Ziziphi izinto ezijongene nobungozi?
Umonakalo odibeneyo wokuqhubekayo kukuba oogqirha, abaphandi kunye nezigulane ezinezifo zesifo se- arthritis kunye nezifo zengqungquthela zizama ukulawula. Ingumphumo wokuvuvukala okungapheliyo kwe- synovial . Unyango luphuhliswa ngeenjongo ezithile kwingqondo-enye yazo kukunciphisa ukuqhubela phambili kwezifo.
Okokuqala nokubalulekayo, kubalulekile ukuqonda ukuba umonakalo ohlanganyeleneyo, ukuba ungalawulwa, unokudibana nokunciphisa ukusebenza kunye nokukhubazeka.
Ziziphi iimeko eziza kuthethwa ngazo ngokusesikweni ukuhlaselwa ngokusesikweni kunye nomonakalo ohlangeneyo?
Izinto eziqhelekileyo ezihambelana nokulimala okuhlangeneyo
Isalathisi esinamandla kunomonakalo ohlanganyeleneyo kunye nesifo se- rheumatoid isifo senyoka . Oko kwathiwa, ubungqina be-seronegativity abuyithinteli umonakalo ohlangeneyo. Ndiyakwazi ukufakazela oko kusuka kumava okuqala.
Ukuqhubela phambili ngokukhawuleza komonakalo ohlanganyeneyo kubandakanya ukuxhamla kwizinto zombini ze- rheumatoid kunye ne-anti-CCP- ngokubanzi kunokuba umntu ekhangelekile kuyo, kunokuba zombini. Izinto ezibhekiselele ekuhlaseleni okungahambi kakuhle kunye nomonakalo ohlanganyeleneyo obandakanyekayo ziquka:
- Ubungqina be-X okanye ubungqina beklinikhi yomonakalo ohlangeneyo
- Ukwandiswa kwenani lamalungu afakwe kwi-synovitis esebenzayo, isisa, ukuvuvukala, okanye ukudibanisa
- Isantya se-sedimentation esiphezulu se-erythrocyte (sed sed) okanye iproteyini esebenzayo yeC (CRP) . Ngomlinganiselo omiselweyo, ukunyuka kwe-1 mm / iyure nganye kuxhunyiwe kwipesenti ezi-2 zandisa ingozi yomonakalo ohlangeneyo.
- Efanelekileyo kwi- anti-CCP
- Efanelekileyo kwi- HLA-B27 , HLA-B39, okanye i-HLA-DQw3.
- Izinga eliphakamileyo lokusetyenziswa kwamachiza, kuquka i- corticosteroids , esetyenziselwa ukuphatha ukuvuvukala kumalungu athintekileyo
- Impendulo enganeleyo kumachiza
- Umsebenzi odibeneyo odibeneyo njengoko ukhankanywe nguMbuzo woPhando lwezeMpilo
- Ukunciphisa umgangatho wobomi
Iinjongo Zonyango
Ugxininiso lwe-arthritis yophando lwesifo se-rheumatoid kwiingxaki zakuqala, kunye nendlela ukuxilongwa kwangaphambili kunye noonyango lunokuchaphazela ngayo ukuqhubela phambili. Ngokweziphumo zophando ezipapashwe kwi- Arthritis neRheumatism , phakathi kwama-60 ekhulwini kunye nama-95 ekhulwini abantu abane-arthritis ye-rheumatoyi bakhula ubuncinane ukukhula kwamanzi okubonakalayo kwi-radiographical (oko kukuthi, kwi-ray ray) kwiminyaka engama-3 ukuya kwe-8 emva kokuqala kwesi sifo.
Ngokuhambelana neziphumo ezivezwe kwingqungquthela yonyaka ka-2012 we-American College of Rheumatology, abaphandi bafumanisa ukuba umonakalo oqhubekayo oqhubekayo usasaqhelekanga kubantu abanobuchopho be-rheumatoid iminyaka engama-5. Kwakhona kubonakala ngathi yimeko ephantse kwisiqingatha sezigulane ze-rheumatoid arthritis eziphathwe ngeziyobisi ze-biologic .
I-FDA iye yaqaphela ukuba ukukhusela okanye ukunciphisa umonakalo ohlanganyeleneyo kunye nomdla we-rheumatoid arthritis yinjongo enkulu yonyango. Amaphepha okubhaliweyo e-FDA avumelekileyo kwi-DMARD ethile ( izidakamizwa zokuguqula izidakamizwa ezichasene ne-rheumatic) kunye neziyobisi ze-biologic zithetha ukuba imishanguzo iyancipha ukuqhubela phambili komonakalo odibeneyo we-radiographic.
Injongo yokufumana ukuxolelwa kwi-rheumatoid arthritis kukumisa umonakalo odibeneyo. Kodwa, imimiselo ekhoyo yokuphumeza ukuxolelwa isashiya indawo ukuze kubekho ukuqhubela phambili kwe-radiography yomonakalo ohlangeneyo.
Ukuxolelwa kuchazwa yimigqaliselo yesifo sesifo njengoko idibene nokuvuvukala ngokubambisana, kunokuba umonakalo odibeneyo. Ukulawula ukuvuvukala kubalulekile ekulawuleni umsebenzi wesifo kwi-rheumatoid arthritis. Iinkqubo zokungena kumzimba zibandakanyeka. Inethiwekhi eyinkimbinkimbi yamaseli omzimba ekulawuleni inethiwekhi ye- cytokines kunye ne-chemokines. Yiyo ye-crux yomsebenzi wesifo kwi-rheumatoid arthritis. Ngexesha elifanayo njengomsebenzi we-cytokine, kukho imisebenzi ekhethekileyo eyenziwa phakathi kwee-synovial cell cells, ngakumbi i-fibroblasts, ne-cartilage kunye namathambo esifuba. Lo msebenzi, okhoyo kwiimida ezichaphazelekayo, ubangela umonakalo odibeneyo.
Umsebenzi we-synovial wendawo unokusebenza ngokuzimela kwaye kubangele ukutshabalalisa i-cartilage kunye nethambo, ehluke kwi-synovial evalence. Kuyinkimbinkimbi, kodwa umgca wenyani kukuba umonakalo ohlanganyelweyo onokuqhubekayo unokwenzeka nangona ukuvuvukala okulawulwa kakuhle.
ILizwi
Kukho abantu abane-arthritis ye-rheumatoid abangenazo izinto eziqhelekileyo okanye izinto eziqhelekileyo zokulimala, kodwa kunjalo banomonakalo ohlangeneyo. Ndibhekisele kulabo abanokuba ngababi kwi-rheumatoid factor (seronegative), ababi kwi-anti-CCP, okanye abanesilinganiselo se-CR okanye i-CRP engakhange iphakanyiswe. Kuye kwagqunywa ukuba, kwiimeko ezinjalo, kukho ukubonakalisa nokusebenza kwe-MMP-3 (stromolysin-1) kunye ne-MMP-1 (i-collagenase-1) ebangela ukuba kubekho umonakalo ohlangeneyo. I-MMP-3 kunye ne-MMP-1 yi-metalloproteinase yamatriki (i-enzymes). Izinga le-serum ephakamileyo ye-MMP-3 kunye ne-MMP-1 zidibene kakhulu kunye nomsebenzi wesifo kwaye kungabikho kwangaphambili ukulimala komonakalo we-radiological kunye nokunciphisa ukusebenza.
> Imithombo:
> Gladman, Ritchlin. Izinto ezijongene nobungozi bokulimala okuhlangeneyo. Unyango lwe-Psoriatic Arthritis. Isemgangathweno. Ukuhlaziywa kweSeptemba 28, 2016.
> Lafeber Floris PJG et al. Ukuqhubela phambili kweMonakalo ehlangeneyo Nangona ukulawulwa kokuvuvukala kwi-Arthritis yeRumatoid: Inxaxheba yengozi yeCartilage eqhutywe nguSynovial Fibroblast. Iindaba zeBMJ. 2012.
> Lillegraven, S et al. Ukulimala okuhlangeneyo kwamaRadioographic kwi-Rheumatoid Arthritis: Eqhelekileyo kwaye ehambelana kakhulu ne-Seropositivity. Iimpawu ze-ACR: 2660. Umhlangano wonyaka we-ACR ka-2012.
> UPaulus HE et al. Ukuchithwa kweZakhiwo eziManyeneyo kwi-Rheumatoid Arthritis njengeNyqubela okanye engeyiyo ingcipheko esebenzisa inkcazo yeNkqubela ye-Joint Radiographic Change. Arthritis neRheumatism. Epreli 2004.
> Al-Bayyoumy SA, et al. Ulungelelaniso phakathi kweMazamo yokuHlangana okuThuthukayo kunye neSerum Level of Matrix Metalloproteinases: MMP-3 kunye ne-MMP-1 kwi-Arthritis yokuqala ye-Rheumatoid . Rheumatology yaseYiputa kunye nokubuyiswa kwakhona. Julayi 2007.