Kuyeuchidza uye kunonoka-kuita. Vose vari kurondedzera kuti boka rezvinodhaka, rinowanzonzi DMARDs (chirwere-modifying antirheumatic drugs), rinoshandiswa kurapa rheumatoid arthritis mushure mekushandisa madhiragi asinganyanyi kuonekwa. DMARD inoshandiswawo kubata zvirwere zvinokonzera kupisa, zvakadai se ankylosing spondylitis , psoriatic arthritis , lupus.
Mishonga iyi inofungidzirwa yakakonzera nokuti inogona kuderedza chirwere ichi, zvisingaiti kazhinji kutungamirira kuregererwa kwakakwana.
Sezvo zvingatora mwedzi 6 kusvika ku8 kuitira kuti mishonga yacho ipe mhinduro, inotaridzika seyakagadzirisa-kuita zvinodhaka uye inosarudzwa sechipiri yekurapa kurapa mushure mokunge aspirin neNSAIDs (nonsteroidal anti-inflammatory drugs) ikundikana.
Haisi kunyatsonzwisisika kuti DMARD inoshanda sei. DMARD inoratidzika kuderedza kuputika zvisinei kuti haisi maitiro ekurwisa zvinodhaka zvinodhaka. Izvo hazvina kufanana neNSAID sezvo dzisingaderedzi prostaglandin yekugadzira, usanyatsogadzirisa marwadzo, kana kuderedza fever. Mukutaura, DMARD inopedza chirwere ichi kuburikidza nekugadzirisa zvirwere zvemuviri mune imwe nzira.
Kubudirira, kuchengeteka, migumisiro, uye nguva yekushandiswa kweDMARD zvakabvunzwa nevarwere vane hanya. Dzidzo mumakore ose aya akaratidza DMARD kuti inoshanda mishonga inobatsira, zvisingambozivikanwi zvakakomba migumisiro yakaipa. Kakawanda kanotariti yekuongorora inobatsira kutarisa njodzi yemigumisiro. Kana uchinge wafungidzirwa kuva mushonga wenguva pfupi, DMARD iko zvino yaonekwa sechinangwa chenguva refu chekudzora zviratidzo uye kuderedza kuwedzera kwezvirwere.
Ndarama yeArthritis
Akawanikwa achinyangarika nechiremba wechiFrance, sarita yegoridhe yakashandiswa pakurapa arthritis kwemakore anopfuura makumi mashanu. Jacques Forrestier inokonzerwa nesariti yegoridhe muchirwere chetachiona kuti itarame chirwere chacho. Murwere akabatana neArthritis uye pashure pemwedzi yakawanda yekurapa negoridhe, arthritis yakagadziriswa.
Ndarama yakashandiswa kurapa arthritis kubvira ipapo.
Iyo nzira yekushanda kwegoridhe isina kujeka asi zvinoita kuti inopesana nemabasa emasero echena machena anokonzera kukanganisa pamwe nekuputika . Kunyange zvazvo goridhe inogona kupera kuparara, haigone kururamisa maitiro akabatwa edzimhosva.
Ndarama yaimbova inowanikwa chete semishonga inoshandiswa. Zvichigoverwa purogiramu yekugadzirisa inopfuurira, inoda nguva dzose zvirwere zvemuropa uye urini kuti zviitwe. Muna 1986, ndarama yakatanga kuwanika mumuromo wemutauro nezita rekutengesa Ridaura. Zvipembenene zvinowanzobatanidzwa nejinjisipi inogadziriswa ndeyekupisa kunopisa pamagumo akadzika nemakumbo emakumbo zvinowanzonyangarika apo mishonga inomiswa. Gold yegoridhe ine zviduku zvishoma asi inogona kukonzera kubuda kwemashure kana kusununguka kwemafupa. Goridhe inoratidzika kushanda zvakanaka kwazvo kune 10 muzana yevarwere uye zvakanaka chaizvo kune imwe 30-40 muzana. Asi makumi mashanu muzana yevarwere vanorega kushandiswa nemhaka yemigumisiro kana kusakosha.
Kushandiswa kwegoridhe kwakanyanyisa kuderera, zvikurukuru nekuvandudzwa kwemishonga ye biologic . Chokutanga biologic, Enbrel, yakavapo muna 1998.
Penicillamine
Penicillamine, hama iri kure ye penicillin, yakavapo muma 1970.
Penicillamine inozivikanwa se chelator nokuti inokwanisa kusunga zvimbi zvakakura mumuviri. Izvo zvinoshandiswa zvekuita mu rheumatoid arthritis hazvizivikanwi asi zvinofungidzirwa kushandura basa remasero machena eropa anokonzera kukanganisa pamwe. Inogona kuva yakashanda kana ichibatanidza nemhangura iyo inowanzopo mumuviri.
Penicillamine inopiwa mutezo, kutanga nehana yakaderera, uye nokuwedzera chiremba. Inotorwa pachirwere chisina chinhu kweawa imwe chete kana mushure mekudya. Kana zvichibudirira murwere anofanira kugara paine chirwere ichi chisingagumi. Migumisiro yakafanana yakafanana neyekubatanidza negoridhe - maronda emaganda, maronda emuromo, kurasikirwa kwevira uye kugadzikana kwepamuviri.
Mapuroteni mumuginhi anogona kuva chiratidzo chepakutanga chetsvo kukuvara.
Penicillamine inogona kushandiswa pamwe neNSAIDs, kunyange zvazvo NSAID inofanira kutorwa panguva yekudya. Varwere avo vane allergenic penicillin vanogona kutora penicillamine. Iyo inoshanda mune anenge 30% yevarwere.
Plaquenil (Hydroxychloroquine)
Plaquenil yave iripo kwemakore akawanda uye yakashandiswa pakurapa marariya. Iyo iri nyore kushandisa, ine zvishoma migumisiro yechirwere, uye haifaniri kuongorora nekuongorora ropa. Plaquenil inoshandiswa kune varwere vane rheumatoid arthritis vasingatauri zvakanaka kune NSAIDs. Inoratidzika kunge inoshanda mune vanenge 30% yevarwere. Inoshandiswa zvakare kune varwere vane systemic lupus.
Plaquenil inoratidzika kuti inopesana nemusikirwo wemasero. Mishonga inopiwa nemuromo, imwe kana mapiritsi maviri pazuva. Chimwe chisingawanzovi chakakomba chikamu chinokonzerwa nechipo chechirwere mu retina ine simba rekuona kuora mwoyo. Chirwere chehupombwe chinokurudzirwa mwedzi yese mitanhatu. NSAID dzinogona kutorwa neArequenil uye dzinowanzonyorwa pamwechete.
Methotrexate (Rheumatrex)
Methotrexate , inowanikwa kwemakore anodarika makumi mana, inowanzoshandiswa kurapa psoriasis uye yakashandiswawo kurapa kenza. Muma1970s, methotrexate yakaderera yakarongedzerwa nevakawanda vheheatatologists kuti vararame rheumatoid arthritis apo NSAID dzakakundikana. Methotrexate inoshanda nekukurumidza kudarika zvimwe zvinodhaka zvinodhaka, kazhinji zvinounza kubudirira mumavhiki panzvimbo pemwedzi.
Methotrexate is antimetabolite, inopesana nekushandiswa kwe folic acid. Inofungidzirwa kuti inodzivirira zvirwere zvemuviri mabasa uye kuderedza kuputika. Izvo zvinogona kuderedza kukurumidza kukurumidza kwemasero mu synovial membrane iyo inotenderera chibatanidza.
Methotrexate inogona kupiwa mumuromo kana kuti semishonga inopindwa muropa zvichienderana nehuwandu hwemadhora. Pamwe chete neavo vashoma madhigirii emigumisiro, nguva refu methotrexate kushandiswa kunogona kukonzera kuora kwechiropa. Routine chiver function function is required.
Methotrexate inogona kutorwa pamwe neNSAIDs. Varwere vanotora methotrexate vanonyeverwa kuti vasabatwa nedoro.
Sulfasalazine
Sulfasalazine inonzi salicylate uye antibiotic. Yakange iripo kubva kuma1940, pakutanga yekurapa varwere vane chirwere chinoputira chirwere. Pane imwe nguva, yakashandiswa kurapa rheumatoid arthritis asi kushandiswa kwayo kwakange kusingagumi nekuda kwekuzvidya mwoyo pamusoro pemigumisiro. Yakanga ichishandiswawo mumakiriniki ekuedzwa sechimwe chendarama. Paiva nenguva yekufadzwa patsva mumashandisirwo ayo senhengo yekuregeresa pasina zvinetso zvekuvadza zvegoridhe uye penicillamine.
Izvo zvinoshandiswa sulfasalazine hazvizivikanwe kunyange zvazvo zvine zviito zviviri zvingaita, zvinodzivisa kuputika uye kudzivisa kukura kwebhakitiriya. Sulfasalazine inowanikwa muhwendefa uye fomu yemvura. Inofanira kudzivirirwa nevanhu vane zvipembenene kune sulfa zvinodhaka uye / kana aspirin nemamwe salicylates. Migumisiro yakajairika inosanganisira kunyorera, kurarisa, kurutsa, uye kurasikirwa kwechido. Zvimwe zvinokonzerwa nemigumisiro yakakomba urusi hwezvinetso, zvirwere zveropa, uye zvinokonzerwa nehutachiona.
Mukusarudza chero mishonga ipi neipi yekurwisa arthritis, iwe nachiremba wako unofanira kuongorora zvikwereti uye ngozi dzekurapa.
> Kwakabva:
> Duke University Medical Centre Bhuku reArthritis, David S. Pisetsky, MD