Anokurapa Kurapa Kuda Kwevamwe Vanhu
Kusiyana kwakasiyana-siyana kweDMARD (chirwere-kuchinja anti-rheumatic drugs) kunogona kurongerwa kurapa rheumatoid arthritis kusiyana neDMARD imwe chete. Triple therapy, iyo iri pakati pekusarudzwa kweutano, inoreva kushandiswa kweDMARD mitatu yakasiyana; dzimwe nguva inogona kureva maDMARD maviri akasiyana uye imwe nhamba yakaderera glucocorticoid .
Chii Chirwere Chetatu?
Iyo inowanzobatanidzwa DMARDs inoshandiswa seropiratu inonzi rheumatoid arthritis inosanganisira methotrexate , sulfasalazine (zita rechiratidzo Azulfidine), uye hydroxychloroquine (Plaquenil).
Kazhinji, rimwe chete DMARD (monotherapy) raizotanga kuedzwa, asi kana kupindura kusina kukwana, chiremba uye murwere vanozofunga dzimwe nzira dzokurapa.
Ndivanaani Vanofanira Kufunga Kurapa Kutatu?
Muna 2012, mazano ekurapa anobva kuAmerican College of Rheumatology, pamwe neCanada Rheumatology Association, akarayira kushandiswa kwemaawa ekubatanidza neDMARD-kusanganisira kurapa katatu-kune vanhu vane chirwere chepachirwere chepachirwere chekutanga, vane varwere vane chirwere chinotyisa, uye varombo prognosis. Triple therapy inogonawo kunyatsotaridzirwa kune avo vakave vasingakwanisi kupindura kune rimwe DMARD.
Sangano reEuropean Against Against Rheumatism (EULAR) rinorayira rheumatoid arthritis treatment muna 2013 rakanga risina tsanangudzo uye rinongotaura kuti kune varwere vasina kumbobvumirwa DMARD, monotherapy kana kuti pamwe chete pamwe chete inogona kunge yakakodzera. Kana danho rekutanga reDMARD richikundikana, kuchinja kune DMARD yakasiyana kunogona kufungwa.
Iyo yakagadziriswa 2015 American College yeRheumatology mirayiridzo ye rhumumachirwere yemarthritis yehurumende iyo inotangira rheumatoid arthritis, kana chirwere chinorambira chichiramba chichikwirirana neDMARD monotherapy (kana pasina glucocorticoid), kusanganiswa DMARD kana TNF inhibitor kana biologic kunze kweTFF inhibitor (kunze kwekuda kurongeka, uye kana pasina kana methotrexate) inofanira kufungwa pane kugara ne monotherapy.
(Cherechedza: Kurongeka kwekusarura hakushayiki nokuti zvidzidzo zvemusoro-kusvika-musoro zvemishonga zvinoshaikwa.
Ndezvipi Zvidzidzo Zvakaonekwa Nezve Utano Hutatu?
Zvidzidzo zvekutanga izvo zvakaratidza kubatsirwa kwekodzero yekutatu yakaenzaniswa ne monotherapy yakawanikwa mune zvinyorwa zvezvesayenzi muma1991. Chidzidzo che1999 chakaratidza kubudirira uye kushivirira kwetatu remapiritsi (methotrexate, sulfasalazine, uye plaquenil) uye pasi-dose prednisone inofananidzwa ne monotherapy kana kuti isina muromo prednisone kune vanhu vane chirwere chinonzi rheumatoid arthritis. Yakanga yakarongerwa kuti kurapa katatu kwaive kwakabudirira pasina kuve kwakachengeteka kudarika monotherapy apo paifunga kukwanisa kwayo kukonzera kuregererwa .
Chimwe chidzidzo chakabudiswa muna 2002 chakagumisa kuti kune vanhu vane rheumatoid arthritis, chirwere chetatu ne methotrexate, sulfasalazine, uye plaquenil chaibvumirwa zvakanaka uye chinoshanda kupfuura kunyanya kushandiswa ne methotrexate uye sulfasalazine. Triple therapy "yakasimudzika" kune methotrexate uye hydroxychloroquine.
Muna 2010, Cochrane purogiramu yekuongorora uye meta-analysis, iyo inofungidzirwa kuti methotrexate monotherapy pamwe nekusanganiswa kwekodzero, yakagumisa kuti pakanga pane musiyano muduku pakati pezvirongwa.
Pasi pose, vanhu 9 kubva pazana vevanhu vakamira kutora methotrexate pamusana pemigumisiro, asi 14 kubva pazana vakamira kutora methotrexate pamwe chete neimwe DMARD.
Migumisiro inowanikwa mumusangano wesayenzi wegore re2013 weAmerican College yeRheumatology yakaratidza kuti vanhu vakawanda vane rheumatoid arthritis vanorega kurapa katatu pashure pemakore maviri kana maviri. Kuronga kuti nei kune huwandu hwekuregera huri nyore, asi chimwe chikonzero chinogona kunge chiri chokuti vanhu vanosarudza madhoma mapiritsi kutora, kwete mapiritsi.
Iro Utano Hutatu Kazhinji Inotsanangurwa Here?
Pasinei nekuchengeteka uye kubudirira, chirwere chetatu hachisi kazhinji kuenda-kurapwa mune kliniki kana methotrexate chete isingakwanisi.
Zvichitsanangurwa (Sparks JA et al.), Kubva muna 2009 kusvika muna 2014, 0.7 muzana yevamwe vanenge 25 000 rhumumine arthritis varwere vakatakura kusvika pakurapa katatu kubva pamutemo wavo wekutanga weDMARD. Nokuenzanisa, 11.1 muzana yevarwere vakawedzera biologic mishonga pamwe neDMARD yavo. Ndiyo mhaka, kunyange zvazvo zviitiko zvitsva zvakaratidza kuti kurapa katatu kunobudirira se biologics ye rheumatoid arthritis-uye zvechokwadi inodhura yakawanda.
Triple therapy (methotrexate, sulfasalazine, plaquenil) inonyanya kudhura kupfuura kusanganiswa kwe methotrexate uye Enbrel (etanercept) -zvikamu zvishoma pasi pevarwere pagore. Izvo zvave zvataurwa kuti kurapa katatu kunofanira kutongwa kusati kwavapo biologic, yakadai seEnbrel, nekuda kwekubhadhara mari. Ikoko kuenda kune Enbrel inogona kuitwa gare gare, kune varwere vane kukwana kwakakwana kudarapira katatu.
Pasinei nehutengo hwehutano hwetatu, mukurapa, TNF inhibitor ndiyo sarudzo yakasarudzwa yekurapa kana methotrexate chete isingakwanisi. Zvinofadza, nehutachiwana hutsva hutsva huri kukudziridzwa, hunozivikanwa sehuosimilars , hunogona kuchinja zvakare. Bhiosimilar chigadzirwa chezvisikwa chinonyanya kufanana neAmerican-licensed biological reference reference. Zvichida, izvi zvinofanirwa kuita mishonga inowanikwa inobudirira semishonga ye biologic pamutengo unodhura. Zvichida biosimilars inogona kuva nzira yakanakisisa kana methotrexate iga inokundikana.
> Sources:
> Katchamart, W et al. Cochrane Review. Methotrexate chete neye methotrexate pamwe chete nemimwe mishonga ye rheumatoid arthritis. April 14, 2010.
> Mottonen, TT et al. Kusanganiswa DMARD Therapy Inosanganisira Corticosteroids muArma Rheumatoid Arthritis. Clinical uye Ongororo Rheumatology. 1999.
> O'Dell, JR, uye al. Mishonga yekushanda Rheumatoid Arthritis Mushure mekupera kwe Methotrexate. New England Journal of Medicine. July 25, 2013.
> O'Dell, JR, uye al. Kurapa kwe rheumatoid arthritis ne methotrexate uye hydroxychloroquine, methotrexate uye sulfasalazine, kana kusanganiswa kwemishonga mitatu. Migumisiro yemakore maviri, randomized, double-blind, trialbo-controlled control. Arthritis & Rheumatology 46: 1164-1170. 2002.
> Sparks, JA, et al. Brief Report: Kuchengetedza Kurapa Katatu Mushure mekurapa Nebibiicic Disease-Kuchinja Antirheumatic Zvinodhaka zveRheumatoid Arthritis muUnited States Kubva muna 2009 kusvika muna 2014. Arthritis uye Rheumatology. June 24, 2016.