Kutarisira Kubatana Neganda Zvikamu zvePororiary Arthritis
Psoriatic arthritis chirwere chisingaperi chine chirwere chinoputira arthritis chinosanganiswa ne psoriasis, chirwere cheganda. Zviratidzo zvekuvhiringidza pamwe uye psoriasis kazhinji hazviitike panguva imwe chete, kunyange zvakadaro. Mumapiroriyiti akawanda arthritis varwere, zviratidzo zve psoriasis dzinotangira zviratidzo zveArthritis. Zvisinei, munenge 15 muzana yezviitiko, zviratidzo zveArthritis zvinokura pamberi pe psoriasis iripo.
Mune imwe 15 muzana yevarwere, psoriatic arthritis inowanikwa panguva imwechete se psoriasis.
Kune marudzi mashanu e psoriatic arthritis : akaenzana, asymmetric, distal interphalangeal predominant, spondylitis uye arthritis mutilans. Kunyanya kuongororwa uye kurapwa zvakakosha kuitira kuti kuderedza dambudziko rekuparadzwa kwekugara pamwe chete. Kurapa kunotungamirirwa kuronga kutuka, uye pamwe chete pamwe nehuputi hwechirwere, zvose zvinofanira kutaridzirwa.
Rimwe boka reEULAR (European League Against Rheumatism) rakarongedza zvakanyatsogadziriswa mabhuku esayenzi kuti aongorore kurapwa kwemasvomhu ye psoriatic arthritis. Pakutanga, EULAR yakabudiswa mazano muna 2012. Asi muna 2015, chiitiko chakanga chatodiwa kare nekuda kweuchapupu hutsva uye kuwanikwa kwemishonga mitsva. Muna 2012, maiva nemapoka maviri eDMARD (chirwere-chinorwisa anti-rheumatic drugs): chinowanzogadzirwa nemaDMARD (akafuridzirwa csDMARD), ayo anosanganisira methotrexate , Arava (leflunomide) , Azulfidine (sulfasalazine) uye DMARD dzebiologic (zvinyorwa zvinyorwa zveBDMARD).
Pakazosvika gore ra2015, zvinyorwa izvi zvaisanganisira chikamu chechitatu cheDMARD, chinonzi chinoshandiswa nemaitiro DMARDs (akafuridzirwa tsDMARD), anosanganisira PDE (phosphodiesterase inhibitors) uye JAK inhibitors (kureva, Xeljanz [tofacitinib] ). Aya mazano ekuvandudzwa kubva kuEULAR anosanganisira mazano gumi nemitemo yepamusoro yehutano hwe psoriatic arthritis.
Zvinotungamirirwa neMitemo
- Psoriatic arthritis yakasiyana-siyana (kureva, inosanganisira zvinhu zvakasiyana-siyana) uye zvirwere zvinogona kunge zvakanyanya zvinogona kudiwa kurapwa kwemarudzi akawanda.
- Psoriatic arthritis chirongwa chinofanira kuve nechinangwa chekutarisirwa kwakanakisisa uye inofanira kunge yakagadzirirwa pane chisarudzo chakagoverwa pakati pemurwere uye rheumatologist , tichifunga kubudirira, kuchengeteka, uye mari yekurapa.
- Rheumatologists ndivo nyanzvi dzinofanirwa kunyanya kutarisira masukisikeletal zvinhu zve psoriatic arthritis. Nekuvapo kweganda kusanganisira, rheumatologist uye dermatologist vanofanira kushandira pamwe pakuongorora uye kurwara kwezvirwere.
- Icho chinangwa chikuru cheporiorian arthritis kurapwa ndechokuwedzera hutano hunoenderana nehutano hwehupenyu, hwakazadziswa kuburikidza nekudzivirira zviratidzo , kudzivirira kukanganisa kwemugariro, pamwe nekuchengetedza basa rakanaka uye kushamwaridzana. Kuderedza kuputika kunokosha pakuzadzisa zvinangwa.
- Kutungamirirwa kweporioriatic arthritis murwere anofanirwa kutora maonero e-extra-articular zviratidzo (kureva,, kunze kwezvibatanidzwa), chirwere chemagetsi, chirwere chemwoyo nemamwe mamiriro ezvinhu .
Mazano
Kurapa kweporioriatic arthritis kunofanira kukanganisa kuregererwa kana kuti kuderera kusvika kune zvakaderera zvirwere zvinowanikwa kuburikidza nekuongorora nguva dzose nekugadzirisa kurapwa sezvinodiwa.
- NSAIDs (nonsteroidal anti-inflammatory drugs) inogona kushandiswa kugadzirisa musculoskeletal zviratidzo nezviratidzo.
- Mune varwere vane chirwere chinoputika arthritis, kunyanya kune avo vane majoka akawanda anoputika, pamwe chete kukuvadzwa nekuputika, kukwirira kwe sedimentation uye CRP , uye / kana zvimwe zvinoratidza zviratidzo csDMARD zvinofanira kufungidzirwa pamusana pekutanga, ne methotrexate inoshandiswa kune varwere vane ruvara rweganda.
- Majojo emunharaunda ye corticosteroids anofanirwa kuonekwa sechinhu chinogadziriswa (kureva, kuwedzera) chirwere. Systemic corticosteroids panzvimbo yakaderera zvikuru inogona kushandiswa nekuchenjerera.
- Mune varwere vane chirwere chepachirwere chepachirwere vane chirwere chisina kukwana kune imwe csDMARD, kurapwa neBDMARD kunofanira kutanga. BDMARD inowanzovharidza TNF .
- Mune varwere vane chirwere chepachirwere chepachirwere vane chirwere chisina kukwana kune imwe csDMARD vasingakwanisi kushandisa izwi reNADF, bDMARD inotarisa IL12 / 23 (semuenzaniso, Stelara [ustekinumab] ) kana IL17 (semuenzaniso, secukinumab) inogona kufungwa.
- Mune varwere vane chirwere chepachirwere chemhirizhonga vane kusakwanira kugadzirisa kune imwe csDMARD uye vasingagoni kushandisa bDMARD, tsDMARD inogona kufungwa.
- Mune varwere vane zvirwere zvakasimba uye / kana dactylitis (kurira kweiyo yose yakawanda) avo vasina kukwana kugadziriswa kuNSAID kana majekiseni emunharaunda ye corticosteroids, bDMARD inofanira kufungwa. A bloc TNF inowanzoedzwa kutanga.
- Mune varwere vane maitiro axial anoshanda, avo vane kukwana kwakakwana kweNSAID, bDMARD inofanira kufungwa. A bloc TNF inowanzoedzwa kutanga.
- Mune varwere vanokundikana kupindura bDMARD, kushandura kune imwe bDMARD inofanira kufungwa. Kuchinja pakati peNANF dzakasiyana-siyana vanogona kuonekwa sekanaka. TNF blockers dzinosanganisira: Enbrel (etanercept) , Remicade (infliximab) , Humira (adalimumab) , Simponi (golimumab) uye Cimzia (certolizumab pegol) .
Sources:
European League Against Rheumatism (EULAR) mazano ekutungamirirwa kweporioriyamu arthritis nemishonga yemapirmacological: 2015 update. Annals weRheumatic Diseases. Gossec L. et al. 2016; 75: 499-510 ini: 10.1136 / annrheumdis-2015-208337
http://ard.bmj.com/content/75/3/499.full
Mashoko ekushivirira: Psoriatic arthritis (Beyond the Basics). Kusvika pari zvino. Gladman naRitchlin. Yashandurwa 4/9/15.
http://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics