Ukhetho olululo lweZonyango kwabanye abantu
Ukudibanisa okuhlukeneyo kwe- DMARD (izifo ezichasene nezifo ezichasene ne-rheumatic) zingamiselwa ukunyanga i- rheumatoid arthritis ngokuchasene neDMARD enye. Ulwaphulo oluthathu, oluphakathi kweendlela zokonyango, lubhekisela ekusebenziseni i-DMARD ehlukeneyo emithathu; maxa wambi kunokubhekisela kwii-DMARD ezimbini kunye ne-dose ephantsi ye- glucocorticoid .
Luphi unyango oluthathu?
Ukuhlanganiswa okuqhelekileyo kwee-DMARD ezisetyenziswe njengonyango oluthathu lwe-arthritis ye-rheumatoid kuquka i- methotrexate , i- sulfasalazine (igama lomthi-azulidine), kunye ne- hydroxychloroquine (Plaquenil).
Ngokuqhelekileyo, i-DMARD enye (i-monotherapy) iya kuqalwa kuqala, kodwa ukuba impendulo ayinelanga, ugqirha kunye nesigulane kuza kucinga ezinye iindlela zokonyango.
Ngubani Omele Aqwalaselwe Ngonyango Oluthathu?
Ngo-2012, izikhokelo zonyango ezivela kwi-American College of Rheumatology, kunye ne-Canadian Rheumatology Association, zinconywa ukusetyenziswa kwe-ARVs kunye ne-DMARD-kuquka ulwaphulo kathathu-kubantu abane-arthritis yokuqala ye-rheumatoid, kunye ne- ukuxela. Ulwaphulo oluthathu lunokuqwalaselwa ngokufanelekileyo ngalabo abaye banakho ukuphendula ngokwaneleyo kwi-DMARD eyodwa.
Iziphakamiso ze-European League ezichasene neRheumatism (EULAR) zonyango lwe-rheumatoid arthritis ngo-2013 zazingacacile kwaye zichazwe ngokucacileyo ukuba kwizigulane ezingakaze zibekwe i-DMARD, i-monotherapy okanye unyango oludibeneyo lungafanelekile. Ukuba isicwangciso sokuqala seDMARD siphumelele, ukutshintshela kwi-DMARD eyahlukileyo kunokuqwalaselwa.
Iziphumo ezihlaziyiweyo ze- American College of Rheumatology izikhokelo zonyango lwe-rheumatoid arthritis yimeko yokuba kwi-rheumatoid arthritis yokuqala, ukuba umsebenzi wesifo uhlala uyingqamaniso ukuya phezulu kunye ne-DMARD monotherapy (ngaphandle okanye i-glucocorticoid), ukudibanisa i-DMARD okanye i- TNF inhibitor okanye i- biologic ngaphandle kwe-TNF i-inhibitor (ngaphandle kokukhethwa kwimiyalelo, kunye kunye okanye ngaphandle kwe-methotrexate) kufuneka ithathelwe ingqalelo kunokuba iqhubeke ne-monotherapy.
(Qaphela: Umyalelo wokukhetha ungabikhoyo ngenxa yokuba uphando lweentloko zeenhloko zamachiza alukhoyo. Izikhokelo zexesha elizayo zingayichaphazela loo nto.)
Ziyintoni Izinto Eziye Zazifundiswa Ngonyango Oluthathu?
Izifundo zokuqala ezityhila inzuzo yonyango kathathu xa kuthelekiswa ne-monotherapy yabonakala kwiincwadi zenzululwazi kuma-1990. Ucwaningo olwenziwa ngo-1999 lwavavanya ukuphumelela nokunyamezela kweyeza ezintathu (i-methotrexate, i-sulfasalazine, kunye ne-plaquenil) kunye ne-do-do- prednisone ephantsi-phantsi kunye ne-oral prednisone okanye abantu abangenayo i-arthritis yokuqala. Kwaye kwacaciswa ukuba unyango oluthathu lusebenza kakuhle ngaphandle kokuba lukhuseleke ngakumbi kune-monotherapy xa ucinga ukukwazi ukukhupha ukuxolelwa .
Uphando olupapashwe ngo-2002 lwagqiba ukuba kubantu abane-arthritis ye-rheumatoid, unyango oluthathu kunye ne-methotrexate, i-sulfasalazine, kunye ne-plaquenil yayinyamezeleke kwaye iphumelele ngakumbi kunxibelelwano lwe-methotrexate kunye ne-sulfasalazine. Ulwaphulo oluthathu lube "lukhulu kakhulu" ukuya kwi-methotrexate kunye ne-hydroxychloroquine.
Ngo-2010, ukuhlaziywa okucwangcisiweyo kweCchrane kunye nokuhlaziywa kwemeta-meta, eyayiqwalasela i-methotrexate i-monotherapy ngokubhekiselele kwonyango oluhlangeneyo, yagqiba ukuba kwakungekho ncinane umahluko phakathi kwezicwangciso.
Ngokubanzi, abantu abayi-9 kwabangama-100 bayeka ukuthatha i-methotrexate ngenxa yemiphumo emibi, ngelixa i-14 kwabangu-100 bayeka ukuthabatha i-methotrexate kunye nenye i-DMARD.
Iziphumo ezinikezelwe kwingqungquthela yesayensi yonyaka ka-2013 ye-American College of Rheumatology ibonise ukuba ipesenteji ephezulu yabantu abane-rheumatoid arthritis beyeke unyango kathathu emva kweminyaka emibini okanye emibini. Ukuhlelwa ukuba kutheni izinga eliphezulu lokunqanyulwa akulula, kodwa esinye isizathu si nokuba abantu bathanda amapilisi amancinci ukuthatha, kungekhona iipilisi.
Ngaba unyango olunamaxesha amaninzi lubhalwe phantsi?
Nangona ukhuseleko kunye nokusebenza kakuhle, unyango oluphindwe kathathu alisoloko luhamba-kunyango kwiinkqubo zonyango xa i-methotrexate yedwa ayinelanga.
Ingxelo (ibeka i-JA et al.), Ukususela ngo-2009 kuya ku-2014, iipesenti ezingama-0.7 ezingama-25,000 izigulane ze-rheumatoid arthritis zanyuka ukuya kwi-triple unyango kwi-regimen yazo yasekuqaleni. Ngokuthelekiswa, iipesenti ezili-11.1 zezigulane zongeze izidakamizwa ze-biologic ngaphezu kweDMARD yazo. Yiyo loo nto, nangona iziphumo zophando ziye zabonisa ukuba unyango oluphindwe kathathu lunokusebenza njengezinto eziphilayo ze-rheumatoid arthritis-kwaye ngokuqinisekileyo ixabiso elininzi.
Ulwaphulo oluthathu (methotrexate, sulfasalazine, plaquenil) lubiza kakhulu kunexabiso lokuhlanganiswa kwe-methotrexate kunye ne- Enbrel (etanercept) -xhaswa ngamawaka angaphantsi kwesigulane ngonyaka. Kuye kucetyiswa ukuba unyango oluphindwe kathathu lufanele lujonge ngaphambi kokuba i-biologic, njenge-Enbrel, ngenxa yeendleko-mpu melelo. Ukunyuka ukuya kwi-Enbrel kunokwenziwa kamva, kwizigulane ezineempendulo ezinganeleyo kwiyeza ezintathu.
Nangona iindleko ezifanelekileyo zonyango kathathu, ekwenzeni ukliniki, i-TNF inhibitor iyona khetho olukhethiweyo lwenyango ukuba i-methotrexate yodwa ayinelanga. Okuthakazelisayo kukuba, ngodidi olutsha lwezonyango luphuhlisiwe, olubizwa ngokuba yi- biosimilars , oluya kutshintsha kwakhona. I-biosimilar ngumkhiqizo wezinto eziphilayo ezifana ne-US-licensed biological reference reference. Kucetyiswa ukuba, oku kufuneka kwenziwe unyango olukhoyo olusebenzayo njengeziyobisi ze-biologic kwixabiso elincinci. Mhlawumbi i-biosimilars ingaba yindlela ekhethiweyo xa i-methotrexate yedwa ihluleka.
> Imithombo:
> Katchamart, W et al. Ukuhlaziywa kweCchrane. I-Methotrexate yedwa ngokubhekiselele kwi-methotrexate kunye kunye namanye amayeza e-rheumatoid arthritis. Ngo-Apreli 14, 2010.
> Mottonen, TT et al. Ukudibanisa i-DMARD Therapy kuquka neCorticosteroids kwi-Arthritis yokuqala ye-Rheumatoid. I-Rheumatology yeeKliniki kunye noVavanyo. 1999.
> O'Dell, JR, et al. Iipilisi ze-Active Rheumatoid Arthritis Emva kokusilela kweMethotrexate. I-New England Journal of Medicine. Julayi 25, 2013.
> O'Dell, JR, et al. Unyango lwe-arthritis ye-rheumatoid ene-methotrexate kunye ne-hydroxychloroquine, i-methotrexate kunye ne-sulfasalazine, okanye ukudibanisa le miyeza emithathu. Iziphumo zonyaka oneminyaka emibili, i-randomized, i-double-blind, i-placebo elawulwa yi-placebo. Arthritis & Rheumatology 46: 1164-1170. 2002.
> Iintlanzi, JA, et al. Inkcazo emfutshane: Ukunyanzeliswa kwiTransy Triple Emva kokunyanga nge-Nonbiologic Disease-Ukuguqula izidakamizwa ze-Antirheumatic kwi-Rheumatoid Arthritis e-United States Ukususela ngo-2009 ukuya ku-2014. Arthritis neRheumatology. Juni 24, 2016.