Isifundo singasifumana impendulo
Izidakamizwa ezingekho-stteroidal anti-inflammatory ( NSAIDs ) zingenye yezona zinto eziphambili zonyango lwe- osteoarthritis yamagqabi namadolo. I-NSAID isebenza ngokuthintela i-molecule, ebizwa ngokuthi i-cyclooxygenase ekhusela ukuveliswa kwemilinganiselo yamanqamzana abizwa ngokuba yi-prostaglandins. I-Prostaglandins inoxanduva lomsebenzi othile emzimbeni wethu, enye yazo ukuvuvukala.
Ngokuthintela ukuhlanganiswa kwe-prostaglandins ii-NSAID ziyancipha ukuvuvukala emzimbeni wethu, kwaye oko kuya kwehla okukhulu kwiintlungu.
I-Prostaglandins nayo ijongene neminye imisebenzi embalwa emzimbeni onjenge-up-keeping of stomach lining, kwaye ngoko ke ezinye zeziphumo ezimbi ze-NSAID zivela ekuthintela loo mi sebenzi ngokunjalo; I-NSAID ingabunzima kwisisu, kwaye ukusebenzisa ixesha elide le-NSAID kungabangela isisu okanye i-duodenal (amathumbu amancinci). Ezi zi yobisi ziye zafundwa kakuhle kwaye ziqhelekelelwe kubantu abane-osteoarthritis. Ukusetyenziswa kwe-NSAID kule ndlela isisombululo sezona zimbalwa ezinamandla ezinokuthi i-American Academy ye-Orthopedic Surgeons (AAOS) yenzayo kwizikhokelo zonyango lwe-osteoarthritis.
Oogqirha bavame ukuphakamisa ii-NSAID njengonyango lokuqala lwe-OA. Kukho inani lamachiza phantsi kwesi sigaba seziyobisi esithandwa kakhulu yi-aspirin, ibuprofen (Advil), kunye ne-naproxen (Aleve).
I-Acetaminophen eyaziwa nangokuthi i-paracetamol okanye i-Tylenol yipilisi esondelene kakhulu neklasi ye-NSAID, isetyenziswa rhoqo ngeenjongo ezifanayo, kodwa ayinalo iipropati ezichanekileyo ezichasayo kwaye ngokuqhelekileyo ayinakucingwa njengenxalenye yeklasi ye-NSAID.
Nangona sineenkcukacha ezininzi ezixhasa ukusetyenziswa kwe-NSAD kwisimo se-OA, sinemininingwane encinci yokusixelela, yiyiphi i-NSAID isebenzayo ngakumbi kunabanye.
Kuye kwagqitywa ukuhlaziywa kwangoku kweLancet kulo Matshi. Ngaphambi kokuba siqhubekele phambili, vumela ngokufutshane ukuthetha ngolu hlobo lophando. I-Lancet yincwadi yezobugcisa esekelwe e-United Kingdom eye yajikeleza ukususela nge-1820s, yenye yeendaba ezihlonishwayo kakhulu, kwaye ibe yiplati yezinye iziphumo eziphambili kwizinto eziphambukayo zomhlaba kwimbali yamayeza.
Njengomzekelo wamanye amaqhekeza omhlaba apapashwe kwiseLancet yincwadi kaLister ngo-1870 malunga nemveliso yobunzima kwiziphumo ezigqityiweyo ezaziyimpopasho yokuqala eyayikhokelela oogqirha ukuba bathathwe ngezandla zabo kunye nazo zonke izixhobo phambi kokuhlinzwa . I-lancet nayo uRonald Ross ishicilela ukufumanisa kwakhe ukuba i-mosquito ihambisa i-malaria, uMcBride uyashicilela ukuba i-thalidomide (eyake idumile imithi esetyenziswayo xa ukhulelwa) idala iziphene ezinzulu zokuzalwa.
I-Lancet ipapasha amanqaku asemgangathweni aphezulu kwaye kwimbali yabo yakutshanje yenze umsebenzi wokupapasha ukuphononongwa kwezinga eliphezulu apho badibanisa idatha kwiinkalo ezininzi ukuze bazame ukuphendula umbuzo obalulekileyo. Kwiphepha labo lokugqibela, iphepha lizama ukuphendula umbuzo othi "Yiyiphi i-NSAID eyona nto ibhetele ekuphatheni iintlungu ezinxulumene ne-osteoarthritis yamadolo kunye ne-hip?"
Masimise apha kwisibini enye kwaye senze isimemezelo esibalulekileyo. Olu pho nonongo aluyikuhlola. Ngoko akukho nalunye ulwazi olubhekiselele kwiphrofayili yempembelelo yecala okanye ukuba lunobungozi njani la mayeza, bajonga kuphela ukuphumelela kwentlungu yoxolo.
Uphononongo lufumene iingxelo eziyi-8,973, ezi-74 ezizifundo ezilawulwa ngononophelo ngokulandelana neeNSAID eziyisixhenxe kunye neTylenol. Oku kukubungqina obuninzi obuphezulu obuqokelelwa kwisihloko. Phakathi kwazo zonke izilingo kwakukho abantu ababalelwa ku-60,000 baphathwa nge-NSAID ezahlukeneyo kunye neentlobo ezahlukeneyo zeentlungu. Bese benza uhlalutyo lwama-meta, olutyalela zonke izi gulane zibe liqela elinye ukubona i-NSAID kunye namayeza asetshenzisiweyo ayenempumelelo kakhulu ekuphuculeni intlungu.
Ngoxa le nto ilula ngokulula kweendlela zabo, iinkcukacha zeendlela zingaphaya kweli nqaku.
Kuhlanganiswe i-22-dose-dose combination combination, 5 akenzanga naluphi na olungcono kune-placebo (ipilisi yetshukela). Lawa ma-5 yayinguTylenol ngaphantsi kwama-2 amagremu kwaye ngaphantsi kwama-3 amagremu ngosuku, i-diclofenac (i-Voltaren) kwi-70mg ngosuku, i-Naproxen nge-750mg ngosuku, kunye ne-ibuprofen ngo-1200mg ngosuku. Kubalulekile ukuba uqaphele ukuba ezi ziphumo ezithile, kwaye amanani aphezulu ala mayeza kwezinye iimeko aphumelele. Amanqanaba ayisithandathu athatyathwa ngolu hlobo olunempumelelo: i-diclofenac (aka Voltaren) i-150 mg / ngosuku, etoricoxib (aka Arcoxia) 30 mg / ngosuku, 60 mg / ngosuku, kunye ne-90 mg / ngosuku, kunye ne-rofecoxib (i-Vioxx) 25 mg / ngosuku kunye ne-50 mg / ngosuku.
Uvavanyo oluninzi oluninzi lweemvavanyo lubonisa ukuba i-diclofenac 150 mg / ngosuku kunye ne-etoricoxib 60 mg / ngosuku yenza okulungileyo ngokukhululeka kwentlungu xa kuthelekiswa nazo zonke ezinye iziyobisi kunye namayeza. Xa kuthelekiswa nee-NSAID ezahlukileyo ngokwemiphumo yazo ekuphuculeni umsebenzi, kwabonakala ngathi i-diclofenac (i-Voltaren) 150mg / imini kunye ne-rofecoxib (i-Vioxx) 25mg / imini.
Ngaphambi kokuba siqhubele phambili sifanele sibe nengqwalasela emfutshane kwi-Vioxx (rofecoxib). Ngethuba lokulingwa kwaboniswa ukuba isichenge esiphumeleleyo sokuphucula intlungu kunye nokuphuculwa komsebenzi, iVoxx ayikho ikhuseli elikhuselekileyo. I-FDA isisusile kwikarhwebo malunga neengxalaba zokunyuka kweengozi zeentliziyo kunye nokubetha okuhambisana nokusetyenziswa kwexesha elide. Kusebenza njengento yokuhlenga intlungu ayikho nto ngenxa yempembelelo yecala layo. Akufanele kuthathwe njengento efanelekileyo.
Ngoko uthetha ukuthini? Le yonke inkcukacha yedatha ukuhlenga kunye nokutolika. Ngokombono wam kukho isibini sithatha amagosa asekhaya ukusuka kulo mgangatho-mgangatho ophezulu. Okokuqala, i-paracetamol (eyaziwa nangokuthi i-acetaminophen okanye iTylenol) ingaba yincinci ekulawuleni iintlungu kunokuba sicinga. Ngoku kubalulekile ukuba uqaphele ukuba olu phofu lucacile kwi-osteoarthritis ye-hip kunye namadolo. Ngoko mhlawumbi iTylenol inkulu ekulawuleni intlungu kwezinye izicwangciso, njengentloko, le sifundo ayijongisi loo nto. Ukufikelela kwi-OA yamagqabi kunye namadolo ahamba, kubonakala sengathi iTylenol iyona nto ikhethayo. I-Diclofenac kwi-150mg / imini yayiyona ndlela iphumelele ekulawuleni intlungu kunye nokuphucula umsebenzi.
Oku kubhekise kwiziphumo ezifutshane kunye nexesha eliphakathi kwexesha elide malunga neenyanga ezi-3 ngokuqhelekileyo. Ngaba ezi ziyobisi zingenziwa ngokwahlukileyo kwixesha elide njengexesha leminyaka? Mhlawumbi, siya kufuna iimfuno ezide zexesha elide ukuthetha ngokuqinisekileyo. Into ebaluleke kakhulu ngokutolika le datha kukuba ayikujongisi iphrofayili yokhuseleko yalezi yobisi. Ii-NSAID ziboniswe ukwandisa umngcipheko wokuphuma kwamathumbu (isisu kunye nentlungu encinci), kunye nokwandisa umngcipheko wokuhlaselwa kwentliziyo. Kwaye iqondo apho i-NSAID nganye, kunye ne-NSAID nganye, iphakamisa ezo ngozi zingase zihluke. Isigqibo sokuqala amachiza amatsha kunyango lwe-OA ye-hip kunye namadolo maxubushe ngokugqithiseleyo ngogqirha wakho, ukwenzela ukuba bobabini benu banako ukulinganisela ubunzima kunye neengxaki zonyango ngalinye kwaye ukhethe isisombululo esifanelekileyo kuwe .