Iyo Rheumatoid Arthritis Inoitwa

Nzira Yokutenda Kubva Kuchengetedza Kuvhiya

Kunyange zvazvo pasina mushonga we rheumatoid arthritis, kune huwandu hunowedzera huripo hwehutano hwakakwanisa kuderedza kushungurudzika nekuputika kwechirwere chisingaperi chine kupisa. Zvinosanganisira mishonga yekuzvichengetedza, zvokudya, pamusoro-the-counter uye zvinodhaka zvinotapudza zvinodhaka, chirwere chepanyama, uye chizvarwa chitsva-kuchinja zvinodhaka (DMARDs). Matambudziko akakura angada mu-office maitiro akaita sarthrocentesis kana kuti kuvhiyiwa kunogadziriswa kana kutsiva zvakakanganiswa.

Mishonga yeMusha uye Upenyu

Rheumatoid arthritis chirwere chisingaperi, chinopfuurira chinoda kutarisirwa sechikamu chehupenyu hwako. Pane kungorapa chirwere ichi nezvinodhaka, unofanirwa kutora nzira yakazara inoshandiswa pakuvandudza hutano hwako hwose uye kuderedza zvinokonzera ngozi zvinokuisa iwe mukukuvadza.

Izvo zvose nezvekugamuchira hutano hwakanaka uye kuchinja mararamiro aunoita pakurwisa kwakaoma.

Kudya

Kunyange kana maoko ako chete akabatwa, kuwedzera kudarika kana kuvhara kunokonzera kutuka nekuda kwekubudiswa kwezvirwere zvinoputika (zvinonzi cytokines ) kubva kumafuta ane mafuta. Izvi zvinongobatsira kuwedzera zviratidzo zve rheumatoid arthritis uye kuwedzera kusada kunetseka kune zvinyorwa zvemaodzanyemba.

Kunyange zvazvo pasina zvakananga kudya kune vanhu vane rheumatoid arthritis, vanachiremba vakawanda vanobvumira kudya kweMediterranean kunopa hutano hwakanaka hweprotein, mafuta, uye makhahydrates pavanokurudzira kuwedzerwa kwehove (hupfumi muhutano husina kupisa omega-C mafuta acids ) , zviyo zvose, miriwo, michero, uye mafuta ane hutano (kufanana nemafuta emuorivhi).

Dzidzira

Rheumatoid arthritis inoratidzwawo nekuoma kwakakonzerwa nekupfuurira kwekugadzirisa kwema synovial tishu mune imwe sangano. Nokutanga purogiramu yekudzidzira basa , iwe unogona kurasikirwa nehutano uye unotsigira mararamiro ekufamba kweshamwari yakabatanidzwa. Kurarama hupenyu huripo, nenzira yakasiyana, kunobvumira masanganisi akabatanidzwa kuti a "tered" -kubatanidzwa pamwe chete seglue-inotungamirira kusingagumi kusingaperi kwekufamba.

Kudzidzira muviri kunogonawo kuvimbisa kuti mapfupa ako anoramba akasimba uye kurwisa zviratidzo zvehasteoporosis inowanikwa nevanhu vane rheumatoid arthritis.

Kusvuta

Isu tose tinoziva kuti kusvuta hakunakidzi kwatiri, asi kunogona kunyanya kuipa kana uine rheumatoid arthritis. Utsi hwebhegi hunoita zvinhu zvisinganyengeri mumuviri wako, kwete kungokonzera kutuka asi kukonzera kusagadzikana kwemitsipa yeropa kusvika pane imwe nzvimbo iyo kupararira kunogona kumira zvachose mune dzimwe nhengo dzomuviri.

Izvi zvinogona kukurudzira kufambira mberi kwerhumatoid vasculitis , chirwere chinowanzobatana chinoratidzirwa nekusingaperi kusuruvara, ganda rehutachi uye rashes, fever, kuora kurasikirwa, uye musuru uye marwadzo akabatana. Uyezve, kutsvakurudza kwakaratidza kuti kusvuta kunogona kuwedzera njodzi yako yekuwana rheumatoid arthritis, mune dzimwe nguva inenge 300 muzana.

Apo kusasiya cigareti kunogona kunge kwakaoma, zvinobatsira kune yako (pamwe chete uye hutano) hutano hungave hukuru. Taura nachiremba wako pamusoro pezvokurapa. Zvinodhaka zvakadai seZyban (bupropion) uye Chantix (varenicline) zvinogona kubudirira mune vamwe vanoputa uye hazvizopindirani nemishonga yako yeramuti arthritis.

Over-the-Counter (OTC) Mishonga

Sezvo chikamu cherongwa hwekutanga rwerutsva rwekutsvaga, chiremba wako acharamba achikurudzira kune-over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAID) kuti kuderedze urombo kusvika pakuenzanisa nekurwadziwa.

Izvi zvinosanganisira mazita eOTC mazita akadaro seAleve (naproxen) kana Advil (ibuprofen). Mukuwedzera pakuve ne-anti-inflammatory properties, NSAIDs zvakare ane analgesic uye antipyretic (zvinoreva kuti vanogona kugadzirisa marwadzo uye fever, zvichienderana).

NSAIDs haidzikidzi kufambira mberi kwechirwere chacho. Kana zviratidzo zvikawedzerwa, chiremba wako anokwanisa kupa NSAID dzakasimba zvakadai seCelebrex (celecoxib) kana Voltaren (diclofenac) . NSAID nemigumisiro inosanganisira kuvhiringidzika mumimba, kukwira kweropa, kurira munzeve dzako, gastric ulcers, uye chiropa chepfu.

Zvinyorwa

Kana iwe wakamboonekwa uine rheumatoid arthritis , chiremba wako anowanzotaurira kusanganiswa kwemishonga, zvimwe zvayo inobata zviratidzo nezvimwe zvinotarisana nehutachiona hwehutachiona hwemhuka .

Izvi zvinosanganisira muromo uye inokwana corticosteroids, zvirwere-kuchinja antirheumatic drugs (DMARDs), uye chizvarwa chitsva-biologic zvinodhaka.

Corticosteroids

Corticosteroids inobatsira zvikuru asi mishonga yakasimba inogona kuderedza kuvhiringidza uye kubatsira rubatsiro rwemagetsi ega. Corticosteroids inoshandiswa nekutevedzera cortisol, horrenone yeAdrenal inobatsira kuronga kuputika, metabolism, memory, uye shuga yeropa.

Vanowanzomirirwa sechikamu chemishonga yakasiyana-siyana uye ichiendeswa kana mumuromo (mumapiritsi), nejisi (mu musumbu kana mubatanidze nzvimbo), kana mukati-kati (mukati mutsva). Prednisone ndiyo mishonga inowanzoshandiswa pakutsvaga rheumatoid arthritis.

Corticosteroids inongorayirwa kushandiswa kwenguva pfupi nekuda kwehuwandu hwemigumisiro yemigumisiro, kusanganisira osteoporosis, kupfuma, kuputika nyore, cataracts, glaucoma, uye chirwere cheshuga. Kana inotorwa nemuromo, inorondedzerwa mumadhodhi maduku uye kazhinji inotorwa mangwanani. Injection yakachengeterwa kurwisa kwakanyanya uye haishandisi kudarika katatu kana kanomwe pagore.

DMARDs

Dendaase-modifying antirheumatic drugs (DMARDs) inoshanda kuburikidza nekudzivirira mafungiro ezvirwere zvemuviri. Sechirwere chekudzivirira muviri, rheumatoid arthritis inokonzerwa nekushaya kushanda kwemagadzirirwo ezvirwere mumuviri umo zvinowanzoita masero zvinotarisirwa kurwisa. Basa reDMARD nderekudzivirira maitiro ezvirwere zvezvirwere semuviri.

DMARD inoshanda zvakanyanyisa kana inotorwa nokukurumidza sezvinobvira mushure mekunge chirwere chinowanikwa. Kune zvirevo zveDMARD zvakagamuchirwa kuitira kurapwa, izvo zvinosanganisira zvizvarwa zvekare zvinodhaka sePaquenil (hydroxychloroquine) uye zvitsva zvakadai seArava (chengetori) . Zvizhinji zvinotorwa nemuromo.

Kubva kure, DMARD inonyanya kutaurwa ndiyo methotrexate . Methotrexate yave yakapoteredza kwemakore anopfuura makumi mashanu uye inoenderera mberi kuva musana we rheumatoid arthritis treatment. Pakati pezvakanaka zvakawanda, methotrexate inogona kutorwa yakachengeteka kwenguva yakareba, kazhinji inoda kamwe chete-weekly dosing, uye inogona kushandiswa kunyange nevana.

Pamusoro pemanzwiro, methotrexate inogona kukonzera chiropa chekutyisa uye kupisa kwemapfupa. Periodic kuongororwa ropa kunodiwa kuti urege kudzivirira izvi. Dzimwe mimwe migumisiro inosanganisira kuneta, kuora mwoyo, kushungurudzika mumimba, kuputika, chirwere, maronda emuromo, uye nyore kupwanya. Kutora folic acid supplement zuva rega rega kunogona kubatsira kuderedza zvimwe zvezvipembenene zvine chokuita nemishonga.

Dzivisa methotrexate kana uri nepamuviri kana kuedza kutora pamuviri sezvo zvichigona kukonzera kukanganisa kuberekwa.

Biologic Response Modifiers

Biologic response modifiers rudzi rutsva rweDMARD rune chinangwa chezvikamu zvemuviri wezvirwere mumuviri panzvimbo yezvose. Zvinonzi biologic nokuti hazvisi vanhu-asi zvinobva kune mapuroteni evanhu kana zvipfuwo.

Kunyange zvazvo zvinodhaka zvemishonga zvinoshandiswa pakurapa rheumatoid arthritis dzine nzira dzakasiyana dzekuita, zvose zvinoshanda nekuvhara chinangwa chekuzvidzivirira chemuviri: kana tumor necrosis factor (TNF) (iyo inoshandiswa kuratidza kuvhiringidzika), interleukin (iyo inotungamirira kudzivirira kwezvirwere zvemuviri), uye T-seli (iyo inoronga uye kurwisa kunokonzerwa nemakiriniki).

Kazhinji inorayirwa biologic zvinodhaka dzinosanganisira:

• Actemra (tocilizumab)
• Cimzia (certolizumab pegol)
• Enbrel (etanercept)
• Humira (adalimumab)
• Kineret (anakinra)
• Orencia (abatacept)
• Remicade (infliximab)
• Rituxan (rituximab)
• Simponi (golimumab)

Biologics inonunurwa kana nejojo ​​kana intravenously uye inowanzotarisirwa kune vanhu vasina kupindura kune dzimwe mishonga.

Nemhaka yekuti biologics inopesana nemararamiro emusununguko, vanhu vari kurapwa vangave vari pangozi yakawanda yehutachiona. Sezvo zvakadaro, chero kuchekwa, kuora, kana chiratidzo chekurwereka kunofanirwa kurapwa nachiremba. Matambudziko anowanzowanzobatanidza chirwere chinonzi injection site, zvirwere zvokuputika, uye zvirwere zvakadai semvura.

JAK Inhibitors

Janus kinase (JAK) inhibitors ikirasi idzva reDMARD risina-biologic iro rinoshanda nokuvhara kupisa kwemukati mukati memusero. Jafaki (ruxolitinib) uye Xeljanz (tofacitinib) ndiyo yekutanga yeJAK inhibitors inobvumirwa kushandiswa muUnited States Yose inotorwa nemuromo uye inotarisirwa kune vanhu vasina kumbobvuma zvakakodzera methotrexate kana vakundikana pa biologics.

JAK inhibitors inoshandiswa pamwe chete ne methotrexate uye inotorwa kaviri zuva rimwe nerimwe. Zvimwe zvinokonzera zvinosanganisira misoro, kuneta, kusuruvara kwemudumbu, zviratidzo zvakadai semaguruva, zvirwere, mararamiro epamusoro, uye kuwedzera kwehutachiona.

Therapy Therapy

Mukuwedzera kumishonga, chiremba wako angakuendesa kune unyanzvi hwekugadzirisa uyo anogona kushanda newe kuti udzose pamwe basa nekufamba. Izvi zvinosanganisira mafiropiti ehutano uye maitiro emishonga.

Chirwere chepanyama chinotarisa pakuvaka simba nekuvandudza kufamba. Vanhu vane muongorori kuhutachiona rheumatoid arthritis vanowanzoshanda nechiremba wepanyama nguva dzose uye vanogona kuratidzirwa maitiro akasiyana-siyana zvichienderana nezviratidzo zvavo kana zvikanganiso.

Mishonga inogona kusanganisira:

• Simba-kuvaka uye maitiro-yekufamba-maitiro
• Kupisa uye kupisa zvinotapira
• Therapeutic ultrasound
• Transcutaneous magetsi stimulation
• Hydrotherapy

Occupational therapy inotarisira kutsigira rusununguko rwako nekuvandudza hupenyu hwako nekukubatsira kukurira kusakwana kwepanyama, kazhinji nekushandisa zvishandiso zvinobatsira uye zvigadzirwa.

Mienzaniso inosanganisira:

• Kuisa hurukuro dzekuvhenekera kana kushandisa zviri nyore kubata
• Kutsvaga zvigaro zve ergonomic zvinokubvumira kugara pasina kusagadzikana
• Kusarudza matani, walkers kana mamwe maikironi ekufambisa akakodzera kudiwa kwako
• Kugadzirisa makabati uye mashefu kuitira kuti zvinhu zvive nyore kusvika
• Kudzorera chiedza chinoshandiswa nemashamba
• Kushandisa izwi-murairo panzvimbo pekugadzirisa keypad

Dzimwe nyanzvi, kusanganisira podiatrists, kuisa masayendisiti, uye masayendisiti epfungwa, zvinogona kutsvaga kukurira zvimwe zvipingamupinyi zvenyama uye zvepfungwa.

Pre-Surgical Options

Kuvhiya kunowanzoonekwa sechinhu chokupedzisira kana iwe uine rheumatoid arthritis. Usati watofunga nezvekuvhiyiwa, chiremba wako angada kuongorora zvishoma zvishoma, mahofisi emahofisi, kunyanya kana iwe uri muduku uye mune zvimwe hutano hwakanaka.

Pakati pezvisarudzo ndeye nzira inonzi arthrocentesis iyo inoshandiswa mvura inobva pane imwe sangano ine nheyo kuti ibvise zvinetso. Inowanzoshandiswa sechirwere chekuongororwa asi inogona kunge yakakosha mumamiriro ezvinhu apo kushandiswa kwemvura kunokonzera kurwadziwa kukuru.

An arthrocentesis inogona kuitwa pachedu kana kuti isati yatarisa kurwisa corticosteroid. Mamwe majekiseni e-intra-articular aisanganisira kushandiswa kwe hyaluronic acid kuisa ganda rakabatana kana platelet-rich plasma (PRP) yakabviswa kubva kumunhu wega pachake kuti iite kuti hurumende ishandiswe muzvikamu zvakakanganisika.

Zvisinei, pachava nenguva apo arthrocentesis haichazopa rubatsiro runotarisirwa, uye kuvhiyiwa ndiyo chete inosarudzwa.

Surgery

Kana urombo hwako huri pamwe chete husingaregeri, chiremba wako anogona kukurudzira kuvhiyiwa kuti agadzirise hutachiona hwakakanganiswa kana kuhutsiva. Kakawanda, kuvhiyiwa kunongororwa chete kana zvimwe zvese zvasarudzwa zvapera uye iwe unonzi iwe unofanirwa kubvumirwa kuti uite.

Joint Repair

Sezvo rheumatoid arthritis inofambira mberi, majoka akabatanidzwa anogona kunhuwa. apo kudengenyeka kwekateti uye bone kunokonzera kubatana kurasikirwa kwekuenzanisa uye chimiro, zvichiita kuti kuwirirana pamwe . Kunyanya muzvikamu zviduku apo kushandiswa hakusi kusarudzo, vanachiremba vanovhima vachishandisa nzira dzakasiyana dzekubatsira kudzorera kufamba uye kuderedza marwadzo.

Pakati pezvokugadzirisa:

• Arthrodesis , iyo inozivikanwawo sefupa uye inobatana fusion, inoshandiswa kugadzirisa marwadzo akabatana asingagadziriki nekubatanidza mapfupa pamwe chete kudzivirira kufamba kwema-articular.
• Arthroscopy inzira inoshandiswa nechiedza chinonzi chiedza (inonzi arthroscope) inopindirwa mune imwe sangano kuitira kuti bits bone uye cartilage inogona kuwanikwa uye yabviswa.
• Mutambo weCarp wakasunungurwa , unonziwo nerve yekusunungurwa, inoberekerwa umo mukana we carpal muromo wechanza unobviswa kuti uwane nzvimbo yakawanda yehutano nematononi.
• Synovectomy inosanganisira kubviswa kwembambo yakabatana, inonzi synovium, iyo inogara isingagumi uye inopesana nekutaurirana kwekubatana.

Joint Replacement

Kuvhiyiwa pamwe chete kunoshandiswa , kunonziwo arthroplasty, kwave kuri kuwedzera kune vanhu vane rheumatoid arthritis. Chisarudzo chekuongorora kushandiswa kwekugoverana kunenge kuchibva pakuongororwa kwezviratidzo zvepanyama, nhoroondo yekurapa, uye zvitsva kubva kumifananidzo yekufungidzira.

Uyezve, makore ako aizotora chikamu chikuru muchisarudzo chakapiwa chokuti joint joa prostheses inowanzopfuura chero ipi zvayo kubva pamakore gumi nemashanu kusvika kune makumi maviri. Sezvo zvakadaro, vanachiremba vakawanda vanozoda kunonoka nzira iyo kwenguva yakareba sezvinobvira zvichiita, kazhinji kusvikira iwe pane imwe nzvimbo mumakore ako makumi mashanu.

(Nezvo izvo zvataurwa, vanhu vazhinji vane rheumatoid arthritis vari kuita nzvimbo dzakagadzirwa vakaita makore ekutanga makumi matanhatu nemakumi matanhatu nekuda kwekuwedzera kwekuita kweDMARD itsva.)

Sezvo DMARD inoshanda kuburikidza nekudzivirira zvirwere zvemuviri, iwe unoda kumira kurapwa zvakanaka pamberi nepashure mushure mekuvhiyiwa kuderedza dambudziko rekukanganisa kwemazuva ano.

Mazuva ano, mabvi uye kuchinjwa kwemajaya zvakagadzikana zvakachengeteka uye zvinobudirira nepamusoro pepfumbamwe kubva muzana kubudirira. Zvinetso zvemashure-operative kune vanhu vane rheumatoid arthritis zvakafanana zvakanyanya kune mumwe munhu uye zvinogona kusanganisira kuora kwehutachiona, utachiona, ropavha, uye kubatana kwemajoka.

Mishonga Inobatsira Inobatsira (CAM)

Mukubata nechirwere chisingaperi, chirwere cheupenyu hwose, vanhu vane rheumatoid arthritis vachawanzogamuchira mishonga inobatanidza kuti vatsigire kurapa kwavo.

Kunyange zvazvo kurapa kwakawanda kwakadaro kuchipa rubatsiro, zvose zvechokwadi uye zvakaonekwa, zvakakosha kutaura nachiremba wako pamusoro pezvimwe zvizere, mushonga, kana mushonga wemagariro iwe ungave uchitora. Izvi zvinogona kudzivirira kupindira kwezvinodhaka izvo zvinogona kuderedza kurapwa kwako kana madhara nemishonga inokonzera kuti urware.

Pakati pemishonga inonzi inobatsira kurwara rheumatoid arthritis:

• Mafuta ehove anowedzera ane mazana maviri omega-3 fatty acids ayo muviri unoshandisa kuderedza kupisa. Zviongorori zvakawanda zvakaratidza kuti katatu-gramu gwaro rekuwedzera rinogona kupa rubatsiro ruregerero rwekunetseka kweArthritis uye unyoro. Kunyange zvakadaro, mafuta emafuta ehove anofanirwa kudziviswa muvanhu vanoshandisa ropa vanoonda sezvinoita warfarin sezvavanokwanisa kuwedzera dambudziko rekubuda ropa.
• Borage , manheru primrose , nemafuta emucheka, zvinowanikwa mujeri-cap uye mvura inogadzirwa, zvinowanzobva kune omega-6 fatty acids iyo inewo zvinopesana nokuvhiringidza zvinobatsira kuvanhu vane rheumatoid arthritis. Kunyanyisa kunofanira kudziviswa sezvo borage inogona kukonzera kukuvadzwa kwechiropa pamvura yakakwirira, asi manheru primrose inogona kukanganisa zvirwere zve phenothiazine zvinoshandiswa mumishonga yepfungwa.

Zvimwe zvinowanzoshandiswa zvinowanzogadziriswa zvakadai seglucosamine, chondroitin, acupuncture, uye magnetic therapy hazvina kuratidzwa kuti inonyanya kubatsira pakurapa rheumatoid arthritis.

> Sources:

> National Centre yeKubatsira uye Mimwe Mishonga. "Nyaya Yokutsvakurudza: Rheumatoid Arthritis uye Inowedzera uye Mimwe Mishonga Mishonga." Bethesda, Maryland; yakarongedzwa naMay 4, 2016.

> Nikiphorou, E .; Konan, S ;; MacGregor, A. et al. "Kurapwa kwerheumatoid arthritis; Nguva itsva?" Bone Joint J. 2014; 96-B: 1287-9. DOI: 10.1302 / 0301-620X.96B.34506.

> Singh, J .; Saag, K .; Mabhiriji, L. et al. "2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis." Arthritis Care Res. 2016: 68 (1); 1-25. DOI: 10.1002 / acr.22783.

> Smolen, J .; Aletaha, D .; uye McInnes, I. "Rheumatoid arthritis. " Lancet. 2017; 388 (10055): 2023-38. DOI: 10.1016 / So140-6736 (16) 30173-8.

> Sugiyama, D .; Nishimura, K .; Tamaki, K. et al. "Kukanganisa kwekuputa semugove wekutengesa rheumatoid arthritis: meta-kuongorora kwekuongorora zvidzidzo. " Anals Rheum Dis. 2010; 69 (1): 70-81. DOI: 10.1136 / ard.2008.096487.