Chidzidzo chinogona kunge chakawana mhinduro
Zvisiri-steroidal anti-inflammatory drugs ( NSAIDs ) ndeimwe yepamusoro yekurapa kwewasteoarthritis yehudyu nemabvi. NSAIDs inoshanda nokuvhara molecule, iyo inonzi cyclooxygenase iyo inodzivisawo kugadzirwa kwezviverengero zvinoratidza malekemu anonzi prostaglandin. Prostaglandins inokonzerwa nemabasa akawanda mumuviri wedu, chimwe chacho chiri kuputika.
Nokudzivisa kushandiswa kweprogaglandins NSAIDs dzinoderedza kupisa mumuviri wedu, uye izvozvo zvinouya kuderera kukuru mukurwadziwa.
Prostaglandins inotarisirawo mamwe mabasa mashomanana mumuviri akadai sokusimudza-kusachengetedza mudumbu, uye saka zvimwe zvinokanganisika zveNSAID zvinobva pakuvhara mabasa acho zvakare; kunyanya NSAIDs inogona kuva yakaoma mudumbu, uye kushandiswa kwenguva refu kweNSAID kunogona kukonzera mudumbu kana chechi (chinetso chemukati) chironda. Iyi mishonga yakave yakanyatsodzidza uye inowanzonyorerwa kuvanhu vane osteoarthritis. Kushandiswa kweNSAID mumamiriro ezvinhu aya ndechimwe chemashoko mashomanana akasimba akakurudzira ayo American Academy of Orthopedic Surgeons (AAOS) inoita mumitemo yavo yekurapa kwemafupa osteoarthritis.
Vanachiremba vanowanzoratidza kuti NSAIDs ndiyo inotanga kushandiswa kweAA. Pane huwandu hwemishonga pasi peyikirasi yechirwere ichi inonyanyozivikanwa iyo aspirin, ibuprofen (Advil), uye naproxen (Aleve).
Acetaminophen inozivikanwawo separacetamol kana Tylenol imishonga inonyanya pedyo nekirasi yeNSAID, inowanzoshandiswa nechinangwa chakafanana, asi haina simba rinopesana nekuputira uye naizvozvo haigoni kufungidzirwa zvakakwana chikamu cheNSAID.
Kunyange zvazvo tine deta yakawanda iyo inotsigira kushandiswa kweSADS mumamiriro ezvinhu eOA, tine zvishoma zvingada kutitaurira, izvo NSAID inoshanda kupfuura dzimwe.
Icho ndechokuti kuongorora kwechangobva kuitika kwakasvika muLancet iyi Mbudzi. Tisati taenda mberi, regai muchidimbu kutaura pamusoro pekubva kwekutsvakurudza uku. ILancet ibhuku rezvechiremba rinowanikwa muUnited Kingdom rave riripo kubva kuma1820s, nderimwe remabhuku anoremekedzwa zvikuru, uye rave riri chikwata cheimwe yepamusoro-soro inonyanya kugadzirisa nyaya munhoroondo yemishonga.
Semuenzaniso wezvimwe zvikamu zvevhu zvinoputika izvo zvakave zvakabudiswa kutanga muLancet ibhuku raDhidha muna 1870 pamusoro pemigumisiro yemaitiro pamusoro pemigumisiro yekuvhiya ndiyo yaiva yekutanga yekutanga yakaita kuti vanachiremba vabatise maoko avo uye zvigadzirwa zvose vasati vavhiyiwa . Nechirongwa cheRancald Ross chinobudisa pachena kuwanikwa kwake kuti utsi hunoendesa malaria, McBride anoparidzira kuti thalidomide (iyo yakambozivikanwa inonzi anti-druga inoshandiswa pakuve nepamuviri) inokonzera kukanganisa kuberekwa kwakakomba.
ILancet inoparidzira zvakanakisa nyaya uye munhoroondo yavo ichangobva kuitika yakaita basa rekubudisa maitiro epamusoro ekuongororwa kwokuti inosanganiswa nedhidzo kubva kuongororo dzakawanda kuitira kuedza kupindura mubvunzo unokosha wekliniki. Muhurukuro yavo yekupedzisira, magazini yacho yakaedza kupindura mubvunzo wekuti "Ndeipi NSAID ndiyo yakanakisisa mukurapa marwadzo ane chokuita neasteoarthritis yemabvi uye chiuno?"
Ngatirei pano kwechipiri kwechipiri uye tiite chiziviso chakakosha zvikuru. Ichi chidzidzo haCHI KUZIVA KUZIVA. Saka hapana chekuwana iyi inotaura nezvemagumisiro emigumisiro kana kuti inovhiringidza sei mishonga iyi, iyo inongotarisa kubudirira kwekununurwa kwehurwa.
Chidzidzo chacho chakawana 8 973 mishumo, iyo 74 iyo maitirwo akaenzana akaongororwa achienzaniswa neNSAID dzakasiyana siyana neTylenol. Izvi ndezvepamusoro-soro hwehupupuri hwehutano hunofanira kuunganidzwa pamusoro. Pakati pematambudziko aya pane vanhu vanenge 60 000 vaibatwa neNSAID dzakasiyana-siyana uye maitiro akasiyana-siyana ekurwadziwa. Vakabva vaita meta-analysis, iyo inoshambadza vose vevarwere ava muchikwata chimwe kuti vaone kuti ndeipi yeNSAID uye madhesi anoshandiswa ainyanya kubudirira mukuvandudza marwadzo.
Kunyange zvazvo iri iri pamusoro pekushandura kwemaitiro avo, tsanangudzo dzenzira yacho haisi yepamusoro pechinyorwa ichi.
Kunze kwemasvondo makumi maviri nematanhatu emishonga yekurapa yakaongororwa, 5 haana kuita chero nani pane placebo (sugar-pill). Vaya 5 vaiva Tylenol pasi pe2 gramu uye pasi pe3 gm zuva dosing, diclofenac (Voltaren) pa70mg pazuva, Naproxen pa 750mg pazuva, uye ibuprofen pa1200mg pazuva. Zvakakosha kucherechedza kuti izvi ndezvipi zvinokonzerwa nemigumisiro, uye kuwedzerwa kwemishonga yemishonga iyi pane dzimwe nguva yakaratidza kubudirira. Zvinyorwa zvitanhatu zvakabuda kunze zvakanyanya kubudirira: diclofenac (aka Voltaren) 150 mg / zuva, etoricoxib (aka Arcoxia) 30 mg / zuva, 60 mg / zuva, uye 90 mg / zuva, uye rofecoxib (Vioxx) 25 mg / zuva uye 50 mg / zuva.
Zvimwe zvakanyanyisa zvakaongororwa kuongorora zvinoratidza kuti diclofenac 150 mg / zuva uye etoricoxib 60 mg / zuva yakaita zvakanakisisa kuburikidza nekununurwa kwokurwadziwa kana ichienzaniswa nemamwe mishonga nemadhora. Pakufananidza NSAIDs dzakasiyana-siyana maererano nemigumisiro yadzo pakuvandudza basa, yakaita se diclofenac (Voltaren) 150mg / zuva uye rofecoxib (Vioxx) 25mg / zuva.
Tisati taenderera mberi tinofanira kufungisisa zvishoma nezve Vioxx (rofecoxib). Panguva iyi iri muedzo iyi yakaratidzwa kuva mishonga inobatsira pakununura marwadzo nekuvandudzwa mumabasa, Vioxx haisi mushonga wakachengeteka. IA FDA yakabvisa kubva pamusika pamusoro pezvinetso zvekuwedzera kwehutano hwekurwadziwa kwemoyo uye kushungurudzwa kunoenderana nekushandiswa kwenguva refu. Iyo inoshanda sekurwadziwa kunorwadza hakusi kukonzerwa nokuti kune ngozi yaro migumisiro. Hazvifanirwe kuonekwa sechinhu chinokwanisa.
Saka izvi zvinorevei? Iyi iyi yose yakawanda yedhadharo yekutarisa nekududzira. Mune maonero angu kune vanhu vaviri vanotora mapepa kubva kumusha kubva kune zvakanakisisa meta-analysis. Chokutanga, paracetamol (inozivikanwawo seAcetaminophen kana Tylenol) inogona kunge isiri kushanda pakuraira marwadzo kupfuura zvatakafunga. Iye zvino zvakakosha kuona kuti chidzidzo ichi chakanyatsojekesa osteoarthritis yehudyu nemabvi. Saka zvichida Tylenol yakakura pakuraira marwadzo mune mamwe maitiro, sezvakaita misoro, izvi zvidzidzo hazvitauri izvozvo. Sezvo kune OA muhudyu nemabvi anoenda, zvinoratidzika seTylenol chisarudzo chisina kunaka. Diclofenac pa 150mg / zuva ndiyo yakanyatsoshanda mukudzivirira marwadzo nekuvandudza basa.
Izvi zvakatarisa pamigumisiro pamusoro pepfupi nepakati pemazuva ekugadzirisa kwemaawa anenge anenge matatu pamusana. Mishonga iyi ingadai yakaita zvakasiyana pane nguva yakareba yakadai semakore akawanda here? Zvichida, tinoda zvimwe zvidzidzo zvekugara kwenguva refu kuti titi zvechokwadi. Chinhu chakaoma zvikuru pamusoro pokududzira deta iyi ndechokuti haigadziri purogiramu yekuchengetedza yemishonga iyi. NSAID dzakaratidzwa kuwedzera dambudziko rekudzivirira kwepamuviri kumimba (mudumbu nemukomana muduku), uyewo kuwedzera ngozi yekutambudza mwoyo. Uye iyo iyo imwe NSAID imwe neimwe, uye imwe NSAID dosing, inomutsa dambudziko idzodzo inogona kunge yakasiyana. Chisarudzo chekutanga mishonga mutsva yekurapa kweAA yemuchiuno nemabvi inofanira kunyatsokurukurwa nechiremba wako, kuitira kuti iwe mose mugone kuenzanisa kubatsirana uye kunetseka kwemishonga imwe neimwe uye kusarudza mhinduro yakakunakira iwe .