Gudanar da Harkokin Hadin gwiwa da Bincike na Arthritis Psoriatic
Psotic arthritis wani abu ne na yau da kullum wanda ke dauke da psoriasis, cutar fata. Kwayoyin cututtuka na haɗin gwiwa da kuma psoriasis sau da yawa ba sa faruwa lokaci ɗaya, ko da yake. A mafi yawan marasa lafiya na jini, alamun cututtuka na psoriasis suna ci gaba kafin bayyanar cututtuka na arthritis. Duk da haka, a cikin kimanin kashi 15 cikin dari, alamun bayyanar cututtuka na ci gaba kafin psoriasis ya bayyana.
A cikin wani kashi 15 cikin dari na marasa lafiya, an gano cututtuka na psoriatic a cikin lokaci guda kamar psoriasis.
Akwai nau'o'i 5 na cututtukan zuciya na psoriatic : ma'auni, matsakaici, magungunan kwakwalwa na distal, spondylitis da arthritis mutilans. Sake ganewar farko da magani yana da mahimmanci don rage haɗari na lalacewar haɗin gwiwa. An yi amfani da magani don kulawa da kumburi, kuma tare da haɗin gwiwa da fata na cutar, duka dole ne a magance su.
Ƙungiya mai aiki ga EULAR (Ƙungiyar Turai da Rheumatism) ta yi nazari mai zurfi na wallafe-wallafen kimiyya don nazarin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin maganin ƙwayar cutar. A asali, EULAR ya wallafa sharuddan shawarwarin a shekara ta 2012. Amma a shekara ta 2015, an riga an bukaci sabuntawa saboda sabon shaida da kuma samun sababbin kwayoyi. A shekara ta 2012, akwai nau'o'i biyu na DMARDs (maganin cututtuka na maganin cututtukan cututtuka): DMARDs na roba na al'ada (ƙananan csDMARDs), wanda ya haɗa da methotrexate , Arava (leflunomide) , Azulfidine (sulfasalazine) da kuma DMARDs na bio (abbreviated bDMARDs).
A shekara ta 2015, sabuntawa ya ƙunshi nau'i na uku na DMARDs, wanda ake kira DMARDs na roba (abbreviated tsDMARDs), wanda ya haɗa da PDE (magunguna na phosphodiesterase) da kuma masu hana JAK (misali, Xeljanz [tofacitinib] ). Sharuɗɗan da aka sauke daga EULAR sun hada da shawarwari 10 da kuma 5 ka'idoji masu mahimmanci don maganin cututtuka na psoriatic.
Ƙarin Mahimmanci
- Psotic arthritis abu ne mai banbanci (watau, ya ƙunshi nau'o'i daban-daban) da kuma cutar mai tsanani wanda zai iya buƙatar magungunan multidisciplinary.
- Magungunan cututtukan zuciya na Psoriatic ya kamata yayi la'akari da kulawa mafi kyau kuma dole ne ya dogara ne akan shawarar da aka yanke a tsakanin mai haƙuri da rheumatologist , la'akari da tasiri, aminci, da kuma farashin magani.
- Rheumatologists su ne kwararru waɗanda suka kamata su kula da nauyin ƙwayoyin cuta na psoriatic arthritis. Tare da kasancewar fararen fata, likitan ilimin lissafi da kuma likitan dermatologist zasu hada kai akan ganewar asali da kuma maganin cutar.
- Manufar farko na maganin cututtukan maganin ƙwayar cutar ta jiki ita ce ta kara yawan rayuwar rayuwa, ta hanyar kula da bayyanar cututtuka , rigakafin lalacewar tsarin, da ci gaba da aiki na al'ada da haɗin kai. Rage ƙonawa yana da muhimmanci ga cimma burin.
- Gudanar da magungunan rubutun cututtuka na psoriatic dole ne yayi la'akari da abubuwan da ke nunawa (watau, sauran kayan aiki), ciwo na rayuwa, cutar cututtukan zuciya da sauran ka'idodi .
Shawara
Yin jiyya na cututtukan cututtuka na psoriatic ya kamata a yi izinin gyarawa ko kuma kadan ga rashin lafiya da aka samu ta hanyar kulawa ta yau da kullum da kuma yin gyare-gyare a farfado da ake bukata.
- Za a iya amfani da NSAID (magungunan ƙwayoyin maganin kare ƙwayoyin cuta) don taimakawa wajen nuna alamu da maganin cututtuka.
- A cikin marasa lafiya da cututtukan zuciya, musamman ma wadanda ke da mahallin mahalli, haɗuwar haɗuwa tare da kumburi, ƙananan zazzage da kuma CRP , da kuma / ko kuma karin bayani game da mahimmanci csDMARDs ya kamata a yi la'akari da su a farkon mataki, tare da hanyoyin da aka fi so ga marasa lafiya da kullun fata.
- Dole ne a yi la'akari da injections na gida na corticosteroids a matsayin ƙayyadaddun tsari (watau ƙarin) farfadowa. Corticosteroids na jiki a mafi yawan ƙananan zafin iya amfani dasu da hankali.
- A cikin marasa lafiya da cututtukan ƙwararren ƙwayar cuta wanda basu da amsa mara dacewa a kalla guda csDMARD, za'a fara farawa tare da bDMARD. BDMARD shi ne yawancin mai tsaro TNF .
- A cikin marasa lafiya da cututtuka na jiki wanda basu da mahimmanci amsawa ga akalla csDMARD wanda ba zai iya amfani da na'urar TNF ba, bDMARDs da ke cike IL12 / 23 (misali, Stelara [ustekinumab] ) ko IL17 (misali, secukinumab) za a iya la'akari.
- A cikin marasa lafiya da cututtukan da ke dauke da maganin rashin dacewa a kalla guda csDMARD kuma wadanda basu iya amfani da bDMARDs, za a iya la'akari da tsDMARD.
- A cikin marasa lafiya waɗanda ke da ciwon aiki da kuma / ko dactylitis (kumburi na dukan digiri) waɗanda basu da amsa mara dacewa ga NSAID ko ƙwayoyin corticosteroids na gida, ana bukatar la'akari da bDMARD. Mai cajin TNF an gwada shi da farko.
- A cikin marasa lafiya da ke fama da cutar, wadanda ba su da isasshen amsa ga NSAIDs, dole ne a yi la'akari da bDMARD. Ana amfani da mahimmancin TNF na farko.
- A marasa lafiya waɗanda basu kasa amsawa ga bDMARD ba, za a yi la'akari da canzawa zuwa wani bDMARD. Canji tsakanin masu rarraba TNF daban-daban na iya dacewa. Ma'aikata na TNF sun hada da: Enbrel (akida) , Remicade (infliximab) , Humira (adalimumab) , Simponi (golimumab) da Cimzia (certolizumab pegol) .
Sources:
Ƙungiyar Turai kan Rheumatism (EULAR) shawarwari game da gudanar da maganin cututtuka na psoriatic tare da maganin maganin maganin pharmacological: 2015 sabuntawa. Annals na Rheumatic Diseases. Gossec L. et al. 2016; 75: 499-510 a: 10.1136 / annrheumdis-2015-208337
http://ard.bmj.com/content/75/3/499.full
Bayanin haƙuri: Psithic arthritis (Baya ga Basics). Na zamani. Gladman da Ritchlin. Updated 4/9/15.
http://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics