Kunyange zvazvo pasina mushonga we ankylosing spondylitis (AS), chirongwa chekurapa chinosanganisira kurapwa kwepanyama uye mishonga inogona kugadzirisa zviratidzo zvemunhu zvehutano hwekubatana, kuomesera, nekudzimba, uyewo kunatsiridza zuva rega rega kushanda.
Muna 2015, American College of Rheumatology (ACR) yakagadzira mirayiridzo yekurapa ankylosing spondylitis.
Aya mazano akafanirwa kubatsira vanachiremba kusimudzira kutarisira varwere vavo vane AS nenzira yakarongeka, zvichibva pane zvidzidzo zvekutsvakurudza.
Sezvo munhu ane AS (kana kuti iwe une mudiwa ane AS), ruzivo pamusoro pemitemo yekurapa ichakubatsira iwe kufamba nechirwere ichi chakakomba uye chisingaperi zvakasimba uye nechivimbo.
Non-Steroidal Anti-Inflammatory (NSAID) Therapy
Mushonga wokutanga we ankylosing spondylitis isiri-steroidal anti-inflammatory (NSAID) therapy. NSAIDs dzave dziri nguva refu uye dzinoshanda zvikuru pakudzikisa kuputika mumuviri. Dzinoshanda nekuvhara maitiro enyama anonzi cyclooxygenase enzyme (COX enzymes).
Nokudzivirira ma enzyme, maitiro e prostaglandin akaderedzwa mumuviri. Sezvo prostaglandin ichiita basa rinokosha mukuputika, nekudzikisa, zviratidzo zvekuputika sekurwadziwa nekudzimba zvishoma nezvishoma.
Nechepasi yeNSAID ndeyekuti haigoni kutorwa nemunhu wose, nekuda kwekugona kwavo kukuvadza.
Ichi ndicho chikonzero zvakakosha kutora chete NSAID pasi pekutungamirirwa kwachiremba wako.
Semuenzaniso, rimwe rinonyanyozivikanwa kukuvadzwa kunokonzerwa neAsaid therapy ndeyokuti inogona kukonzera kuora kwemudumbu, kuvonda, uye kubuda ropa. NSAIDs inogonawo kuwedzera njodzi yekurwadziwa kwemwoyo, kukanganisa kwemwoyo, kana kurohwa. Vanogonawo kusimudza ropa rehupenyu hwemunhu uye kukonzera kana kukanganisa zvinetso zvepvo.
Mukuwedzera kune izvi zvinogona kuipa, NSAIDs inogona kuwirirana nemimwe mishonga yako. Ichi ndicho chikonzero zvakakosha kutaurira chiremba wako zvose mishonga yaunenge uchitora, kusanganisira mishonga, mavhithamini, kana kuwedzera.
Mienzaniso yeNSAIDs
Kune dzimwe NSAID dzakasiyana dzakasiyana dzinowanikwa mukurapa AS, kusanganisira zvose pasi-the-counter NSAIDs uye mishonga inorayirirwa NSAIDs. Mienzaniso inosanganisira:
- Over-the-counter NSAIDs: Advil kana Motrin (ibuprofen) uye Aleve (naproxen)
- Zvinyorwa NSAIDs: Voltaren (diclofenac), Mobic (meloxicam), kana Indocin (indomethacin).
Over-the-counter NSAIDs dzakadai se ibuprofen dzinowanikwawo nemishonga yepamusoro pane simba rakakwirira.
Imwe mhando yeNSAID inowanzogadziriswa kurapa AS ndiyo Celebrex (celecoxib) , iyo inogona kubatsira kudzivirira matumbu uye mumukaka zvinetso zvisingaiti. Celebrex inosarudza-NSAID nokuti inodzivirira COX-2 enzyme chete (dzimwe NSAID dzinodzivirira COX-1 uye COX-2 enzyme). Nokuchengetedza basa re COX-1 uye rinongodzivirira COX-2, mudumbu uye mumatumbo kukuvara kunoderedzwa. Ichi ndechokuti COX-1 inobatsira kuchengeta gumbo rekumusoro.
Tumor Necrosis Factor Inhibitors (TNFi)
Kana munhu ane AS asingakwanisi kutora NSAID, kana kana zviratidzo zvavo semarwadzo uye kusindimara zvisati zvavandudzirwa nehutano hweNSAID, blocker yeTF inokurudzirwa.
Tumor necrosis factor (TNF) ipuroteni inobatanidzwa mukuputira, saka nokudzivisa kubudisa kwayo, kupisa mumuviri kunoderedzwa.
Mashoko akanaka pamusoro peNADF blockers pane huwandu hunopupurirwa hwezvesayenzi hunotsigira kubatsirwa kwavo mukuderedza zvirwere zvechirwere mu ankylosing spondylitis-mune mamwe mazwi, kutyisa kupisa pasi mumuviri. Kunyange zvakadaro, TNF blockers haisi maitiro ekurapa. Ivo vane zvipingamupinyi, uye izvi zvinofanirwa kuyerwa zvakananga kune umwe neumwe.
Pamusana pekuti TNF blockers inodzvinyirira zvirwere zvemuviri wemunhu (kunyange zvazvo zvinopfurikidza zvakanyanya mumatambudziko evaya vane ankylosing spondylitis), vanogona kuwedzera dambudziko remunhu wehutachiona hushoma uye hutachiona hwehutachiona.
Muenzaniso wehutachiona hunyoro hunofuridza. Kune rumwe rutivi, chirwere chakakomba icho vanachiremba vanonetseka zvikuru pamusoro pekuti munhu ari kutora TNF inhibitor chii chinonzi TB. Nokuda kwehutachiwana hwekurwisa chirwere chetachiona, chirwere cheTB chinodiwa vasati vatanga chirwere cheNCTF chekuvhara. Kazhinji, TNF blockers dzakabatanidzirwa mukana wekuwedzera dzimwe kenza.
Zvakakoshawo kuziva kuti vamwe vanhu havakwanisi kutora TNF blockers sevaya vane:
- Multiple sclerosis (TNF blockers haigoni kuwedzera kuderedza kurasikirwa kweyanguelin muuropi nemutsipa wesipinha)
- Heart failure
- Chirwere chakaita sepineumonia
Vakadzi vane pamuviri kana kuyamwisa havasi ivo vanobvumirwa neTFF pakuchengetedza chirwere.
Mienzaniso yeTNF Blockers
Muna 2010, Kuongorora kweSpondyloArthritis International Society (ASAS) yakabudisa sarudzo yemitemo yekushandisa TNF blockers kune varwere vane ankylosing spondylitis. Aya mazano anobatsira vanachiremba kuti vaone kuti ndiani anonyatsopindira weTBF blocker therapy.
Semuenzaniso, maererano nemitemo yeAASAS, munhu anofanira kungofungidzirwa neTNF blocker kana chirwere chake chisingavandudzi nemamwe marudzi maviri akasiyana eASAIDs (pamusana pekurasikirwa kwechiremba).
Iyo TNF blockers inoshandiswa kurapa ankylosing spondylitis ndeyi:
- Enbrel (etanercept)
- Remicade uye Renflexis (infliximab)
- Humira (adalimumab)
- Simponi (golimumab)
- Cimzia (certolizumab)
Remicade naRenflexis (infliximab) vanopiwa sechidimbu kuburikidza nemuviri kana Enbrel (etanercept), Humira (adalimumab), Simponi (golimumab), uye Cimzia (certolizumab) inopiwa se-subcutaneous (mumuviri wemafuta).
Cosentyx (Secukinumab)
Kana munhu asingatauri zvakanaka kune TNFi, chiremba wavo angafunga nezveCosentyx (secukinumab). Cosentyx yakagamuchirwa neU.S. Food and Drug Administration (FDA) muna 2016 kuzobata chirwere chinopisa chinonzi spondylitis.
Inoshanda nekudzivirira IL-17A, iyo inonzi proinflammatory cytokine (mutumwa wenhare inobatsira kupikisa kwemuviri mumuviri). IL-17A inozivikanwa kuti inotamba basa guru mukusimudzirwa kwe AS.
Cosentyx inopiwa pasi kamwechete pavhiki kwevhiki ina, uye shure kwemavhiki mana shure kweizvozvo. Kutsvakurudza kunoratidza kuti zvakanyatsorambidzwa, nemigumisiro inowanzovhiringidza yakaita zviratidzo zvinotonhora, semhino inoputika nehuro.
Kutsvakurudza kuchiri kuenderera kuCosentyx. Kunyange zvakadaro, zvinonakidza kune ikozvino inosarudzwa kune vanhu vane chirwere chinoramba chichifambira mberi kune TNF inhibitor kana asingagoni kutora TNF inhibitor.
Therapy Therapy
Mukuwedzera kumishonga, American College of Rheumatology inorumbidza chirwere chepanyama kuvanhu vanoshanda AS (zvinoreva zviratidzo zvekuputika sekurwadziwa pamwe chete nekuoma). Izvi zvinokurudzirwa pane dzakawanda zvidzidzo zvakawana kurapwa kwepanyama kunobatsira pakudzivirira marwadzo nekuvandudza kugona kwepelinha, kurongeka, kushanduka, kushanda muviri, nekugara zvakanaka.
Nhau dzakanaka pane zvishoma zvinokuvadza zvine chokuita nekurapa muviri. Uyezve, munhu anogona kuita zvidzidzo uye anotambanudza pamba kana mukati meboka rakarongeka. Izvozvo zvakati, tsvakurudzo inoratidza kuti boka rakarongedzwa rinorapwa remitambo rinogona kuva rakakosha kudarika maitiro ekumba.
Chingave chinonyanya kukosha (uye chinoshamisa) kune avo vane AS ndiyo chirongwa chemishonga inonzi spa-exercise therapy. Rudzi urwu rwehutano hunosanganisira kudzidzira mumvura inodziya, uchiita massage kubva ku-hydrotherapy jets, uye unofara mune sauna inotyisa. Kutaura zvazviri, kutsvakurudza kwakawana kuti spa-yekurovedza kurapa pamwe chete neboka boka remishonga inorapira zviri nani kudarika boka remishonga chete.
Surgery
Muzviitiko zvisingawanzoitiki, kuvhiyiwa kunodiwa kurapa ankylosing spondylitis. Izvi zvinowanzochengeterwa vanhu vane hupombwe hwakaoma hupano pamwe nekurwadziwa. Mune zviitiko izvi, kushandiswa kwechikwata zvachose kunowanzokurudzirwa pamusoro pekuvhiyiwa zvachose. Riskier kuvhiyiwa sezvinobatanidza mutsara zvakanyanya kudarika uye zvinowanikwa apo kune kuora kwakadzika kwekunze kwepamusoro ("hunchback posture").
Shoko Rinobva
Ankylosing spondylitis chirwere chisingaperi, uye hapachina mushonga. Asi pane nzira dzekutarisira. Nekodzero yekurapa kwakanaka (iyo inoda kudimburirwa kwenguva yakawanda pasi pekutungamirirwa kwechiremba wako), unogona kurarama zvakanaka ne AS.
> Sources:
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> Callhoff J et al. Kubudirira kweNATF block blockers kune varwere vane ankylosing spondylitis uye kwete-radiographic axial spondyloarthritis: meta-analysis. Ann Rheum Dis . 2015 Jun; 74 (6): 1241-8.
> Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy zvinyorwa zve ankylosing spondylitis. Cochrane Database Syst Rev. 2008 Jan 23; (1): CD002822.
> van der Heijde D et al. 2010 Kuvandudzwa kwemasangano eAASAS munyika yose yekushandiswa kwevanhu vanorwisa-TNF vanoshanda nevarwere vane axial spondyloarthritis. Ann Rheum Dis . 2011 Jun; 70 (6): 905-8.
> Ward MM et al. American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network 2015 Mazano ekurapa kweAnkylosing Spondylitis uye Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol . 2016 Feb; 68 (2): 282-98.