Ta yaya aka tabbatar da cututtukan cututtukan cuta da cututtuka
Ritumatoid arthritis ya bambanta da osteoarthritis (cututtukan "ciwo da hawaye") a cikin cewa kwayar cutar ne kawai wanda tsarin yarinya yayi kuskure ya kai wa kansa kwayoyin halitta da kyallen takarda, musamman wadanda ke cikin gidajen. Saboda haka, cutar bata iya gano asali ta hanyar bayyanar cututtuka ba. Maimakon haka, kuna buƙatar yin amfani da gwaje-gwajen hade-ciki har da jarrabawar jiki, gwajin hoto, da gwaje-gwaje-jini-don sanin ko sakamakon ya haɗu da ƙaddamarwar asibiti na cutar.
Yin haka ba kawai tabbatar da cewa ganewar asali daidai ba ne, yana taimaka wajen ƙayyade hanya mai kyau na magani.
Nazarin jiki
Ɗaya daga cikin kayan aikin farko na ganewar asali shine jarrabawar jiki. Manufar kimantawa shine, a wani ɓangare, don ƙayyade halaye na ciwon haɗin gwiwa da kuma kumburi don gane da shi daga mafi tsammanin ake zargi, osteoarthritis .
Daga cikin bambance-bambance:
- Ritumatoid arthritis yana tsammanin yana shafar mahaɗin mahaɗin ( polyarthritis ). Osteoarthritis yakan rinjaye hannayensu, ƙafafu, da gwiwoyi da kuma lokutan da suka hada da haɗin gwiwa daya ( monoarthritis ).
- Rheumatoid arthritis yana da tsayin daka da alama, kuma yana nufin cewa haɗin gwiwar jiki a gefe ɗaya na jiki za a nuna su a wani gefe na jiki. Osteoarthritis yana da yawa sau daya (ko kuma asymmetrical idan fiye da ɗaya hadin gwiwa yana da hannu).
- Saboda ilimin cututtuka na rheumatoid yana haifar da ƙonewa, jiki, malaise, har ma da ƙananan zazzabi na kowa. Osteoarthritis, wanda ba cutar cututtuka ba ne, bazai kasance tare da wadannan cututtuka ba.
- Girmawar matsala ta kasance tare da cututtukan arthritis na rheumatoid amma yana da jinkiri na tsawon minti 30 kawai kuma ya inganta tare da motsi mai sauƙi. Tun da osteoarthritis ya ƙunshi lalacewar haɗin gwiwa, tsararren rana zai wuce tsawon lokaci.
Bugu da ƙari da yin nazarin bayyanar cututtukanka, likita zai sake nazarin tarihin iyalinka.
Ritumatoid arthritis iya sau da yawa gudu a cikin iyalai, doubling ka hadarin da cutar idan wani mataki na biyu mataki da shi da kuma sauƙaƙe ku hadarin idan wani dan lokaci na iyali ya shafi.
Labaran Lab
Ana amfani da gwajin Lab don dalilai biyu na farko na bincikar cututtuka na rheumatoid: don rarraba tsarin dinku da auna da kuma kula da matakin kumburi a jikinka.
Serostatus
Serostatus (wanda aka fassara a matsayin "matsayin jini") yana nufin masu gano magungunan cutar a cikin jini. Idan ana gano waɗannan mahadi a cikin gwajin jini, an ce ku zama tsaiko. Idan ba a samo su ba, za a ba ku a matsayin sakonni. Sakamakon zaɓuɓɓuka za'a iya ƙayyade matsayin ko dai mai kyau, tabbatacciyar tabbataccen, ko babban / karfi mai kyau.
Akwai gwaje-gwaje biyu da aka yi amfani da su don kafa sakonka:
- Rheumatoid factor (RF) wani nau'i ne na autoantibody da ke cikin kashi 80 na mutanen da ke zaune tare da cutar. Sauyewar kwayoyin halitta sunadaran sunadarai ne da jiki ke haifarwa wanda ya kai hari kan kwayoyin lafiya. Duk da yake manyan matakan RF suna nuna damuwa game da cututtukan cututtuka na rheumatoid, zasu iya faruwa tare da wasu cututtuka irin su lupus ko marasa lafiya irin su ciwon daji da cututtuka na kullum.
- Cikakken peptide (anti-CCP) mai tsayayya ta anti-cyclic shine wani nau'i na autoantibody wanda aka samo a cikin mafi yawan mutanen da ke dauke da ciwon maganin jini. Babban tabbacin gwajin-ikonsa na gano magungunan CCP-shi ne irin wannan zai iya gano mahalarta a cikin hadarin cutar har ma idan basu da wata alama.
Inda duka gwaje-gwaje biyu sun rabu da su, wanda ke da kashi 80 cikin dari. Abin da ake nufi shi ne, gwaje-gwajen, yayin da suke da muhimmanci wajen yin ganewar asali, sunyi kuskuren sakamakon sakamako mara kyau ko ɓoye . Dalili ne saboda wannan dalili ana amfani da su a matsayin ɓangare na tsarin bincike maimakon a matsayin alamomi na kai tsaye.
Alamar Flammatory
Kumburi ita ce halayyar rheumatoid arthritis. An gwada gwaji don kimanta matakin ƙumburi ta hanyar kallon alamar alamar jini. Wadannan alamomin ba kawai taimaka mana mu tabbatar da ganewar farko ba amma ana amfani dasu a duk lokacin da cutar take tantance yadda muke amsawa ga magani .
Don haka, likitoci za suyi amfani da matakai guda biyu:
- Erythrocyte sedimentation rate (ESR) jarrabawa ne wanda yayi la'akari da yaduwar kwayoyin launin jini wanda ya kasance a cikin kwasfa mai tsayi, wanda aka sani da jaririn Westergren, a cikin awa daya. Idan akwai kumburi, kwayoyin jini za su tsaya tare su nutse da sauri. Yana da ƙananan ƙin ƙonawa amma wanda zai iya samar da mahimman bayanai masu mahimmanci ga ganewar asali.
- Kwayar C-reactive (CRP) wani nau'i ne na gina jiki wanda hanta ya haifar a mayar da martani ga kumburi. Yayinda kuma ba a ba da takamaiman ba, yana da ƙari sosai game da amsawar ƙwayar cuta.
ESR da CRP kuma za a iya amfani dasu don tantance cututtuka na arthritis , yanayin rashin rashin lafiya wanda wurin da ƙonewa ya fi yawa ko žasa a rajistan.
Gwaje-gwajen Hoto
Matsayin da gwaje-gwajen hotunan da ke cikin maganin wariyar launin fata shine gano alamun haɗuwar haɗin gwiwar, ya haɗa da kashi da ƙwayar faya-fukan da ƙuntatawa na sararin samaniya. Hakanan zasu iya taimaka wajen lura da ci gaban cutar da kuma kafa lokacin da ake buƙatar aikin tiyata .
Kowace jarrabawar zai iya samar da hanyoyi daban-daban da kuma musamman:
- Hanyoyin X sune mahimmanci a gano maɓallin yashi da haɗin haɗuwa. Yayinda ake daukar nauyin X-rayayyen kayan aikin kayan aikin asali don maganin wariyar launin fata, ba su da taimako a farkon farkon cutar yayin da canje-canje a cikin faya-fayen da ƙwayoyin sulhu ba su da alamun.
- Hanyoyin fuska ta Magnetic (MRI) suna iya kallon bayan kashi da kuma canje-canje a cikin suturar haɗin kai har ma da nuna alamar ƙonewa a farkon cutar.
- Hakanan mafi mahimmanci shine ya fi kyau a gano wuri da haɗuwa da haɗin gwiwa kuma zai iya bayyana wasu ƙananan yankuna na ƙonewa. Wannan kyauta ne da aka ba da cewa kumburi na iya cigaba da ganuwa ba tare da ganuwa ba kodayake ESR da CRP sun gaya mana cewa mutumin yana cikin gafara. A irin wannan hali, za a ci gaba da kulawa har zuwa lokacin da aka samu gafara ta gaskiya.
Criteria na ƙayyadewa
A shekara ta 2010, Cibiyar Kwalejin Rheumatology (ACR) ta Amirka ta sake sabunta ka'idoji da yawa akan cututtukan arthritis. An sake janyo hankular, a wani ɓangare, ta hanyar ci gaba da fasahar bincike. Yayin da aka tsara fassarar don dalilai na bincike na asibiti, ana amfani da su a cikin aikin likita don samar da ƙimar ganewar ƙwarewar.
Abubuwan da aka tsara na ACR / EULAR na 2010 sunyi la'akari da matakan kimanin hudu daban-daban kuma suna ƙidayar su a kan sikelin 0 zuwa 5. Dalili mai yawa daga 6 zuwa 10 zai iya ba da tabbacin amincewa cewa kai, a gaskiya, yana da ciwon maganin ƙwayar cuta.
| Jagora | Darajar | Ma'ana |
| Duration na bayyanar cututtuka | Kasa da makonni shida | 0 |
| Fiye da makonni shida | 1 | |
| Hadin gwiwa | Ɗaya daga cikin manyan haɗin gwiwa | 0 |
| Abubuwa biyu zuwa 10 | 1 | |
| Ɗaya daga cikin manyan ƙananan kayan abinci (ba tare da haɗin haɗin ginin) | 2 | |
| Hanyoyi hudu zuwa 10 (ba tare da haɗin haɗin haɗaka) | 3 | |
| Fiye da 10 (tare da akalla karamin haɗin gwiwa) | 5 | |
| Serostatus | RF da anti-CCP ba su da kyau | 0 |
| Low RF da low-CCP | 2 | |
| High RF da high anti-CCP | 3 | |
| Alamar inflammatory | Aiki na ESR da CRP | 0 |
| Abubuwa maras kyau ESR da CRP | 1 |
Binciken Gyara
Binciken cutar gyaran cututtuka ba hanya ce mai sauƙi ba. Yana buƙatar ba kawai gwajin gwaje-gwaje amma nazarin ra'ayi na abin da kake, kamar yadda mai haƙuri, ke ji game da yanayinka. Tabbatar da ganewa na hakika yana da mahimmanci saboda yana ƙayyade ko wasu jiyya za a iya dakatar ko idan yin haka zai iya zama wanda bai dace ba kuma ya sake dawowa .
A karshen wannan, ACR ta kafa abin da ake kira DAS28, wanda ya ƙunshi nau'o'i hudu. "DAS" shine kallon kallon "ciwon cututtuka," yayin da 28 yana nufin yawan mahaɗin da aka bincika a cikin kima.
DAS yayi la'akari da haka:
- Yawan adadin ƙarancin likitanku ya sami (daga 28)
- Yawan mahallin da likitanku ya samu (daga 28)
- Sakamakon ESR da CRP (al'ada da mawuyacin hali)
- Yaya kake ji lafiyar lafiyarka ita ce ta wurin yin la'akari da matsayinka a kan iyaka 10-centimita wanda ƙarshen ya kasance "mai kyau" kuma ɗayan "mummunan"
Wadannan sakamakon ana ciyar da su a cikin wata matsala ta ilmin lissafi don lissafin yawan ci gaba. DAS28 mafi girma fiye da 5.1 yana nuna rashin lafiyar cutar, žasa da 3.2 yana nuna rashin lafiya, kuma žasa da 2.6 an dauke shi gafara.
Binciken Bambanci
Hakazalika gwaje-gwaje na iya taimakawa wajen rarraba tsakanin cututtukan arthritis da osteoarthritis, wasu za a iya umurce su don gano ko akwai wasu dalilai na alamar cututtuka. Wannan shi ne ainihin gaskiyar idan gwajin gwajin wutsiyar rheumatoid naka ko dai ba daidai ba ne, maras tabbas, ko korau.
Wadannan zasu iya haɗawa da cututtuka na autoimmune, cututtuka na haɗin kai, da kuma cututtukan ƙwayoyin ƙwayoyin cuta kamar:
- Fibromyalgia
- Cutar Lyme
- Magungunan myelodysplastic
- Magungunan ƙwayar cuta
- Polymyalgia rheumatica
- Psoriatic arthritis
- Sarcoidosis
- Sjogren ciwo
- Tsarin lupus erythematosus (lupus)
> Sources:
> Aletaha, D .; Neogi, T. Silman, A. et al. "Fassara Rubuce-tsaren Arthritis na Rheumatoid na 2010: Kwalejin Kwalejin Rheumatology na Amirka / Ƙungiyar Turai da ke Rheumatism Collaborative Initiative." Rheum arthritis. 2010: 62 (9): 2565-81 DOI: 10.1002 / art.27584.
> Anderson, J; Caplan, L .; Yazdany, J. et al. "Rheumatoid Arthritis Disease Matakan Ayyukan: Cibiyar Kwalejin Rheumatology na Amirka na Amfani da Aikin Gudanar da Harkokin Clinical." Ciwon Magungunan Arthritis. 2012; 64 (5): 6. DOI: 10.1002 / acr.21649.
> Bykerk, V. da Masarotti, E. "Sabuwar ka'idojin gyaran gyaran ACR / EULAR: mahimmanci don samar da sababbin ka'idoji don gyarawa." Rheumatology . 2012; 51: vi16vi20. DOI: 10.1093 / rheumatology / kes281.
> Smolen, J. Aletaha, D .; da McInnes, I. "Rheumatoid arthritis. " Lancet. 2017; 388 (10055): 2023-38. DOI: 10.1016 / So140-6736 (16) 30173-8.