifo sikashukela, i-cholesterol ephezulu), kunye nabakishi be-rheumatoid arthritis graverity markers, banegalelo.
Ingozi ye-Cardiovascular Risk kwi-Rheumatoid Arthritis: Into esiyaziyo
Kwiminyaka emininzi, abaphandi baye bafunda umbutho kunye nokuba ingqalelo eyaneleyo ihlawulwa kwizinto ezinobungozi bomzimba kubantu abaneentlobo ezinokuvutha kwamathambo . Kuye kwatsho nokuba i-rheumatoid arthritis ngokwayo iyingozi yobomi bentliziyo. Iziphumo abaphandi abaphangiweyo ziquka:
- Kukho umngcipheko omkhulu wesifo senhliziyo esenzeka ekuqaleni kwexesha lesifo sesifo se-rheumatoid arthritis, esingaba nesifo sesandulela sesifo.
- Ukuvuvukala kudlala indima ephambili kwisifo senhliziyo.
- Abantu abane-arthritis ye-rheumatoid babonakala bekhawuleza i- atherosclerosis , eyona nto ithathwa njengesiqhumane. Kungenzeka ukuba inkqubo yokuvuvukala kwe-rheumatoid arthritis kunye ne-extofines engaphezu kwe-proinflammatory inegalelo ekwakheni i-plaque.
- Ukuqhaqha ngokuzenzekelayo komzimba we-rheumatoid arthritis kunomdla wokwandisa ukuphela komsebenzi , ukunyanzeliswa kwe-oxidative , kunye nokusebenza kunye nokufuduka kwama-leukocytes (amaseli egazi ezimhlophe) ngaphakathi kwemithwalo yegazi. Ukunamathela kwe-leukocytes ukuya ekupheleni kwe-vasothemine isifo esichaphazelekayo senkqubo yokuvuvukala.
- Ukuvutha komzimba okuhambisana ne-rheumatoid arthritis ngokudibanisa nezinto ezinobungozi bomzimba ezinxulumene nendlela yokuphila kunokubangela ukuba izifo zengqondo zixhomekeke kwi-rheumatoid arthritis.
Kutheni Ubunxibelelwano Kubaluleke Kangako?
Phantse isiqingatha sazo zonke ukufa kubantu abane-rheumatoid arthritis idibene nesifo senhliziyo. Ukufa kwe-Cardiovascular mortality kwenyuka ngama-50 ekhulwini kwaye ingozi yesifo senhliziyo iya kunyuka ngama-48 ekhulwini kulabo abane-rheumatoid arthritis xa kuthelekiswa nabemi bonke (Avina-Zubieta).
Abantu abanesifo se-rheumatoid arthritis ixesha elide, abo banezibonakaliso ezongezelelweyo (okt, kuthintela ngaphezu kwamalungu nje), kunye nalabo abanesifo se- rheumatoid kunye ne-anti-CCP (i-autoantibodies) banomngcipheko omkhulu wokufa kwegazi. Ukulawula ingozi kubalulekile.
IINGCEBISO ZE-EULAR zokuLawula ingozi ye-cardiovascular in RA
Ngo-2009, I-EULAR (i-European League echasene neRheumatism) yabutha iqela lokunika iingcebiso zokulawula ingozi yomzimba kubantu abanesifo se-rheumatoid arthritis. Iziphakamiso zahlaziywa ngo-2015/2016.
Kukho imigaqo emithathu ephezulu eyenziwa yi-EULAR-kunye neencomo ezili-10 ezinikezelweyo, enye entsha kunye neyesithandathu yatshintshwa ukusuka kwinguqulelo ka-2009.
Imigaqo ephezulu:
1) Oogqirha kufuneka baqaphele ingozi ephezulu yesifo senhliziyo kubantu abanesifo se-rheumatoid arthritis xa kuthelekiswa nabemi bonke.
2) I-rheumatologist kufuneka iqinisekise ukuba ukulawulwa kwengozi ye-cardiovascular disease kuyenziwa kwizigulane ze-rheumatoid arthritis kunye nezinye izifo ezidibeneyo.
3) Ukusetyenziswa kwe- NSAID (izidakamizwa ezichasayo ezingekho komzimba) kunye ne- corticosteroids kufuneka zilandelwe ngokweengcebiso ezithile ezivela kwi-EULAR ne-ASAS (Uvavanyo lwe-Spondyloarthritis International Society).
Iingcebiso ezili-10 zibandakanya:
1) Imisebenzi yesifo kufuneka ilawulwe ngokufanelekileyo kwi-arthritis ye-rheumatoid, i- spondylitis ene-ankylosing kunye ne- psoriatic arthritis ukwenzela ukunciphisa ingozi yesifo senhliziyo.
2) Ukuhlolwa kweengozi ze-cardiovascular is advised for those with rheumatoid arthritis, spondylitis i-ankylosing, okanye i-psoriatic arthritis ubuncinane kanye emva kweminyaka emihlanu kwaye mhlawumbi ilandele nayiphi na inguqu enkulu kunyango.
3) Uqikelelo lomngcipheko wesifo sengqondo somntu kubantu abane-arthritis ye-rheumatoid, i-spondylitis e-ankylosing, okanye i-psoriatic arthritis kufuneka yenziwe ngokwemiqathango yesizwe, kunye ne-SCORE ye-CVD yokubikezela ingozi xa kungekho zikhokelo.
4) Ixabiso le- cholesterol kunye ne-high-density lipoprotein cholesterol kufuneka zisetyenziswe ekuhloleni komngcipheko we-rheumatoid arthritis, i-spondylitis e-ankylosing, kunye ne-psoriatic arthritis kunye ne-lipids kufuneka ilinganiswe xa umsebenzi wesifo uzinzile okanye uxolelwe. Iipilisi ezingadliyo ziyamkeleka.
5) Iimodeli zokubikezela umngcipheko we-cardiovascular risk should be adapted to people with rheumatoid arthritis by multiply by 1.5.
6) Ukucatshungulwa kweeplathi ze-atherosclerotic ezingenasiphelo ngokusebenzisa i-carotid ultrasound kunokubhekwa njengengxenye yokuhlolwa kwengozi yomsindo kulabo abane-rheumatoid arthritis.
7) Iziphakamiso zokuphila kufuneka zigxininise ukutya okunempilo, ukuzivocavoca rhoqo kunye nokuyeka ukutshaya.
8) Ukulawulwa kweengozi ze-cardiovascular disease kufuneka kwenziwe ngokuhambelana nezikhokelo ze-rheumatoid arthritis, i-spondylitis eskylosing kunye ne-psoriatic arthritis. Iinqwelo ezikhuselekileyo ze-hypertensives kunye nama-statins zingasetyenziselwa njengoko zihlala ngokubanzi.
9) I-NSAID kufuneka imiselwe ngokuqaphela isifo se-rheumatoid nesifo sesifo se-psoriatic, ngakumbi kubantu abanezifo zengqondo okanye izazi eziyaziwayo.
10) Ukuze unyango olude, umthamo we-corticosteroids kufuneka ugcinwe uphantsi kwaye kufuneka ulungiswe xa ukukhutshwa okanye isifo somzimba esezantsi senzeka. Ukuqhubela phambili kwe-corticosteroids kufuneka kuhlaziywe rhoqo.
Iziphumo zophando ezenziwe kwiNgxelo ye-ACR yonyaka we-2016
Kwintlanganiso yonyaka ye-American College of Rheumatology, eyayibanjwe ngoNovemba 2016, bekukho ubuncinane izifundo ezintathu ezinikezelwe ngengozi yomoya kwi-rheumatoid arthritis. Enye yezifundo (i-ID ye-ID: 664363 i-ACR Newsroom) iphetha ngokuthi ngaphezu kweminyaka engama-15 ubudala, abantu abane-arthritis ye-rheumatoyi banomngcipheko wokuba nemicimbi ye-cardiovascular as the population-rate as similar to type 2 diabetes.
Olunye uvavanyo (i-ID ye-ID: 663451 ACR Newsroom) ivavanywa ukuba ngaba abantu abane-arthritis esebenzayo kodwa abanakho izifo zesifo senhliziyo basenobungqina bokuvuvukala kwe-myocardial. Baye baqwalasela nokuba ukuvuvukala kwe-myocardial kwathatha unyango nge- DMARD (izifo eziguqula izidakamizwa ezichasene ne-rheumatic) . Abaphengululi baphetha ukuba kukho into ebonakala ngathi i-myocardial inflammation kwaye yabonakala iphendule unyango nge-DMARD.
Isifundo sesithathu (i-ID ye-ID: 664367 I-ACR Newsroom) igxininise ekulawuleni ngaphantsi kwezifo zentliziyo yesifo kubantu abanezifo ezidibeneyo. Kwagqitywa ukuba nangona kukho ukufumaneka kwamachiza anesifo esiphezulu kunye ne-lipid-downing, inani elingaphantsi kwezigulane lichazwe iziyobisi.
Ngaphantsi
Kude kakhulu, ingozi eyongezelelekileyo yesifo senhliziyo kubantu abantu abane-arthritis ye-rheumatoid iyalinyanzeliswa kwaye ilawulwa phantsi. Umngcipheko owenziwe ngumfutho wexinzelelo, ukukhuluphala, ukutshaya, kunye ne-dyslipidemia, kunye nenkqubo yokuvuvukala eqhubekayo kwi-arthritis ye-rheumatoid, akufanele ihoywa. Kukho imfuno ye-rheumatology kunye noogqirha bokunakekelwa ngokusisiseko ukuba basebenze ngokubambisana ukulawula izifo zengozi ye-cardiovascular and activity activity related to rheumatoid arthritis.
Nangona uphando lujolise ekubalukeleni kokulawula ingozi ye-cardiovascular ihambelana nesifo se-rheumatoid arthritis, kufuna uphando olungakumbi. Iithagethi zonyango ezichazwe kakuhle zihlala zingekho. Kukho imfuno yezikhokelo ezicacileyo zokunciphisa ngempumelelo umngcipheko wesifo senhliziyo kubantu abanesifo se-rheumatoid arthritis okanye ezinye izifo ezidibeneyo ezivukisayo.
> Imithombo:
> Agca R. et al. IINGCEBISO ZE-EULAR zokulawulwa kweengozi zeengqondo zomoya kwizigulane ezine-rheumatoid arthritis kunye nezinye iintlobo zokuxhatshazwa ngokubambisana: 2015/2016. Iziganeko zeeRheumatic Diseases . Oktobha 2016.
> Barber CE et al. Izikhalazo ekujonganeni nomngcipheko we-Cardiovascular Risk kwi-Arthritis ye-Rheumatoid: Ukuvavanya ukusebenza kusetyenziswa izibonakaliso zee-Cardiovascular Quality Indicators. Journal of Rheumatology . Novemba 2016.
> USolomon DH et al. Ukuchaza ingozi ye-cardiovascular associated with arthritis ye-rheumatoid: iziganeko zengozi zemveli ngokubhekiselele kumakishi obunzima be-rheumatoid arthritis. Iziganeko zeeRheumatic Diseases . Novemba 2010.
> Tournadre, Anne et al. Ukulawula ingozi ye-cardiovascular in patients kwi-arthritis evuthayo: ukucingisisa. Uphuhliso lwezeMpilo kwiMisculoskeletal Disease . 2016.
> van-Breulelen-van der Stoep DF et al. Ingozi yeengqondo kwi-rheumatoid arthritis: njani ukunciphisa ingozi? Atherosclerosis . Novemba 2013.