Iziphakamiso zokusetyenziswa kwee-DMARD kunye nee-Biologic Drugs
Ngo-2012, i-American College of Rheumatology (ACR) ihlaziywe iingcebiso zonyango lwe- rheumatoid arthritis . Iziphakamiso ze-ACR ze-2012 zokusetyenziswa kwezidakamizwa ezichasene ne-rheumatic drugs (DMARDs) kunye neziyobisi ze-biologic kwi-arthritis ye-rheumatoyi sihlaziya iziphakamiso ze-2008.
Uhlaziyo olwenziwa ngo-2012:
- izibonakaliso zokuqala okanye ukutshintsha i-DMARD kunye neziyobisi ze-biologic
- ukusetyenziswa kwezinto eziphilayo ezigulane kakhulu, kuquka abo abane-hepatitis, ukungaphumeleli kwintliziyo kunye nokugula
- Ukukhuselwa kwesifo sofuba kwizigulane eziqala okanye ngoku zithatha iziyobisi ze-biologic
- ukugonywa kwizigulane eziqala okanye ngoku zithatha i-DMARD okanye iziyobisi ze-biologic
Iziphakamiso zisekelwe ekuphandweni kwincwadi ye-PubMed kunye neDecchrane Database yeeNkqubo eziPhezulu, ukuhlolwa kwimeko yekliniki kunye neengcamango zengcali. Iincwadi zafunyanwa nge-8 DMARD: i- azathioprine (Imuran), i- cyclosporine , i- hydroxychloroquine (i-Plaquenil), i- leflunomide (i-Arava), i- methotrexate , i-minocycline (i-Minocin), igolide kunye ne- sulfasalazine (i-Azulfidine) kunye neyeza ezi-9 ze-biologic: i- abatacept (i-Orencia) , adalimumab (Humira), anakinra (Kineret), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan) kunye ne -cilizumab (Actemra). Ngenxa yokusetyenziswa kakubi kweziyobisi kunye nokungabikho kolwazi olutsha olusuka ekusesheni, i-azathioprin, i-cyclosporine, igolide kunye ne-anakinra ayifakiwe kwiingcebiso.
Orencia, Rituxan, Kineret, kunye ne-Actemra zingekho iziyobisi ze-biologic non-TNF. Enbrel, Remicade, Humira, Simponi, kunye neCimzia yi-block block ye-TNF.
Izigulane ezine-arthritis zakuqala (ezichazwa ngokuba ne-rheumatoid arthritis ezinyangeni ezingaphantsi kwe-6) kunye nezigulane ezine-arthritis ezisisiseko eziphathwe ngayo nayiphi na i-DMARD okanye iziyobisi ze-biologic, injongo yonyango ngumsebenzi wesifo esiphantsi okanye ukuxolelwa.
Ukuqala okanye ukutshintsha ii-DMARD kunye ne-Biologic Drugs
- I-DMARD i-monotherapy (unyango kunye nesicatshulwa esisodwa) yacetyiswa kwizigulane ze-rheumatoid zezifo zesifo esiphantsi kwesifo okanye isifo somlinganiselo esiphezulu / esiphakamileyo ekungabikho kwempawu ezichasayo (oko kukuthi iimeko ezingekho phantsi kwesi sifo).
- Udweliso lwe-DMARD lwenyango lwacetyiswa kwizigulane ze-arthritis zakuqala zengqondo ze-rheumatoid ezineentshukumo eziqhelekileyo okanye eziphezulu kunye neziganeko zokuhlaziya ezimbi.
- Ukusetyenziswa kwe- blocker ye- TNF kunye okanye ngaphandle kwe-methotrexate kunconywe kwizigulane zesifo se-rheumatoid esasisifo esiphezulu somsebenzi kunye neziganeko zokuhlaziya. Ukuba i-blocker ye-TNF i-infliximab (Remicade), nangona kunjalo, kufuneka isetyenziswe nge- methotrexate.
- Kwizigulane ezine-arthritis ezisemgangathweni, ukuba emva kweenyanga ezi-3 ze-DMARD monotherapy isigulane sichitha ukusuka kwisifo esiphantsi kwesifo ukuya kumsebenzi ophantsi okanye wesifo esiphambili, i-methotrexate, i-hydroxychloroquine, okanye i-leflunomide (Arava) kufuneka ifakwe.
- Emva kweenyanga ezi-3 ze-methotrexate okanye i-methotrexate / i-DMARD yonyango, yongeza enye i-non-methotrexate i-DMARD okanye ishintshele kwenye i-non-methotrexate i-DMARD ukuba isigulana esisisigxina sisenomlinganiselo wesifo esiphakamileyo - okanye ungeze okanye utshintshe kwi-blocker ye-TNF, i-abatacept ( Orencia), okanye i-rituximab (Rituxan).
- Emva kweenyanga ezi-3 zonyango nge-blocker ye-TNF, ukuba isigulane sinomsebenzi wesifo esifanelekileyo / esiphakamileyo esiphathelene nokungabikho kwempendulo okanye ukulahlekelwa yinzuzo kwonyango, ukutshintshela kwenye i-blocker ye-TNF okanye engekho i-TNF biologicalic.
- Ukuba kukho umsebenzi wesifo olinganiselayo / ophezulu emva kweenyanga ezili-6 zonyango nge-non-TNF biologic ngenxa yokungaphumeleli kwempendulo okanye ukulahlekelwa yintlawulo, isiguli kufuneka sitshintshelwe kwi-biologic eyahlukeneyo engeyiyo ye-TNF okanye kwi-blocker ye-TNF.
- Ukuba isigulane sinomsebenzi ophezulu wesifo kwaye sihluleka i-blocker ye-TNF ngenxa yesiganeko esibi kakhulu, ukutshintshela kwi-biologic engekho ye-TNF.
- Ukuba isigulane sinomsebenzi wesifo esifanelekileyo / esiphakamileyo kwaye sihluleka i-blocker ye-TNF ngenxa yesiganeko esingathandekanga, sitshintshela kwenye i-blocker ye-TNF okanye ingekho i-TNF biologicalic.
- Ukuba isigulane sinomsebenzi wesifo ophezulu / ophezulu emva kokusilela i-biologic engeyiyo ye-TNF ngenxa yesiganeko esibi, ukutshintshela kwenye i-blocker engekho ye-TNF okanye i-blocker ye-TNF icetyiswa.
Ukusetyenziswa kwezinto ze-Biologics kwi-Rheumatoid Arthritis Iziguli ezine-Hepatitis, i-Malignancy, okanye i-Congestive Heart Failure
- I-Etanercept (Enbrel) icetyiswa kwizigulane ze-rheumatoid arthritis ezine-hepatitis C.
- Iziyobisi ze-biologic azikhuthazwa kwizigulane ze-rheumatoid arthritis ezine-hepatitis B ezingapheliyo okanye ezinye izigulane ze-hepatitis B ezingapheliyo.
- Ukuqala okanye ukuqala kwakhona unyango lwe-biologic Kunconywa ukuba izigulane zonyango zixhatshazwe ixesha elingaphezu kweminyaka emi-5 edlulileyo okanye kwizigulane eziye zanyangwa ngenxa ye-nonmelanoma yomhlaza wesikhumba ngaphezu kweminyaka emi-5 edlulileyo.
- I-block block ye-TNF ayinyanzeliswa kwizigulane ze-rheumatoid arthritis ezine-moderation or heart failure.
Isifo sofuba (TB) Ukuhlola
- Ukuhlolwa kwintsholongwane ye-TB efihlakeleyo kucetyiswa kwizigulane ze-rheumatoid arthritis ziqwalasela unyango lwe-biologic.
- Kungakhathaliseki ukuba kukho ingozi yokusuleleka kwintsholongwane ka-TB, ukuhlolwa kwesifo se-tuberculin okanye i-interferon-gamma-release-assay kufuneka kwenziwe kwiigulane ezikulungele ukuqala unyango lwe-biologic.
Izigulane zezigulane Ukuqala okanye ukufumana i-DMARD okanye i-Biologic Drugs
- Izitofu zokugonywa (i-pneumococcal, i-influenza, kunye ne-hepatitis B), i-recombinant (i-papillomavirus yabantu), kunye nokugonywa (i-herpes zoster) kufuneka ihanjiswe ngaphambi kokuqala i-DMARD okanye iziyobisi ze-biologic.
- Ukuba akukwenziwanga, izitofu ezibuleweyo okanye ezihlaziyiweyo kufuneka zinikezelwe kwizigulane ezithatha iDMARD okanye iziyobisi ze-biologic.
- I-herpes zoster yokugonya inganikwa abo bathathe i-DMARD.
NGAPHAMBILI - 2015 I-ACR Izikhokelo zokuPhatha i-Rheumatoid Arthritis
Izikhokelo zaphinda zishicilelwa ngo-2015 njengesibuyekezo kwizikhokelo ze-2012. Isikhokelo sika-2015 siquka ukusetyenziswa kwezidakamizwa zokuguqula izifo zesifo se-antirheumatic (i-DMARD), i-biologic agents, i- Xeljanz (tofacitinib) , kunye ne-glucocorticoids ekuqaleni (ezinyangeni ezingaphantsi kweenyanga ezili-6) kwaye isungulwe (iinyanga ezintandathu okanye ngaphezulu) i-rheumatoid arthritis. Kwakhona kunikezelwa kwisikhokelo sika-2015 iziphakamiso ekusebenziseni indlela yokuphatha unyango , ukupakisha nokuyeka amayeza kunye nokusetyenziswa kwee-biologic agents kunye nee-DMARD kwizigulane ezine-hepatitis, ukungabikho kwenhliziyo, ukungabikho kwezifo kunye nezifo ezinzulu.
Isikhokelo sijongene nokusetyenziswa kwezigulane kwizigulane zokuqala okanye ukufumana i-DMARD okanye iziyobisi ze-biologic, ukuhlolwa kwesifo sofuba kwizigulane zokuqala okanye ukufumana ii-biologic agents okanye i -facitinib, kunye nokubeka iliso kwi-laboratory ye-DMARD. Isikhokelo siquka iingcebiso ezingama-74 apho i-23% ithathwa njengomeleleyo kwaye i-77% inemeko. Unokuyifumana apha: 2015 Ikholeji yaseMelika yaseRheumatology Isikhokelo seNyango yeRheumatoid Arthritis.
Umthombo:
Ukuhlaziywa kweziphakamiso ze-ACR zika-2008 zokusetyenziswa kwe-DMARD kunye ne-Biologics kwiNyango yeRheumatoid Arthritis. Ugqirha lwe-Arthritis noPhando. iphe. 625-639. Singh JA et al. Meyi 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract
2015 Ikholeji yaseMelika yeRheumatology Isikhokelo soNyango lwe-Rheumatoid Arthritis Singh JA et al. Ukunyamekela kweArthritis & Uphando DOI 10.1002 / acr.22783
http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf