Indlela iSifo kunye nezifo Ukukhutshwa kuVunyelwe
I-rheumatoid arthritis ihluke kwi-osteoarthritis ("ingubo yokugqoka" kunye ne-arthritis) ngokuba yinto yokuzimela ngokuzenzekelayo apho i-immune system ihlasela kakubi iiseli kunye nezicubu zayo, ngokukodwa ezo zihlanganiso. Ngaloo ndlela, isifo asikwazi ukuxilonga ngeempawu kuphela. Kunoko, kufuneka usebenzise ukudibanisa iimvavanyo-kuquka ukuhlolwa ngokomzimba, iimvavanyo zokucinga, kunye nokuhlolwa kwegazi-ukuchonga ukuba ngaba iziphumo ziyahlangabezana nencazelo yekliniki yesifo.
Ukwenza oko akugcini nje kuphela ukuqinisekisa ukuba ukuxilongwa kuchanekile, kukunceda ukufumana inkqubo efanelekileyo yokonyango.
Uvavanyo lweMzimba
Esinye sezixhobo zokuqala zokuxilonga sisisigqibo somzimba. Injongo yovavanyo, ngokwengxenye, ukucacisa iimpawu zentlungu kunye kunye nokuvuvukala ukuze kulunge ngakumbi ukuchasisa kumntu osesikweni, okanye i- osteoarthritis .
Phakathi kwezinto eziphambili:
- I-rheumatoid arthritis ivame ukuchaphazela amaninzi amaninzi (i- polyarthritis ). I-Osteoarthritis ihlala ichaphazela izandla, iinyawo, namadolo kwaye ngokuphindaphindiweyo kufaka iqela elilodwa ( monoarthritis ).
- I-rheumatoid arthritis ivame ukulingana, oku kuthetha ukuba iimpawu ezihlangeneyo kwicala elinye lomzimba ziya kuhlanjululwa ngaphesheya komzimba. I-Osteoarthritis idla ngokungaqhelekanga (okanye i-asymmetrical if more joint one single).
- Ngenxa yokuba i-rhythmic arthritis ibangela i-systemic (umzimba wonke), ukukhathala , i-malaise, kunye ne-fever-grade-grade. I-osteoarthritis, engesiyo isifo esivuvuzayo, asiyi kuhamba kunye nale mpawu.
- Ukuqina koMasa kufana ne-rheumatoid arthritis kodwa kuthatha ukuphela kwemizuzu engama-30 kwaye kuphuculwe ngokunyanzelisa. Ekubeni i-osteoarthritis iquka umonakalo ohlanganyeleneyo wendawo, ukuqina kobusiya kuya kuhlala ixesha elide.
Ukongezelela ukuvavanya iimpawu zakho zomzimba, ugqirha uya kuhlaziya imbali yakho yentsapho.
I-rheumatoid arthritis inokuthi iqhutyelwe kwiintsapho, ngokuphindwe kabini ingozi yesifo ukuba isihlobo sesekondari sinalo kwaye sithatha kathathu umngcipheko ukuba ilungu lentsapho lichaphazelekayo.
Uvavanyo lweBeb
Iimvavanyo zetabha zisetyenziselwa iinjongo ezibini eziphambili ekuxilongeni i-arthritis ye-rheumatoid: ukuhlukanisa i- sterostatus yakho kwaye ukulinganisa nokubeka esweni izinga lokuvuvukala emzimbeni wakho.
Serostatus
I-Serostatus (ngokuguqulelwe ngokuguqulelwe ngokuthi "isimo segazi") ibhekisela kwizihlomelo eziphambili zesifo egazini lakho. Ukuba ezi zinto zifunyenwe ekuhlolweni kwegazi, kuthiwa unesophelo. Ukuba ayifumaneki, uya kuthiwa ubekwe njenge-seronegative. Iziphumo ezingenasiphelo zingabalwa njengento ephantsi, efanelekileyo, okanye ephezulu / enamandla.
Kukho iimvavanyo ezimbini ezisetyenziselwa ukuseka i-serostatus yakho:
- I-Rheumatoid factor (RF) luhlobo lomntu oluthile olufumaneka kuma-80 ekhulwini labantu abaphila nesi sifo. I-Autoantibodies iiprotheni eziveliswa ngumzimba ezihlasela iiseli eziphilileyo. Nangona amazinga aphakamileyo e-RF aphakamisa kakhulu isifo se-rheumatoid arthritis, ziyakwenzeka kunye nezinye izifo ezizimeleyo ezifana ne-lupus okanye izifo ezingekho mzimbeni ezifana nomhlaza kunye nezifo ezingapheliyo.
- I-peptide ye-anti-cyclic citrullinated (anti-CCP) yinto enye yomntu obonakalayo kwininzi yabantu abane-arthritis ye-rheumatoid. Ubume obuphezulu bokuvavanya-amandla akhe okuchonga ngokuchanekileyo ukulwa neCCP-yinto enokuthi ichonge amanqaku omndeni engozini yesifo nokuba ngaba ayinayo impawu.
Apho zombini iimvavanyo zingaphantsi kobubele bazo, ngokubanzi ziphantsi kweepesenti ezingama-80. Oko kuthetha ukuthini ukuba iimvavanyo, ngelixa zixabisekileyo ekwenzeni ukuxilongwa, zixhomekeke kwimiphumo engalunganga okanye engalunganga . Kungenxa yesi sizathu sokuba zisetyenziswe njengenxalenye yenkqubo yokuxilonga kunokuba zibonise zodwa.
Amakhwala avuthayo
Ukuvuvukala kukubonakalisa isifo se-rheumatoid arthritis. Uvavanyo luyenziwa ukuvavanya izinga lokuvuvukala ngokujonga kumakishi abalulekileyo egazini. La manqaku asinceda kuphela ukuba siqinisekise ukuxilongwa kokuqala kodwa sisetyenziswe kuyo yonke inkqubo yesifo ukuhlola impendulo yethu kunyango .
Kule nto, oogqirha baya kusebenzisa amanyathelo amancinci:
- Intlawulo ye-sedimentation ye-Erythrocyte (ESR) yolu vavanyo olulinganisa isantya apho amangqamuzana egazi abomvu ahlala khona phantsi kwebhubhe elide elide, elibizwa ngokuba yi-Westergren tube, ngeyure. Ukuba kukho ukuvuvukala, amangqamuzana egazi abomvu aya kubamba kunye kunye nokucima ngokukhawuleza. Ingumlinganiselo ongacacanga wokuvuvukala kodwa omnye unokunika iinkcazelo ezibalulekileyo ekuxilongeni.
- Iprotheyini esebenzayo e-C (i-CRP) luhlobo lweprotheni oluveliswa sisibindi ngokuphendula ukuvuvukala. Ngona kunjalo nangona kungeyona ethile, umlinganiselo othe ngqo wempendulo yokuvutha.
I-ESR kunye ne-CRP zingasetyenziselwa ukuxilonga ukuxolelwa kwe-arthritis , imeko yesifo esiphantsi kwesifo apho ukuvuvukala kuncinci kukhangela.
Uvavanyo lweemvavanyo
Indima yokujonga iifom kwi-rheumatoid arthritis kukubona iimpawu zomonakalo ohlangeneyo, zibandakanya amathambo kunye ne-cartilage erosion kunye nokunciphisa izithuba ezidibeneyo. Banokukunceda ukulandelela ukuqhubela phambili kwesi sifo kwaye kusekwe xa kufuneka unyango .
Uvavanyo ngalunye lunokubonelela ngeenkcukacha ezahlukeneyo kunye neenkcukacha ezithile:
- I-ray-ray iyona incedo ngokukhethekileyo ekufumaneni ukukhutshwa kwethambo kunye nokulimala ngokubambisana. Nangona ii-X-ray zibhekwa njengesicatshulwa sokuqala se-arthritis, asinakunceda kwizigaba zokuqala zesi sifo xa utshintsho lwezicubu ze-cartilage ne- synovial tissues zingabonakali.
- Ukubonwa kwe-Magnetic resonance (MRI) iyakwazi ukubheka ngaphaya kwethambo kunye neenguqu zenguqu kwiisiski ezixhumeneyo kwaye ngokuqinisekileyo zichonga ukuvuvukala okufanayo kwizifo zakuqala.
- I-Ultrasounds nayo ingcono ekuboneni ukukhutshwa kokuqala kokudibana kunye kwaye iyakwazi ukubonakalisa imimandla ethile yokutshatyalaliswa ngokubambisana. Lo luphawu olubalulekileyo olunikezwa ukuba ukuvutha ngamanye amaxesha kungaqhubeka kungabonakaliyo nangona i-ESR ne-CRP isitshela ukuba umntu uxolelwe. Kwimeko enjalo, unyango luya kuqhutyelwa de kube lixesha lokuba ukuxolelwa kwangempela kufezekiswe.
Iikhrayithi zokuHlola
Ngo-2010, i-American College yeRheumatology (ACR) ihlaziye imilinganiselo yayo yokudala i-rheumatoid arthritis. Ukuhlaziywa kwashukumiswa, ngokwengxenye, ngokuqhubela phambili kwezobuchwepheshe bokuxilonga. Nangona uhlalutyo lujoliswe kwiinjongo zophando lwekliniki, kunjalo kusetyenziswa kwiinkqubo zonyango ukubonelela ngezinga eliphezulu lokuxilonga.
I-2010 ACR / EULAR Classification Criteria ibheka amanyathelo ahlukeneyo eekliniki ezine kwaye ihlawulele kwizinga le-0 ukuya ku-5. Amanqaku athileyo aphakathi kwe-6 ukuya kwe-10 anokubonelela ngezinga eliphezulu lokuzithemba ukuba, ngokwenene, une-rheumatoid arthritis.
| Criteria | Xabiso | Amaphuzu |
| Ubude beempawu | Ngaphantsi kweeveki ezintandathu | 0 |
| Ngaphezulu kweeveki ezintandathu | 1 | |
| Ukubandakanya ngokuhlangeneyo | Omnye umdibaniso omkhulu | 0 |
| Amalungu amaninzi amabini ukuya ku-10 | 1 | |
| Elinye ukuya kumathathu amancinci (ngaphandle kokubandakanyeka kwamalungu amaninzi) | 2 | |
| Amalungu amancinci amane ukuya kuma-10 (ngaphandle kokubandakanyeka kwamalungu amaninzi) | 3 | |
| Amalungu angaphezulu kwama-10 (kunye nomncinci omnye omncinci) | 5 | |
| Serostatus | I-RF kunye ne-anti-CCP ayibi | 0 |
| I-RF ephantsi kunye ne-anti-CCP ephantsi | 2 | |
| I-RF ephezulu kunye ne-anti-CCP | 3 | |
| Abamakishi abavuthayo | ESR evamile kunye ne-CRP | 0 |
| ESR engaqhelekanga kunye ne-CRP | 1 |
Ukuchonga ukuxolelwa
Ukufumanisa ukuxolelwa kwesifo akuyona into ecacileyo kwinkqubo. Akufuneki nje kuphela iimvavanyo zokuxilonga kodwa ukuhlolwa okuzimeleyo kwento wena, njengesigulane, uzive ngayo ngemeko yakho. Kubalulekile ukufumanisa ukuxolelwa ngokuchanekileyo kubangelwa ukuba inqumle ukuba unyango oluthile lunokumiswa okanye ukuba ukwenza oko kungasemva kwexesha kwaye kubangele ukuphindwa kwakhona .
Kule nto, i-ACR imise into ebizwa ngokuba yi-DAS28, equlethwe ngamanyathelo amane ahlukeneyo. "I-DAS" isichaza esithi "uphawu lomsebenzi wesifo," ngelixa i-28 ibhekisela kwinani lamalungu ahlolwe kuhlolo.
I-DAS ibheka oku kulandelayo:
- Inani lamanxeba amathenda wakho ugqirha (kwi-28)
- Inani lamalungu axhubileyo ugqirha wakho (kwi-28)
- Iziphumo zakho ze-ESR kunye ne-CRP (eziqhelekileyo ngokungaqhelekanga)
- Indlela ovakalelwa ngayo impilo yakho yonke ngokumakisha izinga lakho kumgca we-10 cm ububanzi ekupheleni komnye "kukuhle kakhulu" kwaye enye "imbi kakhulu"
Ezi ziphumo zifakwe kwisondlo esiyinkimbinkimbi semathematika ukubala amanqaku akho jikelele. I-DAS28 ephezulu ngaphezu kwe-5.1 ichaza izifo ezisebenzayo, ngaphantsi kwe-3.2 ikhombisa umsebenzi wesifo esiphantsi, kwaye ngaphantsi kwe-2.6 kuthathwa njengento yokuxolelwa.
Ukuxilongwa ngokungafani
Ngendlela efanayo ukuba iimvavanyo zinokunceda ukuhlula phakathi kwe-rheumatoid arthritis kunye ne-osteoarthritis, abanye banokuyalelwa ukuba baqinisekise ukuba kukho ezinye izimbangela zempawu zakho. Oku kuyinyaniso ngokuthe ukuba iziphumo zokuhlolwa kwe-arthritis ye-rheumato zingabonakaliyo, zingenangqondo, okanye zibi.
Ezi ziquka ukukhathazeka okuzenzekelayo, izifo ezixhamlayo zezifo, kunye nezifo ezingagqirhayo ezinjengoku:
- Fibromyalgia
- Isifo seLyme
- Myelodysplastic syndromes
- I-Paraneoplastic syndromes
- Polymyalgia rheumatica
- I-Psoriatic arthritis
- Sarcoidosis
- Sjogren syndrome
- I-systemic lupus erythematosus (lupus)
> Imithombo:
> Aletaha, D .; Neogi, T; Silman, A. et al. "I-Rheumatoid ye-Arthritis Classification Criteria: I-American College yeRheumatology / i-European League ngokumelene neRheumatism Ukubambisana Okuqalayo." Arthritis Rheum. 2010: 62 (9): 2565-81 INGXELO: 10.1002 / ubugcisa.27584.
> Anderson, J .; Caplan, L; Yazdany, J. et al. "I-Rheumatoid Arthritis Disease Iimpawu zengqesho: Ikholeji yaseMerika yeRheumatology Iingcebiso zokuSebenza kwiCliniki yokuSebenza." I- Arthritis Care Res. 2012; 64 (5): 6. INGXELO: 10.1002 / acr.21649.
> Bykerk, V. kunye noMasarotti, E. "I-criteria ye-ACR / EULAR yokuxoxwa kwe-EARAR: injongo yokuphuhlisa imigaqo emitsha yokuxolelwa." I- Rheumatology . 2012; 51: vi16vi20. INGXELO: 10.1093 / rheumatology / kes281.
> Smolen, J .; Aletaha, D .; kunye noMcInnes, I. "I-rheumatoid arthritis. " Lancet. 2017; 388 (10055): 2023-38. INGXELO: 10.1016 / So140-6736 (16) 30173-8.