Rheumatoid arthritis chirwere chisingagumi, chinoputira chinoratidzirwa nekunyanya kuwirirana, kushaya muviri , nekuremara kwebasa . Apo ini ndakatanga kuonekwa kuti ndine rheumatoid arthritis (muna 1974 pazera remakore 19) uye pakutanga ndakadzidza nezvekusarudza kwangu kurapwa, chinangwa chakakurumidza kuonekwa - kuronga kuputika, kunonoka chirwere chekuwedzera, uye kubvisa marwadzo nezvimwe zviratidzo zvehutamu hutachiona .
Yakanzwika se plan rakakodzera kwandiri. Sezvo a newbie arthritis murwere, ndakanga ndichida kutanga utano uye kumisa chirwere ichi.
Ndakadzidza kuti kwaive nekugona kwekuregererwa , zvakare, izvo zvakaita kuti ndinzwe ndakanyanya kukurudzirwa. Zvandakanga ndisingazivi zvakakwana panguva iyoyo ndechokuti kunyange nekurapa, arthritis inogona kuwedzera kuwedzera. Kuparara pamwe chete kunogona kukuvadza. Hungu, ichokwadi. Kunyangwe kana murwere ari mukuregererwa, sezvinotsanangurwa nemitemo yakagadziriswa, vanogona kuratidza kufambira mberi kwemashoko (kureva kuti, x-ray uchapupu hwekuwedzera kuwedzera hutano pamwe).
Mishonga Inofanirwa Kuenderera Kuchengetedza Kurwisana
Kwemakumi emakumi, zvirwere-kuchinja antirheumatic drugs (DMARD), zvakadai se methotrexate , Plaquenil , uye sulfasalazine , zvakashandiswa kunonoka kana kuderedza zvirwere zvinosanganiswa ne rheumatoid arthritis. Nekuwanikwa kwemishonga ye biologic ( Enbrel [etanercept] ndiyo yekutanga muna 1998), zvinangwa zvakava zvakajeka pamatomu ema molecular.
Uye ikozvino, pane nzira itsva inofungidzirwa, inonzi " Treat-to-Target therapy" .
Kuchengetedza-ku-Target mapiritsi pasi chirongwa chekurapa chinoenderana nehutano hwehutano hwehutano hwehutano. Chinangwa ndechekuwana hutsika hwechiito chechirwere kana kuregererwa mune imwe nguva yakatarwa - uye chirongwa chimwe nechimwe chinotariswa.
Kuti uise mumashoko akareruka emashoko, kushandiswa kwehutano kunoitwa kana zvinangwa zvekuita zvirwere zvisati zvasangana. Kunyatsobatana-Ku-Target kunobatsira kudzivirira kukanganisa pamwe chete kunoramba kuchionekwa. Chirwere chetachiona-maitiro ekurapa (kureva, anti-inflammatory treatments) hazvive nekudzivirira kwekubatana kwekubatana muvhudzi-vhudzi. Izvo zvave zvataurwa kuti kunyange mushure mekuputika kunotungamirirwa, chirongwa che synovial tissue mu rheumatoid arthritis varwere vanogona kuratidzira katetilage uye kuparadzwa kwemapfupa. Kuti tinzwisise zviri nani, ngatitarisei zvakanyatsojeka kuti kusanganiswa kwekubatana kunowedzera sei uye kunofambira mberi.
Kunzwisisa Maitiro Akabatana Akabatana Sei?
Kuparara pamwe chete kunogona kuonekwa mumwedzi yakawanda yehutachi hutachiona hutachiona. Kutanga kurasikirwa nekurasikirwa uye mapfupa kunokonzerwa nekuunganidza kwevanhu vanovhiringidza masero mu synovial membrane nekubudirira kwepannus (thickened synovial tissue inogona kupinda mufupa). Ikoko kune snovial sublining layer iyo ine mamiriyoni masero evanhu macrophages, T, masero, mabhendi, dendritic, uye mapymymorphonic leukocytes, pamwe neyero ye-synovial yakatakura macrophage uye fibroblast-like synoviocytes (synovial cells).
Iko kune vanhu vakawanda vanobatwa macrophage uye synoviocytes zvinokwanisa kuchengetedza enzyme (proteinases) inobatanidzwa mukugadzirisa kwekunyadzisa.
Kunzwisisa synovial basa, kunyanya nzira uye nzira dzinobatanidzwa panzvimbo yakachengeteka mishonga inonyadzisa inyenzi, inobatsira kana kukanganiswa kwekubatana kunofanira kudzorwa kana kudziviswa. Somuenzaniso, pane molecular level, chii chinokonzera kuti fibroblasts ive nehasha uye inokuvadza?
Maererano neKelley's Textbook yeRheumatology , maprotiniases kubva pamatatu anokonzera kuparara kwechirwere mu rheumatoid arthritis: nharaunda dzemajoka anonyangarika anoparadzwa nemaproteinases ari mu synovial fluid; kuburikidza nekubatana zvakananga pakati pearticular cartilage neproteolytic (kureva, inogona kuputsa mapuroteni) synovium kana pannus tissue kana maviri; kana kuparadzwa kwemukati (kureva, kuparadzwa kunobva mukati) nemaprotineases anobva ku chondrocytes.
Sezvo vatsvakurudzi vanoedza kuwana mhinduro, isu inch inowedzera uye pedyo nekurapa kwakanakisisa - netariro yekupedzisira kuwana nzira yekudzivirira kubatana kwekubatana. Pamusoro penzira ye rheumatoid arthritis, kubatana pamwe chete kunogona kufambira mberi zvishoma nezvishoma. Mukupedzisira kana kuti zvakanyanya kuwedzera rheumatoid arthritis, kuwirirana kwakasimba kunovapo pakati pe x-ray uchapupu hwekubatana pamwe nekuremara. Kuderedza kubatana kwekubatana kunogona kubatsira kuchengetedza basa pamwe chete.
Iyo nzira yekubatana pamwe chete mu osteoarthritis yakasiyana zvakasiyana. Chiitiko chinogadziriswa chinokonzera (semuenzaniso, kukuvadza kana kupfeka-uye-kusvimha) zvinowanzobatanidzwa nehutachiona hwekuora kwekuita. Kuvhiringidzika kunowanzoitika, asi kunowedzera kune dzimwe nguva muhosteoarthritis. IL-1 (interleukin-1), cytokine , inogona kuita basa rinokosha mukuderera kwekatekiti kunobatanidza neosteoarthritis. Chondrocytes (masero anowanikwa mumatenda) anounza zvikamu zvakakura zveI-1 uye synovial kuvhiringidza kunowedzera mubasa re IL-1. Kunyange zvazvo kusina kuchinja kukuru kunowanzoitika mune synovium mumavanga osteoarthritis, kune kuwedzerwa kwekunyora kwemakemikari nema chondrocytes anowedzera kukanganisa kuparara. Ikoko kune, zvisinei, zvinoratidzika kuvawo chimwe chinhu chinonzi phenotype chinonzi osteoarthritis chinowanikwawo zvakare, chirwere chinowedzera chinokonzera osteoarthritis , chinoratidzirwa nekuparadzwa pamwe chete kunotungamirirwa zvikurukuru nekuputika.
Sources:
Kuwedzera kwekuvhiringidza kwekubatana pasinei nekudzivirira kwekuputika mu rheumatoid arthritis: chikamu chekusimudza karoti inotungamirirwa ne synovial fibroblast basa. Floris PJG Lafeber, Willemijn H Van der Laan. Annals of the Rheumatic Diseases 2012; 71: 793-795 doi: 10.1136 / annrheumdis-2011-200950
http://ard.bmj.com/content/71/6/793.full
Pathogenesis yekubatana kwekubatana mu rheumatoid arthritis. Bresnihan B. Journal of Rheumatology. 1999.
http://www.ncbi.nlm.nih.gov/pubmed/10090189
Kubatana pakati pekubatana kwekubatana nekuremara mu rheumatoid arthritis. Rheumatology. 2000.
http://rheumatology.oxfordjournals.org/content/39/2/122.abstract
Kelley's Textbook yeRheumatology. Ninth edition. Bhuku I. Mapeji 111-113.