Bayani don Amfani da DMARDs da Daliyoyin Halittu
A shekarar 2012, Cibiyar Kwalejin Rheumatology (ACR) ta Amurka ta ba da shawarwari game da maganin cututtukan arthritis na rheumatoid . Ƙididdigar ACR na 2012 don amfani da maganin cututtuka masu maganin cututtuka (DMARDs) da kwayoyin halitta don maganin cututtuka na rheumatoid shine sabunta shawarwarin 2008.
Sabuntawa na 2012 ya ce:
- alamomi na farawa ko sauya DMARDs da kwayoyin halittu
- yin amfani da ilimin halitta a cikin marasa lafiya mai tsanani, ciki har da waɗanda ke da ciwo da ciwon hauka, da nakasar zuciya, da kuma rashin tausayi
- tarin fuka ga marasa lafiya farawa ko a halin yanzu shan kwayoyin halitta
- maganin alurar riga kafi a cikin marasa lafiya farawa ko a halin yanzu shan DMARDs ko kwayoyin halitta
Shawarar sun kasance ne bisa ga binciken wallafe-wallafe na PubMed da Cochrane Database na Bincike na Gida, nazarin gwaji na asibiti, da kuma kwarewar masana. An wallafa wallafe-wallafen na 8 DMARDs: azathioprine (Imuran), cyclosporine , hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate , minocycline (Minocin), zinariya , sulfasalazine (Azulfidine) - da kuma kwayoyi 9: abatacept (Orencia) , adalimumab (Humira), anakinra (Kineret), certolizumab pegol (Cimzia), jigon (Enbrel), golimumab (Simponi), da kariyar (Remicade), rituximab (Rituxan), da kuma ma'anar (Actemra). Saboda rashin amfani da magunguna da rashin amfani da sababbin bayanai da aka samo daga binciken, azathioprine, cyclosporine, zinariya, da anakin ba sun hada da shawarwarin ba.
Orencia, Rituxan, Kineret, da Actemra ba su da magunguna na TNF. Enbrel, Remicade, Humira, Simponi, da kuma Cimzia su ne masu jefa kuri'ar TNF.
Ga marasa lafiya tare da kututtukan rheumatoid da aka fara (an ce da ciwon ciwon arthritis na kasa da watanni 6) da kuma marasa lafiya tare da maganin maganin maganin ƙwaƙwalwar cututtuka da duk wani DMARD ko maganin kwayar halitta, makasudin magani shi ne rashin lafiya ko aiki.
Farawa ko Gyara DMARDs da kwayoyin Halittu
- DMARD monotherapy (magani tare da kwayar miyagun kwayoyi) an bada shawara ga farkon marasa lafiya na cututtuka marasa lafiya wanda ke fama da cutar rashin lafiya ko rashin lafiya a cikin rashin lafiyar marasa kyau (watau yanayin rashin lafiya).
- An bada shawarar maganin kutsawa na DMARD don farkon marasa lafiya na arthritis tare da matsananciyar rashin lafiya da kuma rashin lafiya.
- An yi amfani da mai amfani da TNF tare da ko ba tare da wata hanya ba don matukar damuwa ga marasa lafiya na arthritis wanda ke fama da rashin lafiya da kuma marasa lafiya. Idan mai tsaro na TNF ya wuce (Remicade), duk da haka, ya kamata a yi amfani dashi tare da hanya.
- Ga marasa lafiya da cikewar cututtuka na rheumatoid, idan bayan watanni 3 na DMARD monotherapy ne ya kamata a kara yin haƙuri daga rashin lafiyar cututtuka zuwa matsakaici ko kuma babbar cuta, methotrexate, hydroxychloroquine, ko leflunomide (Arava).
- Bayan watanni 3 na hanya ko hanya / DMARD hadewa, ƙara wani DMARD ba tare da wata hanya ba ko kuma canza zuwa wani DMARD wanda ba shi da magunguna idan mai haƙuri ya kasance yana da matsakaici zuwa babban cututtuka - ko ƙara ko canza zuwa mai tsaro TNF, abatacept ( Orencia), ko rituximab (Rituxan).
- Bayan watanni 3 na jiyya tare da mai tsaro na TNF, idan mai haƙuri yana da matsananciyar rashin lafiya da ke da alaka da rashin amsa ko asarar amfani daga jiyya, canzawa zuwa wani mai tsaro na TNF ko wani nazarin halittu mara TNF.
- Idan akwai rashin lafiya a cikin watanni 6 na jiyya tare da rashin lafiya na TNF saboda rashin amsawa ko asarar amfanin, dole ne a canza majiyar zuwa wani nau'in halittu na TNF ko wani mai shiga TNF.
- Idan mai hakuri yana da mummunan cututtukan cuta kuma ya rasa mai tsaron gidan TNF saboda mummunar mummunan lamari, ba a canza matakan da ba a TNF ba.
- Idan mai hakuri yana da matsananciyar rashin lafiya da kuma rashin lafiya na TNF saboda wani mummunan mummunan yanayi, canzawa zuwa wani mai tsaro na TNF ko wani ilimin halitta wanda ba TNF ba.
- Idan mai hakuri yana da matsananciyar rashin lafiya a lokacin da ya kasa cinyewar TNF saboda wani mummunan yanayi, sauyawa zuwa wani mai tsaro TNF ko TNF mai bada shawarar.
Amfani da kwayoyin halittu a marasa lafiya na Rheumatoid na Arthritis tare da Hepatitis, Malignancy, ko Zuciyar Zuciya.
- Etanercept (Enbrel) an ba da shawarar ga marasa lafiya marasa ciwon hauka na cutar da ciwon hauka da cutar hepatitis C.
- Magungunan kwayoyin halitta ba a ba da shawara ga marasa lafiya marasa lafiya na rheumatoid tare da marasa lafiya marasa lafiya marasa lafiya ko kuma marasa lafiya marasa lafiya marasa lafiya B.
- An fara farawa ko dawo da maganin ilmin halitta don bada magani ga marasa lafiya waɗanda aka bi da su don rashin lafiya fiye da shekaru 5 da suka gabata ko kuma marasa lafiya waɗanda aka bi da su don cutar ciwon fata ba fiye da shekaru 5 da suka wuce ba.
- Masu ba da alamun TNF ba a ba da shawarar ga marasa lafiya na arthritis da ke fama da rashin ƙarfi ba.
Tarin fuka (TB) Kulawa
- Kulawa don rashin lafiya na TB da aka ba da shawarar ga marasa lafiya marasa lafiya wanda ke dauke da kwayoyin cutar.
- Ba tare da la'akari da matsalolin haɗari na kamuwa da tarin fuka ba, jarrabawar fata ko tuberculin ko kuma interferon-gamma-release-assay ya kamata a yi a kan marasa lafiya da suke shirye don fara magani biologic.
Alurar rigakafi ga marasa lafiya farawa ko karɓar DMARDs ko kwayoyin halittu
- An kashe alurar riga kafi (pneumococcal, influenza, da hepatitis B), recombinant (ɗan jariri na papillomavirus), da kuma maganin alurar riga kafi (herpes zoster) kafin fara DMARD ko maganin likita.
- Idan ba a rigaya ya aikata ba, dole ne a bai wa marasa lafiya da aka kashe ko maganin rigakafi ga marasa lafiya da suke shan DMARD ko maganin likita.
- Za a iya ba maganin alurar rigakafi na herpes ga wadanda ke shan DMARD.
UPDATE - 2015 ACR Sharuɗɗa don magance Rheumatoid Arthritis
An sake buga magunguna a shekarar 2015 don sabuntawa ga jagororin 2012. Dokar ta yauda ta 2015 ta kayyade amfani da maganin cututtuka na maganin cututtuka na gargajiya (DMARDs), masu sinadarin halittu, Xeljanz (tofacitinib) , da kuma glucocorticoids a farkon (kasa da watanni 6) da kuma kafa (watanni 6 ko fiye) arthritis rheumatoid. Har ila yau, a cikin sharuɗan yau da kullum an bayar da shawarwari game da amfani da tsarin kulawa , da yin amfani da magunguna, da kuma amfani da kwayoyin halitta da DMARDs a cikin marasa lafiya da ciwon daji, cututtukan zuciya, rashin tausayi, da kuma cututtuka masu tsanani.
Jagoran ya adana amfani da maganin alurar rigakafi a cikin marasa lafiya farawa ko karbar DMARDs ko kwayoyin halitta, nunawa ga tarin fuka a cikin marasa lafiya farawa ko karɓar jami'o'in ilimin halitta ko tofacitinib, da kuma saka idanu na labaran DMARDs na al'ada. Wannan jagora ya hada da shawarwari 74 wanda 23% suna dauke da ƙarfi kuma 77% suna da matsala. Kuna iya samun wannan a nan: Kwalejin Kwalejin Rheumatology na Amirka na Amirka na 2015 don maganin Ruttin Arthritis.
Source:
Sabuntawa na shawarwarin ACR na 2008 don amfani da DMARDs da Biologics a Jiyya na Arthritis Rheumatoid. Arthritis Care & Research. shafi na 625-639. Singh JA et al. Mayu 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract
Kwalejin Kwalejin Rheumatology na Amirka a Amirka na 2015 don Kula da Hutun Arthritis Rheumatoid Singh JA et al. Arthritis Care & Research DOI 10.1002 / acr.22783
http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf