Ukufezekisa Injongo Yonyango
"Ukhathalela ukujolisa" ngumgaqo okanye indlela eye yaphumelela ekuphatheni izifo nezimo ezithile. Isicwangciso sokuqala sasisetyenziselwa ukunyanga ingozi yexinzelelo, i-cholesterol ephezulu kunye nesifo sikashukela. Kodwa, ububanzi buye bwandisa kwaye bonyamekela ukujoliswa kwenzelwe indlela eya kwiingcamango zesifo se- rheumatic disease .
Ukujongana nesicwangciso ekujoliswe kuzo kufuneka ube nalezinto ezintathu:
- kujoliswe kuyo
- indlela yokulinganisa ukuba bekujoliswe kuyo okanye kuphunyezwe
- iinketho zokwelapha ezikhoyo ezenza kube lula ukutshitshisa ithagethi
Ngokubhekiselele kwingozi yomshurensi, ukufunyaniswa kwengcinezelo yegazi okujoliswe kuyo kungaphantsi kwe-150/1000 mm Hg, ngaphantsi kwama-140/90 kusebenza ngakumbi ekunciphiseni imicimbi ye-cardiovascular. Ukufezekisa iinjongo ezifunwayo ze-cholesterol epheleleyo kunye ne-LDL, ama-statins aqhelekelelwe. Kwizigulane ezineesifo seswekile, kukho izikhokelo zeklinikhi kwi-blood glucose kunye ne-hemoglobin A1C. Yintoni ekujoliswe kuyo ekujoliswe kuyo kwi-rheumatology?
Phatha ukujolisa kwi-Rheumatoid Arthritis
Kwi- rheumatoid arthritis , ithagethi ephambili kukuxolelwa . Umsebenzi wesifo esincinci uphinde ukhankanywe, mhlawumbi ufikeleleke nakwiimeko ezininzi kwiimeko ezininzi. Ukubetha ithagethi, ukuvuvukala kufuneka kulawulwe okanye kukhutshwe. Oku kulinganiswa ngokuphonononga umsebenzi wesifo. I-DAS28 (i-Score Work Score) okanye i-CDAI (i-Clinical Disease Activity Index) ziphakathi kweendlela iindlela zesifo esingahlolwa ngayo.
Ixesha elifanelekileyo lokujonga iliso lomsebenzi aluzange lucwangciswe, kodwa i-DAS28 ngaphantsi kwe-2.6 ngokuqhelekileyo ithathwa njengoluphawu lokuxolelwa kwisifo se-rheumatoid arthritis.
Elinye ibalulekileyo le-caveat engayinakukujongelwa phantsi - iithagethi zonyango kufuneka zibe ngabanye. Izidlobongela , imbali yeziganeko ezichasene neziyobisi, kunye nawaphi amajoyina achaphazelekayo maziqwalaselwe xa kuphuhliswa isicwangciso esicwangcisiweyo.
Phatha kwiThagethi kwiLupus
Ibutho lamazwe ngamazwe liye laphuhlisa ukuphathwa kwiprogram ekujoliswe kuyo i- lupus . Ibutho elisebenzayo lisungula ukuba ukukhutshwa kwamalungu ebonakaliso, kunye neempawu zesistim ye lupus, yinjongo ephambili yonyango lwe-lupus. Olunye unyango ukujolisa injongo ye-lupus kubandakanya ukuthintela iirhare , kuquka nephritis , iimpawu ze-neuropsychiatric kunye neempawu ze-lupus jikelele. Ukuthintela umonakalo kwakhona kwaqulunqwa njengejoliswe kuyo, ngenjongo yokuthintela umonakalo wequmrhu elikufutshane nangemva kokulawula isifo sesenzo kunye nesetyhefu kwimichiza. Ingqalelo ehlawulwe kumgangatho wesigulane wobomi ibalulekile.
Ukuqhubela phambili, iqela elijongene nalo lihlose ukuphuhlisa iinkcazo ze-lupus remission kunye nomsebenzi wesifo esamkelekileyo. Kukho isidingo sokuvavanya okungcono kweentaba.
Nangona kukho ithemba lamachiza omtsha we-lupus kwixesha elizayo, kukho ezininzi ezininzi zaphuhliswa kwaye zithengiswa kwi-rheumatoid arthritis ukususela ngo-1998 (xa u- Enbrel waba yipilisi ye -biologic yokuqala evunyelwe i-rheumatoid arthritis). Ngokubhekiselele kwiziyobisi ezisetyenziswayo ngoku kunyanga i-lupus, iqela liza kufuna ukujonga ukuba kukho izinga eliphantsi le- steroids eliza kuthathwa njengekhuselekileyo ekuphatheni isicwangciso esicwangcisiweyo.
Kwakhona, imibuzo malunga nokufaneleka kwe- hydroxychloroquine kuzo zonke izigulane ze-lupus zikhoyo.
Phatha kwi-Target ye-Spondyloarthritis
Ngo-2013, iphaneli yecandelo liqwalasele ukuba ngaba izigulane ezine- spondyloarthritis zingenelwa kwiinkqubo zokuphatha. Baphetha ukuba ukuphathwa ngokujoliswe ekujoliswe kuyo kunokusebenza kwi-spondyloarthritis kodwa ukuba ukhokelo malunga nendlela yokuchaza, ukulinganisa okanye ukufezekisa iinjongo zokuxolelwa okanye isifo esingasebenziyo siphumelele kule nkalo yesifo. Izilingo azange zikho zicacise imilinganiselo enokuthi isifo se-spondyloarthritis. Umsebenzi kufuneka wenze. Okwangoku, iziphakamiso zenziwe ngokusekelwe kubungqina obungqalileyo.
Kodwa isifundo esinye, esithile kwi- psoriatic arthritis , xa kuthelekiswa iqela lezigulane ezifumana unyango oluqhelekileyo kunye ne- methotrexate kwelinye iqela elafumana unyango olunzulu kunye neziyobisi. Ngokutsho kweendaba zeRheumatology, iqela elinamandla lilandelelwano olusisigxina kwaye ukuba imilinganiselo yokusebenza yesifo esincinci ayiphumelelwanga, ngoko umthamo we-methotrexate wanda. Kwakhona, ukuba izigulane zahluleka ukuhlangabezana nemigangatho yokusebenza kwezifo, zanikwa inhlanganisela enamandla ye- DMARD . Ukuba abazange bafikelele ekujoliswe kuyo, iqela elikhulu lalinikwa i-blocker ye-TNF . Iziphumo zabonisa ukuba iqela elikhulu lalingcono kuneqela eliqhelekileyo elisele kwi-methotrexate ngaphandle kwesicwangciso sokunyuka kweziyobisi okanye ukulinganisa izifo.
Kwakhona, kwi-European Congress yeRheumatology (i-EULAR 2014), ukwandiswa kweminyaka emi-5 yesilingo esilawulekiweyo, esilawulwayo se- Simponi (golimumab) kwizigulane ezine-arthritis ye-psoriatic zibonisa iziphumo ezingaphezulu kwexesha elide kwizigulana ezikwazi ukufezekisa umsebenzi ophantsi wezofo ukuphatha ukujoliswa kwindlela ekujoliswe kuyo.
Ngaphantsi
Abaphandi baqhuba uphando oluchanekileyo lwencwadi yesayensi (iSchoels, M. et al.) Ngokubhekiselele ekujongeni ukujoliswa kwi-rheumatology. Baphetha ukuba "zifundo ezimbalwa kuphela eziye zasebenzisa indlela yokujonga ixabiso leyeza kunyango ethile. Kodwa ke, bonke banikezela ubungqina obunyanisekileyo bokufumana iinkonzo zekliniki. kunye nezigulane ezine-RA [i-rheumatoid arthritis] ezithembekileyo azizange ziphandwe ngokwaneleyo. "
Iingcali, ukuba neenjongo ezithile zonyango, ingakumbi iinjongo zonyango ezifikelelekayo, zenza ingqiqo. Ukubeka oku kusebenza, iithagethi okanye iinjongo kufuneka zichazwe ngokucacileyo kwizifo ze-rheumatic.
> Imithombo:
> 'Ukunyangwa kwiTgethi': Ukuhambisa iithagethi ezivela kwi-Hypertension, Hyperlipidaemia kunye nesifo sikashukela kwi-Arthritis yeRumatoid. Dan Atar et al. Iziganeko zeeRheumatic Diseases . Epreli 2010.
> Ubungqina bokuPhatha i-Rheumatoid Arthritis ekujoliswe kuyo: Iziphumo zoPhando lweeNkcukacha zoLwazi. Schoels M. et al. Iziganeko zeeRheumatic Diseases . Epreli 2010.
> I-Treat-To-Target kwi-Systemic Lupus Erythematosus: Iingcebiso ezivela kwi-International Task Force. UVan Vollenhoven RF et al. Iziganeko zeeRheumatic Diseases . Ishicilelwe ngo-Apreli 16, 2014.
> Ukwelapha i-Spondyloarthritis, kubandakanya i-Ankylosing Spondylitis ne-Psoriatic Arthritis, kwiNjongo: Iingcebiso ze-International Task Force. Smolen JS et al. Iziganeko zeeRheumatic Diseases . Juni 8, 2013.
> Indlela yokuThatha ukuya kwiTgethi ye-Psoriatic Arthritis Eyifanelekileyo. News Rheumatology . Doug Brunk. Novemba 4, 2013.
> Ukunyanga kwiiNjongo zokuThola ukuThuthukiswa okuPhezulu kwiArthritis Psoriatic. IiNgxelo zeMpilo zoPhakathi . UJennie Smith. Juni 12, 2014.