Indlela ekhokelela ekuziphatheni kwiZiyolo
Nangona kungekho naluphi unyango lwe-rheumatoid arthritis, kukho uluhlu oluqhubekayo lwezonyango olukwazi ukunciphisa intlungu kunye nokuvuvukala kwesi sifo esingapheliyo. Ziquka izigulane zokuzinyamekela, ukutya, i-over-counter-counter-re-contrains, i -rapy, kunye nezilwanyana eziza kutshintsha izifo (DMARDs). Iimeko ezinzima zingadinga iinkqubo ze-office ezifana ne-arthrocentesis okanye ukuhlinzwa ukuze zilungiswe okanye zibuyisele endaweni edibeneyo.
IziPhulo zaseKhaya kunye nokuPhila
I-rheumatoid arthritis isifo esingasigxina, esiqhubekayo esifanele ukulawulwa njengenxalenye yobomi bakho. Kunokuba nje uphathe isifo ngezidakamizwa, kufuneka usebenzise indlela epheleleyo ekujoliseni ukuphucula impilo yakho yonke kunye nokunciphisa iimeko ezinobungozi ezikubeka kwingozi.
Konke malunga nokufumana iimpawu eziphilileyo kunye nokutshintsha indlela ophendula ngayo ekuhlaseleni okulukhuni.
Ukutya
Nangona kuphela ukuba izandla zakho zichaphazelekayo, ukugqithisa okanye ukugqithisa kubangela ukuvuvukala ngenxa yokukhutshwa kwamaprotheni avuthayo (okubizwa ngokuba ngama- cytokines ) ukusuka kwiiseli ezinamafutha. Oku kusebenza kuphela ekuphuculiseni iimpawu zesifo se-rheumatoid arthritis kwaye ungeze uxinzelelo olungenakunzima kumalungu eephantsi.
Nangona kungekho nto yokutya kubantu abane-rheumatoid arthritis, oogqirha abaninzi bavumela ukutya okunomdaniso waseMedithera obonelela ngokulinganisela kweeprotheni, amafutha kunye nee-carbohydrate ngelixa ukhuthaza ukunyuswa kweentlanzi (ezityebi kwi- omega-C ezicuthayo ezinamafutha ). , izityalo, imifuno, iziqhamo, kunye namafutha anempilo (njengeoli yeoli).
Ukuzivocavoca
I-rheumatoid arthritis nayo ibonakaliswe ukuqina ngenxa yomonakalo oqhubekayo wee- synovial tisses kwindawo edibeneyo. Ngokuqalisa isicwangciso sokuqeqeshwa esikwaziyo , unako ukulahlekelwa isisindo kwaye ugcine uluhlu lwezandla ezichaphazelekayo. Indlela yokuphila yokuhlala, ngokuchaseneyo, ivumela izicubu ezidibeneyo ukuba "zenzeke" -nokuthi zibophelelane ngokufanayo njenge-glue-ekhokelela ekuthintela isigxina.
Ukuzivocavoca nako kunokuqinisekisa ukuba amathambo akho ahlala eqinile kwaye alwa nempawu ze- osteoporosis eziqhelekileyo kubantu abane-rheumatoid arthritis.
Ukutshaya
Sonke siyazi ukuba ukutshaya akunakulungele thina, kodwa kunokuba kubi kakhulu xa unesifo se-rheumatoid arthritis. Umsi wesigaretha unobungozi emzimbeni wakho, kungekhona nje ukubangela ukuvuvukala kodwa kubangele ukunyanzelwa kwemithambo yegazi kwindawo apho ukujikeleziswa kungagqitywa kwiindawo ezithile zomzimba.
Oku kunokukhuthaza uphuhliso lwe- vasculitis ye- rheumatoid , isifo esifana nesifo esingapheliyo, izilonda zesikhumba kunye ne-rashes, umkhuhlane, ukulahleka kwesisindo, kunye neentlungu zomzimba. Ngaphezu koko, uphando lubonise ukuba ukutshaya kunokwandisa umngcipheko wokufumana i-rheumatoid arthritis, kwezinye iimeko malunga nama-300 ekhulwini.
Nangona ukuyeka ugwayi kungabunzima, iinjongo zakho (zemibutho kunye jikelele) zingabonakala zikhulu. Thetha nogqirha wakho malunga neendlela zokonyango. Izidakamizwa ezinjengeZyban (bupropion) kunye neCantix (varenicline) zinokusebenza ngabanye ababhemayo kwaye aziyi kuphazamisa iziyobisi zakho ze-rheumatoid arthritis.
I-Over-the-Counter (OTC) iziLungiso
Njengenxalenye yesicwangciso sonyango lwenu lokuqala, ugqirha wakho uya kucebisa ukuba i-OTC) engekho-steremal anti-inflammatory drugs (NSAID) ukunciphisa ubuhlungu obukhulu kunye nokuvuvukala.
Ezi zibandakanya ezo zixhobo ezidumile ze-OTC njenge-Aleve (naproxen) okanye i-Advil (ibuprofen). Ukongezelela ekubeni neendawo ezichasayo, ii-NSAID nazo zi- analgesic kunye ne-antipyretic (ithetha ukuba zinokuphelisa intlungu kunye nomkhuhlane, ngokulandelanayo).
Ii-NSAID aziyicotha ukuqhubeka kwesifo. Ukuba iimpawu zibuhlungu, ugqirha wakho unokuyalela ii-NSAID ezinamandla ezifana neCelebrex (celecoxib) okanye i- Voltaren (i-diclofenac) . Imiphumo yesigxina se-NSAID ibandakanya ukuphazamiseka kwesisu, uxinzelelo lwegazi oluphezulu, ukukhalaza ezindlebeni zakho, izilonda zesisu kunye nesibindi sentyhefu.
Imigaqo
Ukuba uye wafumanisa ukuba une-arthritis ye-rheumatoid , ugqirha wakho uya kufaka i-combination combination of medications, enye iyenzayo impawu kunye nabanye abajongana nesifo sengqondo esisisigxina .
Ezi ziquka umlomo kunye nejoject corticosteroids, izidakamizwa zokuguqula izidakamizwa (i-DMARD), kunye neziyobisi ze-biologic ezitsha.
Corticosteroids
I-Corticosteroids iphumelele kakhulu kodwa izidakamizwa ezinamandla ezinokunciphisa ukuvuvukala kunye nokuncedisa umlinganiselo wokusebenza ngokuzenzekelayo. I-corticosteroids isebenza ngokulinganisa i-cortisol, i-hormone ye-adrenal eyanceda ukulawula ukutshaya, imetabolism, imemori kunye noshukela wegazi.
Zivame ukunyulwa njengenxalenye yonyango lwezonyango ezininzi kwaye zithunyelwa ngomlomo (kwifom yefilda), ngejoyiki (kwisithuba se-muscle okanye ngokubambisana), okanye nge-intravenously (kwi-vein). I-Prednisone yiyilisi esetyenziswa kakhulu kwisifo se-rheumatoid arthritis.
I-Corticosteroids imiselwe kuphela ukusetyenziswa kwexesha elifutshane ngenxa yengozi yokwanda kwemiphumo emibi, kubandakanya i-osteoporosis, ukufumana ubunzima, ukunyunyuza lula, i-cataracts, i-glaucoma, nesifo sikashukela. Xa kuthathwa ngomlomo, zichazwe kumaqondo aphantsi kwaye zidlalwa ngokusa. Izigulane zigcinwe ukuhlaselwa ngokuthe tye kwaye zisetyenziswanga ngaphezu kweethathu okanye ezine ngonyaka.
DMARD
Izidakamizwa zokuguqula izidakamizwa (i-DMARD) ngokusebenza ngokunyusa ukuphendula kwamagciwane onke. Njengesi sifo sokuzimela, i-rheumatoid arthritis ibangelwa ukungasebenzi kwe-immune system apho iiselingi eziqhelekileyo zijoliswe ekuhlaselweni. Indima ye-DMARD kukukhusela isistim somzimba ngokubanzi.
Umsebenzi we-DMARD usebenza ngokugqithiseleyo xa athatyathwa ngokukhawuleza emva kokuba isifo sifumaneka. Kukho iinjongo ezininzi ze-DMARD ezivunyelwe unyango, ezibandakanya izidakamizwa zesizukulwana esidala njenge- Plaquenil (i-hydroxychloroquine) kunye neentsha ezifana ne- Arava (i-leflunomide) . Ininzi ithathwa ngomlomo.
Kude, i-DMARD echazwe ngokuqhelekileyo i- methotrexate . I-Methotrexate sele ijikeleze iminyaka engaphezu kwama-50 yaye iyaqhubeka ibe ngumqolo wesifo se-rheumatoid arthritis. Phakathi kweenzuzo ezininzi, i-methotrexate inokuthathwa ngokukhuselekileyo ixesha elide, ngokuqhelekileyo idinga i-dosing ye-weekly, kwaye ingasetyenziselwa abantwana.
Kwi-downside, i-methotrexate ingabangela ubuthi obunobuthi kunye nokunciphisa umongo we-bone. Iimvavanyo zegazi ezifunekayo zifunekayo ukuphepha ezi ngxaki. Ezinye iziphumo ezichaphazelekayo zibandakanya ukukhathala, isicathulo, isisu, ukugqithisa, isifo sohudo, izilonda zomlomo kunye nokululaza. Ukuthatha isongezelelo se-folic acid nsuku zonke kunokuncedisa ukunciphisa ezinye zeziphumo zecala ezichaphazela iziyobisi.
Gwema i-methotrexate ukuba ukhulelwe okanye uzama ukukhulelwa njengoko kunokubangela ukukhubazeka kokuzalwa.
Biologic Response Modifiers
Iinguqu ze-biologic response guides zihlobo olutsha lwe-DMARD olujolise kwiindawo ezithile zesistim somzimba kunokuba sonke. Zijongwa njenge- biologic kuba azikho ezenziwe ngabantu kodwa zivela kwiiprotheni zomntu okanye zezilwanyana.
Nangona iziyobisi zezilwanyana ezisetyenziselwa ukunyanga i-rheumatoid arthritis zineendlela ezahlukeneyo zokusebenza, zonke zisebenza ngokuthintela ukujoliswa kwe-immune target: i- tumor necrosis factor (TNF) (inxaxheba yayo ukubonisa ukuvuvukala), i-interleukin (elawula ukumelana nomzimba), kunye neeseli ze-T (ezijolise kunye nokuhlaselwa okulitshutshisayo).
Iziyobisi eziphilayo eziqhelekileyo ziquka:
- Actemra (tocilizumab)
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- Humira (adalimumab)
- Kineret (anakinra)
- Orencia (abatacept)
- Remicade (infliximab)
- Rituxan (rituximab)
- Simponi (golimumab)
I-biologics ihanjiswa okanye i-injection okanye i-intravenously kwaye iboniswe ngokuqhelekileyo kubantu abangazange baphendule kwezinye iyeza.
Ngenxa yokuba i-biologics iphazamisa iinkqubo zokuzivikela, abantu abantu kunyango bangase babe mngcipheko omkhulu wokusuleleka. Ngaloo ndlela, nayiphi na isinqunyiweyo, isifo, okanye uphawu losulelo kufuneka luphathwe ngugqirha. Iziphumo eziqhelekileyo zeziphumo ziquka intlungu yesifo senkunkuma, izifo zokuphefumula, kunye neempawu ezifana nezifo.
JAK Inhibitors
UJanus kinase (JAK) inhibitors yiklasi elitsha ye-DMARD engekho ye-biologic esebenza ngokunqanda inkqubo yokuvuvukala ngaphakathi kweseli. I-Jafaki (i-ruxolitinib) kunye ne- Xeljanz (tofacitinib) yiyona yokuqala ye-JAK inhibitors evunyelwe ukuba isebenzise e-US Bobabini bathathwa ngomlomo nangokwemiselo kubantu abangakhange baphendule ngokwaneleyo ukuya kwi-methotrexate okanye bahlulekile kwi-biologics.
I-JAK inhibitors isetyenziswe ngokudibanisa ne-methotrexate kwaye ithathwa kabini imihla ngemihla. Iziphumo ezichaphazelekayo zibandakanya intloko, ukukhathala, ukucasula isisu, iimpawu ezinjengomkhuhlane, isifo sohudo, i-cholesterol ephezulu, kunye nomngcipheko ophezulu wokusuleleka.
Ulungiso lwenyama
Ukongezelela kumachiza, ugqirha wakho unokukuthumela kwi-specialist ye-rehabilitator engakwazi ukusebenza nawe ukubuyisela umsebenzi kunye nokuhamba. Ezi zibandakanya iiphilisi zenyama kunye neengcali zengcali.
Ulwaphulo oluthile lugxininisa ekwakheni amandla nasekuphuculeni ukuhamba. Abantu abaneemodareyithithi ezinzulu zesifo se-rheumatoid badla ukusebenzisana nomgulana wenyama ngokuqhubekayo kwaye banokubonakalisa iindlela ezahlukeneyo ezisusela kwimpawu okanye iimida zabo.
Ezi zonyango ziquka:
- Ukuzomelezwa kwamandla kunye nokuhamba kweendlela zokuhamba
- Ukunyusa okufudumeleyo nokubandayo
- I-ultrasound yezokwelapha
- Ukukhutshwa kwamandla kagesi
- Hydrotherapy
Ulwaphulo lomsebenzi lujolise ekuxhaseni ukuzimela kwakho nokuphucula umgangatho wobomi ngokukunceda ukunqoba ukulinganiselwa komzimba, ngokuqhelekileyo usebenzisa izixhobo zokuncedisa kunye nezixhobo.
Imizekelo ibandakanya:
- Ukufaka ii-cookie ezinkulu okanye izibambiso ezilula ukuzibamba
- Ukufumana izitulo ze-ergonomic ezikuvumela ukuba uhlale ngaphandle kobuhlungu
- Ukukhetha iishubhu, abahambahambayo okanye ezinye izixhobo zokuhamba ezifanelekileyo kwiimfuno zakho
- Ukulungiswa kwakhona kweekhabhinethi kunye namashalofu ukuze izinto zibe lula ukufikelela
- Ukutshintshela ukutshintshisa ukukhanya kunye nezixhobo zokuhambisa
- Ukusebenzisa umyalelo wezwi kunokuba ulawulo lweefowuni
Ezinye iingcali, kuquka iipolitri, ukuxilisa iingcali kunye neengcali zengqondo, kunokufunwa ukunqoba ezinye izithintelo zomzimba nezomzwelo.
Izinketho zangaphambili zokupanda
Uphando luhlala lubonwa njengoluhlobo lokugqibela xa unesifo se-rheumatoid arthritis. Ngaphambi kokuba uqwalasele ukuhlinzwa, ugqirha wakho unokufuna ukuphonononga ubuchule obuncinci, kwii-ofisi, ngakumbi ukuba usemncinci kwaye unempilo enempilo.
Phakathi kweendlela ezikhoyo zibizwa ngokuba yi- arthrocentesis apho i-fluid isuswa kwiindawo ezidibeneyo kunye nenaliti yokunciphisa uxinzelelo. Ngokuqhelekileyo kusetyenziswa njengentsingiselo yokuxilongwa kodwa kunokusebenza ngokufanelekileyo kwiimeko apho ukwakhiwa kwamanzi kudala kubangele intlungu.
I-arthrocentesis ingenziwa ngokwayo okanye ngaphambi kokulawula i-corticosteroid shot. Ezinye ii -injection zangaphakathi zibandakanya ukusetyenziswa kwe- acaluronic acid ukucoca indawo edibeneyo okanye iplasma ene-platinum (IPP) esetyenziswe kwigazi lomntu ukukhuthaza ukuveliswa kwe-cartilage kumalungu amaninzi awonakele.
Nangona kunjalo, kuya kubakho amaxesha apho i-arthrocentesis ayiyi kunika uncedo olulindelekileyo, kwaye utyando luyodwa kuphela.
Ukuhlinzwa
Ukuba intlungu yakho edibeneyo ingenakuxhatshazwa, ugqirha wakho unokuncoma utyando ukuba ahlaziywe iqela elonakalisiweyo okanye ulibuyisele kuyo. Ngokubanzi, utyando luqwalaselwa kuphela ukuba zonke ezinye iinketho sele ziphelile kwaye uthathwa njengomviwa ofanelekileyo wenkqubo.
Ukulungiswa Okuhlangeneyo
Njengoko i-rheumatoid arthritis iyaqhubeka, ama-tissue ahlangeneyo anokwenziwa. ngelixa ukukhukuliseka kwe-cartilage kunye nethambo kuya kubangela ukuba idibeneyo ilahlekelwe ukulungelelaniswa kunye nokuma, okubangele ukukhubazeka ngokuhlangeneyo . Ngokukodwa kwiincinci ezincinci apho ukutshintshwa kungabikho ukhetho, oogqirha baya kusebenzisa iindlela ezahlukeneyo zokunceda ukubuyisela ukunyakaza nokunciphisa intlungu.
Phakathi kweendlela zokulungisa:
- I-Arthrodesis , eyaziwa nangokuthi i-bone kunye ne-fusion ehlangeneyo, isetyenziselwa ukunciphisa intlungu edibeneyo enganyangekiyo ngokubambisana amathambo kunye nokuthintela intlangano ye-intra-articular.
- I-Arthroscopy yinkqubo apho i-arthroscope (ebizwa ngokuba yi-arthroscope) ifakwe kwindawo edibeneyo ukwenzela ukuba i-bone of bone and cartilage ifumaneke kwaye isuswe.
- Ukukhululwa kwee-carpal tunnel, ebizwa ngokuba yi-nerv release, yindlela yokuhlinzwa apho i-carpal tunnel ligament yesandla ikhutshwe ukwenzela ukuba yenze indawo engakumbi yezibilini kunye neeton.
- I-Synovectomy ibandakanya ukususwa kweminye yokubambisana, ebizwa ngokuba yi synovium, xa ihlaselwa ingapheli kwaye iphazamise ukuxubusha komxube.
Ukutshintshwa okuhlangeneyo
Ukuhlinzwa okuhlanganyelweyo okuhlangeneyo , okubizwa ngokuba yi-arthroplasty, kuye kwanda ngokuqhelekileyo kubantu abane-arthritis ye-rheumatoid. Isigqibo sokuphinda sitshintshwe ngokubambisana siya kusekelwe ekuhlaziyweni kwempawu zomzimba, imbali yonyango, kunye neziphumo ezivela kwiimvavanyo zengqondo.
Ngaphezu koko, ubudala bakho buza kuthatha inxaxheba enkulu kwisigqibo esinikwe ukuba iiflothees ezidibeneyo zihlala zihlala phi ukusuka kwiminyaka eyi-15 ukuya kwe-20. Ngaloo ndlela, uninzi lwagqirha luya kufuna ukulibazisa inkqubo ngokukhawuleza, ngokunjalo uze ube kwindawo ethile kuma-50s.
(Ngaloo nto kuthiwa, abaninzi abantu abane-arthritis ye-rheumatoid bafake indawo yokuthatha indawo yabo kwiminyaka engama-60 ubudala ngenxa yokuphucula ukwenziwa kwe-DMARD entsha.)
Ekubeni i-DMARD isebenze ngokukhusela isistim somzimba, kufuneka uyeke unyango kakuhle ngaphambi kokuba utyunjelwe ukunciphisa ingozi yokusuleleka kwintsholongwane engasemva.
Namhlanje, ukuguqulwa kwamadolo kunye nokuqhaqhaqhaqhayisa kuye kwandisa ngokukhuselekileyo kwaye kusebenza ngezinga eliphezulu lokuphumelela kweepesenti ezingama-90. Iingxaki zentsebenziswano kubantu abane-arthritis ye-rheumatoid zifana kakhulu nakwezinye izinto kwaye zibandakanya umonakalo weentsimbi, ukusuleleka, i-blood clots kunye nokudibanisa okuhlangeneyo.
I-Alternative Medicine (CAM)
Xa bejongene nesifo esingapheliyo, isigulo sobomi, abantu abane-rheumatoid arthritis baya kuvamelana nemithi yokuxhaswa yokuxhasa unyango lwabo lwamayeza.
Nangona ezininzi iindlela zokwelapha zinika iingenelo, zombini zinyani kwaye ziqondwe, kubalulekile ukuthetha nodokotela wakho malunga nayiphi na isongezelelo, isityalo okanye imithi yendabuko onokuyithatha. Oku kunokuthintela ukusebenzisana kwezidakamizwa ezinokunciphisa unyango lwakho okanye iziphumo zecala kunye neetyhefu ezingenza ugula.
Phakathi kwezilwanyana ezinokuthathwa njengenzuzo kwiyeza zokwelapha i-rheumatoid arthritis:
- Ukuncediswa kweoli yeentlanzi kuqulethe ixabiso elincinci le-omega-3 fatty acids elisebenzisela umzimba ukunciphisa ukuvuvukala. Uninzi lwezifundo zibonise ukuba i-gram yegram yesihlanu inokubonelela ngokukhawuleza intlungu yesifo se-arthritis kunye nokuqina. Nangona kunjalo, ukunyuswa kweoli yeentlanzi kufuneka kugwenywe kubantu abasebenzisa igazi abagciniweyo njenge- warfarin njengoko banokunyusa umngcipheko wegazi.
- I-Borage , i- primrose yasebusuku kunye namafutha omnyama ase-currant , atholakala kwi-gel-cap kunye ne-liquidulations formulations, awona mthombo omega-6 we-fatty acids, enezinto ezinxamnye nokutshabalalisa ezizuzisa abantu abane-rheumatoid arthritis. Ukugqithiseleka kufuneka kugwenywe njengokuba ibhonage ingabangela ukulimala kwesibindi kumaqondo aphezulu, ngelixa i-primrose yasebusuku ingaphazamisa izidakamizwa ze-phenothiazine ezisetyenziswe kwizifo zengqondo.
Ezinye izinto ezisetyenziswayo eziqhelekileyo ezifana ne-glucosamine, i-chondroitin, i-acupuncture, kunye ne-magnetic therapy ayibonakalwanga ukuba luncedo kakhulu ekuphatheni i-rheumatoid arthritis.
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> Nikiphorou, E .; Konan, S; MacGregor, A. et al. "Utyando lotyando lwe-rheumatoid arthritis; Ixesha elitsha?" I- Bone Joint J. 2014; 96-B: 1287-9. INGXELO: 10.1302 / 0301-620X.96B.34506.
> Singh, J .; Saag, K .; Bridges, L. et al. "Inkcazo yase-American American College of Rheumatology Guideline ye-Treatment of Rheumatoid Arthritis." I- Arthritis Care Res. 2016: 68 (1); 1-25. INGXELO: 10.1002 / acr.22783.
> Smolen, J .; Aletaha, D .; kunye noMcInnes, I. "I-rheumatoid arthritis. " Lancet. 2017; 388 (10055): 2023-38. INGXELO: 10.1016 / So140-6736 (16) 30173-8.
> Sugiyama, D .; Nishimura, K .; UTamaki, K. et al. "Impembelelo yokubhema njengengozi yokuphuhlisa i-rheumatoid arthritis: uhlalutyo lweemeta zophando. " Uchaza iRheum Dis. 2010; 69 (1): 70-81. INGXELO: 10.1136 / 2008.2009.