IQela lokusebenzisana ukusuka ku-ACR kunye no-EULAR
Izikhokelo zolawulo lwe- polymyalgia rheumatica (PMR) zakhishwa ngoSeptemba 2015, njengenxalenye yomgudu wokusebenzisana phakathi kwe-American College of Rheumatology (ACR) kunye ne-European League Against Rheumatism (EULAR). Izikhokelo ziyisiqalo sokuqala seziphakamiso zamazwe ngamazwe kunyango kunye nokulawulwa kwezigulane ngepolymyalgia rheumatica.
Yintoni i-Polymyalgia Rheumatica?
Kulinganiselwa ukuba malunga nama-711,000 ase-Amerika ase-Amerika asepolymyalgia rheumatica - imeko edla ngokuqhubekayo. Nangona iimpawu zingakhula ngokukhawuleza, oko akufanekanga ne-polymyalgia rheumatica. Iimpawu zibandakanya ukuqina koxinzelelo lwe-musculoskeletal, kunye neentambo kunye namahlombe ngokubandakanyeka ngokubanzi, kunye neengalo ezingaphezulu, intamo, kunye nezantsi. Ngokuqhelekileyo akukho ukuvuvukala kwamajoyina. Kungenzeka ukuba nepolymyalgia rheumatica kunye nesinye isifo se-rheumatic . Kuye kwahlukahluka kakhulu kunyango lwe-polymyalgia rheumatica, njengexesha lokusebenzisa i- glucocorticoids okanye izidakamizwa zokuguqula izidakamizwa (i-DMARD) kunye nexesha elingakanani.
Imigaqo kunye neNcomelo zokuLawula i-PMR
Izikhokelo zika-2015 ezikhutshwe yi-ACR kunye ne-EULAR ziquka imigaqo-siseko kunye neengcomo ezithile malunga nokufikelela kwonyango, ukuthunyelwa kwiingcali, ukulandelelana kwesigulane kunye neendlela ezithile zokonyango.
Iinqununu ezithile zenziwa ngezigaba:
- "kucetyiswa ngamandla" xa ubungqina bubhekiselele kwinzuzo enkulu enokungabikho mngcipheko
- "umqathango" xa kwakungekho ubungqina obuncinane bokunceda okanye xa uncedo aluzange lube lukhulu ngaphezu kweengozi
Imigaqo ephambili ibandakanya:
- Ukwamukelwa kwendlela yokuqinisekisa ukuba i-polymalgia rheumatica, kunye nokuhlolwa kwekliniki okujoliswe ekukhutsheleni izimo ezifanisa i-polymyalgia rheumatica.
- Ngaphambi kokumisela unyango, zonke iimeko kufuneka zibe neempendulo zovavanyo lwebhoratri.
- Ngokuxhomekeke kwiimpawu kunye neempawu, iimvavanyo ezongezelelweyo maziyalelwe ukuba zingabandakanyi izimo ezixelisa. Iinqwelo ezifanelekileyo kufuneka zichongwe. Imiba yengozi yokubuyela kuphinda okanye unyango olude kufuneka iqwalaselwe.
- Ukuqwalaselwa kufuneka kunikezelwe ukuthunyelwa kweengcali.
- Izigqibo zonyango kufuneka zabelwana ngesigulane kunye nodokotela.
- Izigulane kufuneka zibe neprogram yonyango ngokwamntu ngamnye wepolymyalgia rheumatica.
- Izigulane kufuneka zibe nokufikelela kwimfundo malunga neprophylaxism rheumatica unyango kunye nolawulo.
- Zonke izigulane eziphathiswe kwi-polymyalgia rheumatica mazibekwe iliso ngokusebenzisa iimvavanyo ezithile. Ngonyaka wokuqala, izigulane mazibonwe rhoqo kwiiveki ezi-4 ukuya kwezi-8. Ngomnyaka wesibini, ukutyelela kufuneka kuhlelwe rhoqo kwiiveki eziyi-8 ukuya kwe-12. Ukubekwa iliso kufuneka kube njengokuba kuyimfuneko yokubuyisela kwakhona okanye i- prednisone tapering.
- Izigulane kufuneka zifumane ufikelelo olufanelekileyo kwiinkonzo zabo zononophelo lwezempilo ukuze zichaze utshintsho, njengeentsimbi okanye iziganeko ezimbi.
Iingcebiso ezikhethekileyo zolawulo lwe-polymyalgia rheumatica ziquka:
- Isiphakamiso esinamandla sokusetyenziswa kwe-glucocorticoids esikhundleni se- NSAID (izidakamizwa ezichasayo ezingekho komzimba), ngaphandle kwekhosi yexesha elifutshane le-NSAID okanye i- analgesics kwizigulane ezinentlungu ehambelana nezinye iimeko.
- Isiphakamiso esiqinileyo sokwenza ubuncinane obuncinane bomntu wonyango lwe-glucocorticoid (oko kukuthi, sebenzisa izilwanyana ixesha elifutshane elifunekayo ukufumana impendulo efanelekileyo).
- Isiphakamiso semeko ngenqanaba elincinci elisezantsi lokusebenzisa i-glucocorticoids phakathi kwe-12.5 ne-25 mg elilinganayo le-prednisone elilinganayo imihla ngemihla. I-dose ephezulu inokuqwalaselwa ngalabo abasemngciphekweni ophezulu wokuphinda ubuyele kwakhona kunye nomngcipheko omncinci wezehloko ezimbi. I-dose ephantsi iyakucingelwa ngalabo abaneengxaki okanye izinto ezinobungozi kwimiphumo emibi ehlobene nokusetyenziswa kwe-glucocorticoids. I-dose yokuqala ye-7.5 mg / ngosuku yayidangeleka ngokomzimba, kwaye amaxabiso okuqala angama-30 mg / ngosuku adikibala kakhulu.
- Isiphakamiso esiqinileyo kwiishedyuli kunye nokubeka esweni rhoqo. Ishedyuli esicetywayo sokuqala kokupakisha kukuthelela kwi-dose yomlomo ye-10 mg ye-prednisone-elinganayo ngosuku ngosuku lwesine ukuya kwiiveki ezi-8. Ukuphindaphinda unyango, i-prednisone yomlomo kufuneka yonyuka kwi dose isigulane esithathayo ngaphambi kokuba ibuyele kwakhona kwaye yancipha kancane kancane kwiiveki ezi-4 ukuya kweyesi-8 ukuya kwidoloji ephindekayo. Xa ukuxolelwa kuphunyeziwe, i-prednisone yomlomo yansuku zonke ingagqithwa yi-1 mg nganye kwiiveki ezi-4 okanye nge-1.25 mg isebenzisa olunye usuku lwexesha kuze kube yilapho i-prednisone ishiywe, ukunikezela ukuba ukuxolelwa akuphazamiseki.
- Isiphakamiso semeko sokusetyenziswa kweetramuscular methylprednisolone endaweni okanye ngomlomo we-glucocorticoids.
- Isiphakamiso esinyanisekileyo somthamo owodwa kunokuba uhlulwe i-glucocorticoids yomlomo.
- Isiphakamiso sesigqibo sokusetyenziswa kwangaphambili kwe- methotrexate ngaphezu kwe-glucocorticoids, ngakumbi kwizigulane ezithile.
- Isiphakamiso esinamandla malunga nokusetyenziswa kwe- block blockers .
- Isiphakamiso semeko kwinkqubo yokusetyenziswa komntu ngamnye ukugcina ubunzima bemisipha kunye nomsebenzi, kunye nokunciphisa umngcipheko wokuwa .
- Isiphakamiso esinamandla ngokubhekiselele ekusetshenzisweni kwamalungiselelo enqabileyo yaseTshayina uYanghe noBiqi.
Imithombo:
2015 Iziphakamiso zoLawulo lwePolymyalgia Rheumatica. Dejaco C. et al. IArthritis & Rheumatology Vol. 67 No. 10. Oktobha 2015.
http://www.rheumatology.org/Portals/0/Files/2015%20PMR%20guidelines.pdf
Polymyalgia Rheumatica. Ikholeji yaseMerika yaseRheumatology. Ukuhlaziywa ngoJuni 2015.
http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Polymyalgia-Rheumatica