Nangona kungekho nonyango ye-spondylitis e-ankylosing (AS), i-regimen yonyango equkethe unyango lomzimba kunye namayeza angakwazi ukuphucula impawu zomntu zentlungu edibeneyo, ukuqina, kunye nokuvuvukala, kunye nokuphucula ukusebenza kwansuku zonke.
Ngo-2015, i-American College of Rheumatology (ACR) yadala izikhokelo zokuphatha i-spondylitis engavumelaniyo.
Ezi zikhokelo zenzelwe ukunceda oogqirha bakwazi ukunyamekela izigulane zabo nge-AS ngendlela echanekileyo, ngokusekelwe kwizifundo zophando.
Njengomntu one-AS (okanye ukuba unomntu othandayo kunye ne-AS), ulwazi malunga nezikhokelo zonyango luyakunceda ukuba uhambe ngesifo esiyinkimbinkimbi nesifo esingapheliyo ngokuqinisekileyo nangokuqiniseka.
I-Non-Steroidal Anti-Inflammatory (NSAID) unyango
Uphulo oluphambili lwe-spondylitis e-ankylosing ayi-non-steroidal anti-inflammatory (NSAID). Ii-NSAID ziye zadlula ixesha elide kwaye zisebenza kakuhle ekunciphiseni ukuvuvukala emzimbeni. Basebenza ngokuthintela i-enzyme ebizwa nge-cyclooxygenase enzymes (i-COX enzymes).
Ngokuvalela le enzyme, amazinga e-prostaglandin ancitshiswa emzimbeni. Ekubeni i-prostaglandin idlala indima ebalulekileyo ekuvukeni, ngokunciphisa, iimpawu zokuvuvukala njengentlungu nokuvuvukala kuncinci.
I-downside ye-NSAID kukuba ayinakuyithathwa ngumntu wonke, ngenxa yobungozi babo.
Yingakho kubaluleke kakhulu ukuba uthathe i-NSAID kuphela phantsi kolawulo lugqirha wakho.
Ngokomzekelo, enye ingozi eyaziwa yinto enokwenzeka ye-NSAID yonyango kukuba ingabangela umonakalo wesisu, izilonda kunye nokuphuma kwamanzi. Ii-NSAID zinokunyusa ingozi yokuhlaselwa kwintliziyo, ukuhluleka kwentliziyo, okanye ukubetha. Bangaphinda baphakamise uxinzelelo lwegazi lomntu kwaye kubangele okanye zibi ngakumbi iingxaki zeengtso.
Ukongezelela kwezi zibi, i-NSAID inokusebenzisana namanye amayeza. Yingakho kubalulekile ukuxelela ugqirha wakho onke amayeza owathathayo, kuquka nezityalo, iivithamini, okanye izongezo.
Imizekelo ye-NSAID
Kukho iinombolo ze-NSAID ezahlukileyo ezikhoyo ukuphatha i-AS, kubandakanywa ii-NSAID kunye ne-NSAID zogunyaziso. Imizekelo ibandakanya:
- I-NSAID ezingaphezulu kwee-counter: Advil okanye i-Motrin (ibuprofen) ne-Aleve (naproxen)
- I-NSAID yobhalo: I-Voltaren (i-diclofenac), i-Mobic (meloxicam), okanye i-Indocin (indomethacin).
Ama-NSAID afana no-i-profiles afana ne-ibuprofen nawo afumaneka ngomyalelo ophezulu.
Olunye uhlobo lwe-NSAID oluqhelekileyo ukuba lusetyenziswe ukunyanga i-AS yiCelebrex (celecoxib) , enokukunceda ukukhusela iingxaki zesisu neengxenyeni. I-Celebrex yi-NSAID ekhethiweyo kuba inqanda i-COX-2 enzyme kuphela (enye i-NSAID ivimba i-COX-1 kunye ne-COX-2 enzymes). Ngokulondoloza umsebenzi we-COX-1 kwaye kuphela ukuvimbela i-COX-2, isisu nesiswini somzimba sancitshiswa. Oku kungenxa yokuba i-COX-1 inceda ukugcina isilumko sesisu.
I-Norros Necrosis Factor Inhibitors (TNFi)
Ukuba umntu onama-AS akakwazi ukuthatha i-NSAID, okanye ukuba iimpawu zabo ezinjengeentlungu nokuzinza aziphuculwanga ngonyango lwe-NSAID, icebo le- TNF licetyiswa .
I-tumor necrosis factor (TNF) yiprothini ebandakanyekayo kwinkqubo yokuvuvukala, ngoko ngokuvimbela imveliso yayo, ukuvuvukala emzimbeni kuncitshiswa.
Iindaba ezilungileyo malunga nee-blockers ze-TNF zikho ubungqina obunzulu bezenzululwazi ukuxhasa inkxaso yabo ekunciphiseni umsebenzi wesifo kwi-spondylitis e-ankylosing-ngamanye amazwi, ukuphazamisa ukuvuvukala emzimbeni. Sekunjalo, ii-block block ze-TNF aziyizo zonyango. Banoba nobungozi, kwaye oku kufuneka kulingiswe ngokucophelela kumntu ngamnye.
Ngenxa yokuba i-TNF blockers igxotha umzimba womntu (nangona unobungozi kwiimeko zalabo abane-spondylitis ene-ankylosing), banokunyusa umngcipheko womntu wesifo sobabini kunye nosuleleko olunzulu.
Umzekelo wentsholongwane elincinci ishushu ebandayo. Ngakolunye uhlangothi, usulelo olunzulu oogqirha abaxhalabele ngakumbi xa umntu ethatha i-TNF inhibitor isifo sofuba. Ngenxa yengozi yokubuyiselwa kwesifo sofuba, ukuhlolwa kwe-TB kuyadingeka ngaphambi kokuba kuqaliswe unyango lwe-TNF. Ngokuqhelekileyo, ii-blockers ze-TNF ziye zadibaniswa nethuba elongezelelweyo lokuphuhlisa ii-cancer ezithile.
Kwakhona kubalulekile ukwazi ukuba abantu abathile ababaviwa ukuba bathathe ii-block blockers njenge-:
- I-Multiple sclerosis (i-TNF blockers ayifuni ngokugqithiseleyo ukulahlekelwa yi-myelin ebuchosheni nasentanjeni yomthambo)
- Ukumelwa yintliziyo
- Usulelo olunentshukumo njengemiphunga ye-pneumonia
Abasetyhini abakhulelweyo okanye abancelisayo abangekho abaviwa be-TNF yokwelapha.
Imizekelo ye-TNF Blockers
Ngo-2010, ukuVavanywa kwe-SpondyloArthritis International Society (ASAS) kwanyathelisa isethi yezikhokelo zokusebenzisa ii-blockers ze-TNF kwizigulane ezine-spondylitis eskylos. Ezi zikhokelo zinceda oogqirha ukuba banikezele ukuba ngubani umviwa ofanelekileyo we-TNF.
Umzekelo, ngokwemigaqo ye-ASAS, umntu kufuneka acingwe nje nge-blocker ye-TNF xa isifo sakhe singaphuculanga ubuncinane kunye neentlobo ezimbini ezahlukeneyo ze-NSAID (kwiqondo elixhomekeke kwi-dose).
Iibhloko ze-TNF ezisetyenziselwa ukuphatha i-spondylitis e-ankylosing yile:
- Enbrel (etanercept)
- Remicade kunye neRenflexis (i-infliximab)
- Humira (adalimumab)
- Simponi (golimumab)
- Cimzia (certolizumab)
I-Remicade kunye neRenflexis (infliximab) banikezwa njenge-infusion kwi-vein ngelixa i-Enbrel (etanercept), i-Humira (adalimumab), i-Simponi (golimumab) kunye ne-Cimzia (certolizumab) zinikwa njengendlela engaphantsi (kwiimfumi zeoli).
ICosentyx (iSecukinumab)
Ukuba umntu akaphendulanga kakuhle kwi-TNFi, ugqirha wabo unokuqwalasela i-Cosentyx (secukinumab). I-Cosentyx yavunywa yi-US Food and Drug Administration (i-FDA) ngo-2016 ukunyanga i-spondylitis engasebenzi.
Isebenza ngokuthintela i-IL-17A, okuyi- cytokine ene-proinflammatory (isithunywa se-molecule esenza impendulo yokuvuvukala emzimbeni). I-IL-17A iyaziwa ukuba idlale indima enkulu ekuphuhliseni i-AS.
I-Cosentyx inikezelwa ngaphantsi kweveki ezine iveki, kwaye emva kweeveki ezine emva koko. Uphando lubonisa ukuba ibekezeleke kakuhle, kunye nempembelelo echaphazelekayo ebonakalayo yimiqondiso ebanda, njengempumlo eqhutyayo kunye nomqala.
Uphando luyaqhubeka kwi-Cosentyx. Nangona kunjalo, kuyonwaba ngoku kukho ukhetho kubantu abanokugula okuqhubekayo kwi-TNF inhibitor okanye abangenako ukuthatha i-TNF inhibitor.
Ulungiso lwenyama
Ukongezelela kumachiza, i-American College yeRheumatology incoma ukonyango lwangokwenyama kubantu abane-AS esebenzayo (izibonakaliso zentsholongwane ezifana nentlungu kunye kunye nokuqina). Esi siphakamiso sisekelwe kwizifundo ezininzi ezifumene unyango olwenziwe ukuba luncedo ekunciphiseni ubuhlungu nasekuphuculeni ukuhamba komgogodla, ukunyameka, ukuguquguquka, ukusebenza ngokomzimba kunye nentlalo-ntle.
Iindaba ezilungileyo akukho nzakalo enobungozi obuphathekayo. Kwakhona, umntu unokuzibandakanya ekuzilolweni kunye nokwelula ekhaya okanye ngaphakathi kwinqanaba leqela. Oko kwathiwa, uphando lubonisa ukuba unyango lwamaqela olusondelene nalo lunokuba luncedo ngaphezu kwezandla zasekhaya.
Yintoni enokuba yinto ekhangayo ngakumbi (kunye nezobugcisa) kulabo abane-AS luhlobo lonyango olubizwa ngokuba yi-spa-exercising therapy. Olu hlobo lonyango lubandakanya ukusetyenziswa kwamanzi afudumeleyo, ukuhambisa i-massage kwi-jet hydrotherapy, kunye nokuphumla kwi-sauna ene-steamy. Enyanisweni, uphando lufumene ukuba unyango lwe-spa kunye nolwaphulo lwamaqela lungcono kunonyango lwamaqela kuphela.
Ukuhlinzwa
Kwiimeko ezinqabileyo, utyando luyadingeka ukuphatha i-spondylitis e-ankylosing. Oku kufuthi kubalwe abantu abanomonakalo omkhulu kunye neentlungu. Kule meko, ukutshintshwa kwe-hip totally kuyanconywa ngokungabikho utyando kuwo wonke. Utyando olunobungozi olunjengezo zinto ezibandakanya umlanjwane aluqhelekanga kakhulu kwaye zenziwa xa kunzima ukukhawuleza kwintsipho ("ukukhawuleza").
ILizwi
I-ankylosing spondylitis isifo esingapheliyo, kwaye akukho nonyango okwamanje. Kodwa kukho iindlela zokuzilawula. Ngolawulo olufanelekileyo lwezonyango (oluya kufuna ukuguqulwa kwexesha phantsi kolawulo lugqirha wakho), unokuphila kakuhle ne-AS.
> Imithombo:
> Blair Ha, Dhillon S. Secukinumab: Ukuhlaziywa kwi-spondylitis e-ankylosing. Zi yobisi . 2016 Jul; 76 (10): 1023-30.
> Callhoff J et al. Ukusebenza kwe-TNFα blockers kwizigulane ezine-spondylitis ezingenayo i-axial spondyloarthritis: i-meta-analysis. Ann Rheum Dis . 2015 Juni; 74 (6): 1241-8.
> Dagfinrud H, iKvien TK, Hagen KB. Ukungenelela kwe-Physiotherapy ye-spondylitis e-ankylosing. Cochrane Database Syst Rev. 2008 Jan 23; (1): CD002822.
> van der Heijde D et al. Ukuhlaziywa kweengcombolo ze-ASAS zamazwe ngamazwe ngokusetyenziswa kwee-anti-TNF ezigulane kwizigulane ezine-spacyloarthritis. Ann Rheum Dis . 2011 Juni; 70 (6): 905-8.
> Ward MM et al. Ikholeji yaseMelika yeRheumatology / i-Spondylitis Association of America / Spondyloarthritis Uphando kunye neNyango yoNyango 2015 Iziphakamiso zonyango lwe-Ankylosing Spondylitis ne-Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol . 2016 Feb; 68 (2): 282-98.