Mazano ekushandiswa kweDMARD uye Biologic Zvinodhaka
Muna 2012, American College of Rheumatology (ACR) yakarongedza mazano ekurapa rheumatoid arthritis . Nema2011 ACR mazano ekushandiswa kwezvirwere-kuchinja zvinorwisa-rheumatic drugs (DMARDs) uye biologic zvinodhaka zverheumatoid arthritis ndeyekuvandudzwa kwezvirongwa zve2008.
Zvinyorwa zve2012 zvakataurirwa:
- izvo zvinoratidza kutanga kana kushandura DMARD uye biologic zvinodhaka
- kushandiswa kwezvigadzirwa zvebiologics muvanhu vane ngozi yakawanda, kusanganisira avo vane hepatitis, congestive moyo kusakwanisa, uye kuipa
- chirwere chepachifu chekuongorora zvirwere kune vatachiri vanotanga kana kuti ikozvino kutora zvinodhaka zvebiologic
- vaccination muvarwere vanotanga kana kuti ikozvino vachitora DMARD kana biologic zvinodhaka
Mazano acho aibva pamabhuku ekutsvakurudza kwePublicMed uye Cochrane Database yeChechi dzeKubvunzurudza, kuongororwa kwemamiriro ekurapa, uye nyanzvi maonero. Mabhuku acho aitsvaga 8 DMARD: azathioprin (Imuran), cyclosporine , hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate , minocycline (Minocin), ndarama , uye sulfasalazine (Azulfidine) uye 9 biologic zvinodhaka: abatacept (Orencia) , adalimumab (Humira), anakinra (Kineret), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituxab (Rituxan), uyecilizumab (Actemra). Nokuda kwekushandisa kusinganzwisisiki kwemishonga uye kusasha kwemashoko matsva akawanikwa kubva kutsvaga, azathioprine, cyclosporine, ndarama, uye anakinra dzakanga dzisingabatanidzwi mukurumbidzwa.
Orencia, Rituxan, Kineret, uye Actemra havasi-TNF biologic zvinodhaka. Enbrel, Remicade, Humira, Simponi, uye Cimzia vane TNF blockers.
Kune varwere vane rheumatoid arthritis yepakutanga (inotsanangurwa seine rheumatoid arthritis kwemwedzi inopfuura 6) uye varwere vane rheumatoid arthritis inorapwa chero chero DMARD kana biologic drug, chinangwa chekurapa chirwere chechiito chakanyanya kana kuti kuregererwa.
Kutanga kana Kushandura DMARD uye Biologic Zvinodhaka
- DMARD monotherapy (kurapa nemumwe chete zvinodhaka) yakakurudzirwa kutanga kwerheumatoid arthritis varwere vane chirwere chechirwere chisingaiti kana kuti vane chirwere chenguva yakareba / yepamusoro mukusavapo kwechirevo chekutsauka kwakashata (kureva kuti hazvirevi kutarisirwa nzira yechirwere).
- DMARD inonzi therapy yakakurudzirwa kutanga kwerheumatoid arthritis varwere vane chirwere chinotarisa kana chepamusoro uye zviratidzo zvisingabatsiri.
- Kushandiswa kweTBF blocker nekunze kana pasina methotrexate kwakakurudzirwa kutanga kwerheumatoid arthritis varwere vane chirwere chepamusoro chekuita uye maitiro asina kunaka ekufananidzira. Kana iyo blocker yeNADF iine infliximab (Remicade), zvisinei, inofanira kushandiswa ne methotrexate.
- Kune varwere vane rheumatoid arthritis, kana mushure mekunge mwedzi mitatu yeDMARD monotherapy murwere anoramba kubva pane chirwere chechirwere ichi kusvika pakuenzanisa kana kuti chirwere chepamusoro, methotrexate, hydroxychloroquine, kana leflunomide (Arava) inofanira kuwedzerwa.
- Mushure memwedzi mitatu yemethotrexate kana methotrexate / DMARD pamwe chete, itawo imwe isiri methotrexate DMARD kana kushandura kune imwe isiri methotrexate DMARD kana murwere akasimudzika achiri nemwero unoenderana nehutachiona hwekuita - kana kuwedzera kana kushandura kuTBF blocker, abatacept ( Orencia), kana rituximab (Rituxan).
- Mushure memwedzi mitatu yekurapa neTF blocker, kana murwere ane chirwere chemuviri / chiremera chakakonzerwa nekushaiwa kwekupindura kana kurasikirwa kubatsiro kubva pakurapa, kushandura kune imwe yevhavha yeTFF kana kuti isiri TNF biologic inokurudzirwa.
- Kana pane chirwere chakanyanya kufanana nepamusoro pemwedzi mitanhatu yekurapa neusingaiti TNF biologic nekuda kwekushayikwa kwekupindura kana kurasikirwa kwebatsiro, murwere anofanira kuchinjwa kune imwe yakasiyana kwete TNF biologic kana kuti kuvhara kweTFF.
- Kana murwere ane chirwere chakanyanya chekuita uye asingakwanisi kuvhara kweTNF nekuda kwechiitiko chakaipa, kushandura kune asiri TNF biologic inokurudzirwa.
- Kana murwere ane chirwere chemuviri / chepamusoro uye asingakwanisi kuvhara TNF nekuda kwechiitiko chakaipa chisina kuipa, kushandura kune imwe TNF blocker kana kuti kwete TNF biologic inokurudzirwa.
- Kana murwere ane chirwere chakanyanya kufanana / chirwere chepamusoro mushure mekukundikana asiri TNF biologic nekuda kwechiitiko chakaipa, kushandura kune rimwe risati riri TNF blocker kana kuti TNF blocker inokurudzirwa.
Kushandisa Biologics muRheumatoid Arthritis Patients With Hepatitis, Malignancy, kana Congestive Heart Failure
- Etanercept (Enbrel) inokurudzirwa kuti rheumatoid arthritis varwere vane hepatitis C.
- Biologic zvinodhaka hazvikurudzirwi ne rheumatoid arthritis varwere vasina kurapwa vane chirwere chepachirwere chepachirwere B kana vamwe vane chirwere chisingaperi chinonzi hepatitis B varwere.
- Kutanga kana kudzoka zvakare kwehupenyu hwehupenyu hunokurudzirwa kuvarwere vanobatwa nehutachiona hwakareba kwenguva refu kupfuura makore mashanu apfuura kana kune varwere vakamborapwa kwekenza yemaperembudzi yekare isina makore makore mashanu adarika.
- TNF blockers hazvikurudzirwi ne rheumatoid arthritis varwere vane muongorori kana zvakanyanya congestive moyo kusakundikana.
Tuberculosis (TB) Kuongorora
- Kuchengetedza kweTB inotapukira yakakosha kunorudzirwa kuti rheumatoid arthritis varwere vachifunga nezvekurapa kwebiologic.
- Pasinei nezvimwe zvinokonzerwa nehutachiona hweHIV huripo, tuberculin skin test kana interferon-gamma-release-assay inofanira kuitwa kune varwere vakagadzirira kutanga biologic kurapwa.
Vaccination for Patients Kutanga kana Kuwana DMARD kana Biologic Zvinodhaka
- Kuuraya zvirwere (pneumococcal, influenza, uye hepatitis B), recombinant (papillomavirus yevanhu), uye kurarama attenuated (herpes zoster) vachipi inofanira kupiwa vasati vatanga DMARD kana biologic drug.
- Kana isati yatoitwa, zvirwere zvinourawa kana zvekare zvinofanira kupiwa kuvarwere vatotora DMARD kana biologic drug.
- Iyo herpes zoster vaccine inogona kupiwa kune avo vatotora DMARD.
ZVAKAITIKA - 2015 ACR Mirayiridzo yekurapa Rheumatoid Arthritis
Nhungamiro iyi yakabudiswazve muna 2015 sechadzokorora kumitemo ye2012. I 2015 nhungamiro inoshandisa kushandiswa kwetsika zvirwere-kuchinja antirheumatic drugs (DMARDs), biologic agents, Xeljanz (tofacitinib) , uye glucocorticoids mukutanga (pasi pemwedzi 6) uye yakagadzirwa (mwedzi 6 kana kupfuura) rheumatoid arthritis. Yakapiwawo muna 2015 nhungamiro inopa mazano ekushandisa nzira yekubata-kutarisa , kushandura nekurega mishonga, uye kushandisa biologic agents uye DMARD kune varwere vane hepatitis, congestive moyo kusakundikana, kuipa, uye zvirwere zvakakomba.
Nhungamiro inoshandisa kushandiswa kwemishonga muvatachiri vanotanga kana kugamuchira DMARD kana biologic zvinodhaka, kuongororwa kwechirwere chetachiona muvatachiri vanotanga kana kugamuchira biologic agents kana tofacitinib, uye kuongororwa kwebato reDMARD. Iyo nhungamiro inosanganisira 74 mazano ayo 23% anoonekwa seakasimba uye 77% inogumira. Iwe unogona kuzviwana pano: 2015 American College of Rheumatology Guideline yekurapa kweRheumatoid Arthritis.
Kunobva:
Kuvandudzwa kwe2008 Mazano ekushandisa kweDMARD uye Biologics mukurapa kweRheumatoid Arthritis. Arthritis Care & Research. pp. 625-639. Singh JA et al. May 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis Singh JA et al. Arthritis Care & Research DOI 10.1002 / acr.22783
http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf