I-rheumatoid arthritis isifo esingapheliyo, esivuvukalayo esibonakaliswe ngumonakalo ohlangeneyo, umda , kunye nokukhubazeka okusebenzayo . Xa ndandifumanelwa ukuba ndine-arthritis ye-rheumatoid (ngo-1974 eneminyaka engama-19) kwaye ekuqaleni ndafunda ngamanyathelo am unyango, iinjongo zaba zibonakala ngokukhawuleza-ukulawula ukuvutha, ukunyuka kwesifo, ukuphucula intlungu nezinye iimpawu zesifo se-rheumatoid .
Izwakala njengecebo elifanelekileyo kum. Njengo-patient's arthritis patient, ndandifuna ukuqala unyango kwaye ndayimisa inkqubo yesifo.
Ndafunda ukuba kwakukho ithuba lokuxolelwa , nto leyo eyenza ndive ndikhuthazwe ngakumbi. Into endingazange ndiyiqonde ngokufanelekileyo ngeli xesha kukuba nangona unyango, i-arthritis ingaqhubeka ikhula ngakumbi. Umonakalo ohlangeneyo ungadluka. Ewe, kunjalo. Nangona isigulane siphelile, njengoko kuchazwe yimigqaliselo echanekileyo, iyakwazi ukubonakalisa ukuqhubela phambili kwe-radiographic (oko kukuthi, ubungqina be-x yomonakalo obunzima kakhulu ohlangene).
Ulwaphulo olujoliswe kwiCandelo lokuLawula ukuLawula
Kwiminyaka emininzi, izidakamizwa zokuguqula izifo (antidheumatic drugs) (i-DMARD), ezifana ne- methotrexate , Plaquenil , kunye ne- sulfasalazine , zazisetyenziselwa ukunciphisa okanye ukunciphisa umsebenzi wesifo ochaphazelekayo ne-rheumatoid arthritis. Ngokufumaneka kweziyobisi ze- biologic (i- Enbrel [etanercept] yowokuqala ngowama-1998), iithagethi zaba zichanekileyo kwizinga lee-molecular.
Kwaye ngoku, kukho iqhinga elitsha elibonakalayo, elibhekiselwe kwi- Treatment to Target therapy .
Izikhonkwane zokuThatha ukuThola phantsi isicwangciso sonyango esekelwe kumgangatho wesigulane somntu wesifo. Injongo kukufezekisa izinga eliphantsi lomsebenzi wesifo okanye ukuxolelwa kwithuba elithile elichanekileyo - kwaye isicwangciso ngasinye siyimntu ngamnye.
Ukukubeka kumagama alula kakhulu, utshintsho lwezonyango luyenziwe xa iinjongo zomsebenzi wesifo zingagqibekanga. Indlela eyiyo yokuThatha-kuThgethi iya kukhusela ngokukhawuleza umonakalo odibeneyo uhlala ubonakala. Izifo zonyango ezijoliswe kumagciwane (oko kukuthi, unyango oluchasayo) alunalo ukukhutshwa komonakalo odibeneyo kwizinwele zakhe. Kuye kucetyiswa ukuba nangona emva kokuvuvukala kulawulwa, umsebenzi we-synovial tissue kwizigulane ze-rheumatoid arthritis unokudibanisa i- cartilage kunye nokutshatyalaliswa kwethambo. Ukuqonda kangcono, makhe sijonge ngakumbi indlela umonakalo odibeneyo uqhubeka ngayo kwaye uyaqhubeka.
Ukuqonda indlela Ukulimala Okuhlangeneyo Kwenzeka
Umonakalo odibeneyo unokugqalwa phakathi neenyanga zokuqala kwesifo se-rheumatoid arthritis. Ukulahlekelwa kwe-cartilage yasekuqaleni kunye neethambo ezixhamlayo zidibaniswa nokuqokelelwa kwamalungu esilumko esivuthayo kwi- membrane synovial kunye nophuhliso lwe- pannus (i-synovial tissue ehlanganisiweyo engahlaselwa ithambo). Kukho uluhlu lwesincinci lwe-synovial oluqulethwe ngamalungu esele e-macrophages, iiseli ze-T, iiseli ze-B, iiseli ze-dendritic, kunye ne-polymorphonic leukocytes, kunye ne-synovial lining layer equkethe i-macrophages kunye ne-synoviocytes (fibroblast-like synoviocal cells).
Kukho izixube ze-macrophages kunye ne-synoviocytes ezingakwazi ukukhupha i-enzyme (iiprothestases) ezibandakanyeka kwinkqubo yokuchithwa kweethambo.
Ukuqonda umsebenzi we-synovial, ngokukodwa iindlela kunye nezindlela ezibandakanyekayo kwinqanaba apho kukho ukugcinwa kwee-enzymes ezihlaziyileyo, kuyimfuneko ukuba umonakalo odibeneyo ulawulwe okanye ukhuselwe. Ngokomzekelo, kwinqanaba le-molecular, yintoni eyenza i-fibroblast ibe yintlonelo kwaye ibonakalise?
Ngokutsho kweKley's Bookbook yeRheumatology , iiprothestases ezivela kwimithombo emithathu zonakalisa i-cartilage kwi-rheumatoid arthritis: iindawo eziphezulu ze-articular cartilage zitshabalaliswa ngamaprotheni asekhoyo kwi-synovial fluid; ngokuqhagamshelana ngqo phakathi kwe-articular cartilage kunye neproteolytic (oko kukuthi, ukukwazi ukuphula amaprotheni) i-synovium okanye i-pannus tissue okanye zombini; okanye ukutshatyalaliswa kwangaphakathi (oko kukuthi, ukutshabalaliswa kwangaphakathi) ngamaprotheni asetyenziswa kwi-chondrocytes.
Njengoko abaphandi bazama ukufumana iimpendulo, sitshilo ngokusondeza kwaye sisondele ngakumbi kunyango olungcono - nethemba lokufumana indlela yokukhusela umonakalo odibeneyo. Ngaphezulu kwe-arthritis ye-rheumatoid, umonakalo ohlanganyelweyo unokunyuka ngokuthe ngcembe kwaye ngokuqhubekayo. Ekuhambeni kwexesha okanye kwisifo se-rheumatoid esiphezulu, ukulungiswa okunamandla kubakho phakathi kobufakazi be-x-ray yomonakalo odibeneyo kunye nokukhubazeka. Ukunciphisa umonakalo odibeneyo kuya kunceda ukugcina umsebenzi ohlangeneyo.
Inkqubo yomonakalo odibeneyo kwi-osteoarthritis yinto eyahlukileyo. Isiganeko esichukumisiweyo esisisigxina (umz., Ukulimala okanye ukugqoka kunye nokusila) ngokuqhelekileyo kuhambelana nenkqubo yokuchithwa kwe-cartilage. Ukuvuvukala kwenzeka, kodwa kusekondari kwiimeko ezininzi ze-osteoarthritis. I-IL-1 (interleukin-1), i- cytokine , inokudlala indima ebalulekileyo kwi-cartilage dislocation ehlobene ne-osteoarthritis. I-Chondrocytes (iiseli ezitholakala kwi-cartilage) zivelisa ixabiso elincinci le-IL-1 kunye ne-synovial inflammation yongeza kwimisebenzi ye-IL-1. Nangona kungekho tshintsho oluphawulekayo oluvakalayo olwenzeka rhoqo kwi synovium ekuqaleni kwe-osteoarthritis, kukho ukunyuka kwemveliso ye-enzyme yi-chondrocytes ezifaka isandla ekubhubhiseni i-cartilage. Noko ke, kukho, kubonakala ngathi yinto ethile ye-osteoarthritis ekhoyo, kunye nohlobo oluthile lwe-osteoarthritis , olubonakaliswe ngonakaliso oludibeneyo oluqhutyelwa ngokukrakra.
Imithombo:
Ukuqhubela phambili komonakalo ohlanganyelweyo naphezu kokulawula ukuvuvukala kwi-rheumatoid arthritis: indima yomonakalo we-cartilage oqhutywa ngumsebenzi we-synovial fibroblast. Floris PJG Lafeber, Willemijn H Van der Laan. Iziganeko zeRheumatic Diseases 2012; 71: 793-795 i-doi: 10.1136 / ngonyaka-2011-200950
http://ard.bmj.com/content/71/6/793.full
I-Pathogenesis yomonakalo odibeneyo kwi-rheumatoid arthritis. Bresnihan B. Umbhalo weRheumatology. 1999.
http://www.ncbi.nlm.nih.gov/pubmed/10090189
Izixhumanisi phakathi komonakalo odibeneyo kunye nokukhubazeka kwi-rheumatoid arthritis. Rheumatology. 2000.
http://rheumatology.oxfordjournals.org/content/39/2/122.abstract
I-Kelley's Bookbook yeRheumatology. I-ninth edition. Umqulu I. Amaphepha 111-113.