Inkastoo aysan jirin daawo loogu talagalay daawada ankylosing spondylitis (AS), daweyn daaweyn oo ka kooban daweyn jireed iyo daaweyn ayaa si wax ku ool ah u fududayn karta calaamadaha qofka ee xanuunka wadajirka ah, qallafsanaanta, iyo bararka, iyo sidoo kale hagaajinta hawl maalmeedka.
Sannadka 2015-ka, College College of Rheumatology (ACR) ayaa soo saaray habraaca lagu daaweynayo daaweynta ankylosing spondylitis.
Tilmaamahan waxaa loola jeedaa inuu ka caawiyo dhakhaatiirta inay hagaajiyaan daryeelka bukaankooda qaba AS sida hab nidaamsan, oo ku salaysan daraasadda cilmibaarista.
Qof ahaan AS (ama aad leedahay qof la jecel yahay AS), aqoonta ku saabsan shuruudaha daaweynta ayaa kaa caawin doonta inaad u socoto cudurkan xannuunsan iyo dabadheer si hubaal ah oo kalsooni leh.
Therapy Therapy (Non-Steroidal Anti-Inflammatory (NSAID))
Daaweynta ugu muhiimsan ee daaweynta ankylosing spondylitis waa daaweyn aan dawo ahayn oo aan dawo lahayn (NSAID). NSAIDs waxay ku jireen wakhti dheer waxaana ay aad wax ku ool u yihiin dhimista infakshanka jirka. Waxay ku shaqeeyaan iyaga oo xannibaya enzymes loo yaqaanno enzymes cyclooxygenase (COX enzymes).
Marka la xakameynayo enzymes, heerarka prostaglandin waxaa lagu yareeyaa jirka. Maadaama cudurka prostaglandins uu door muhiim ah ka ciyaaro caabuqa, isaga oo yareynaya, calaamadaha caabuqa sida xanuunka iyo bararka ayaa yar yar.
Dhibaatada NSAID-yada ayaa ah in aysan cidna qaadi karin, sababtoo ah suurtogalnimada inay waxyeello u geystaan.
Tani waa sababta ay muhiimad weyn u leedahay in ay qaadato NSAID kaliya iyada oo loo marayo hagidda dhakhtarkaaga.
Tusaale ahaan, mid ka mid ah waxyeellada suurtogalka ah ee loo yaqaan 'NSAID' ayaa ah inuu keeni karo dhaawac caloosha, boogaha, iyo dhiig-baxa. NSAIDs ayaa sidoo kale kordhin kara halista wadnahaaga wadnaha, wadnaha oo shaqeyn waaya ama stroke. Waxay sidoo kale kor u qaadi karaan cadaadiska dhiigga ee qofka wuxuuna sababi karaa ama ka sii dari karaa dhibaatooyinka kelyaha.
Marka laga soo tago waxyeelooyinka iman kara, NSAIDs waxay la macaamilaan daawooyinkaaga kale. Tani waa sababta ay muhiim u tahay in aad u sheegto dhakhtarkaaga dhammaan daawooyinka aad qaadato, oo ay ku jiraan geedaha, fitamiinnada, ama waxyaalo dheeraad ah.
Tusaalooyinka NSAIDs
Waxaa jira tiro ka mid ah NSAIDs kala duwan oo la heli karo si loo daaweeyo AS, oo ay ku jiraan labadaba macaamiisha NSAID-ka iyo daawooyinka NSAID. Tusaale ahaan waxaa ka mid ah:
- NSAID-ga oo ka baxsan: Advil ama Motrin (ibuprofen) iyo Aleve (naproxen)
- Daawada NSAID-ka: Daryeelka (diclofenac), Mobic (meloxicam), ama Indocin (indomethacin).
NSAID-ka oo ka baxsan mida sida ibuprofen ayaa sidoo kale diyaar u ah rijeeto xoog leh.
Nooc kale oo NSAID ah oo sida caadiga ah loogu qoro daaweynta AS wuxuu yahay Celebrex (celecoxib) , taas oo ka caawin karta ka hortagga dhibaatooyinka caloosha iyo mindhicirka. Celebrex waa xulasho-NSAID-ka xulashada sababta oo ah waxay ka kooban tahay COX-2 enzyme oo kaliya (NSAID-yada waxay joojiyaan COX-1 iyo COX-2 enzymes). Iyada oo la ilaalinayo shaqada COX-1 oo kaliya oo xannibaya COX-2, ayaa la dhimayaa dhaawaca caloosha iyo caloosha. Tani waa sababta oo ah COX-1 waxay ka caawisaa sidii ay u ilaalin lahayd xajinta caloosha.
Tumor Necrosis Fayrasta Waxyeelayaasha (TNFi)
Haddii qof qaba AS uusan qaadan karin NSAID, ama haddii astaamahooda sida xanuunka iyo qallafsanaanta aan la hagaajinin daaweynta NSAID, waxaa lagula talinayaa in TNF xoojiso .
Tumor necrosis factor (TNF) waa borotiin ku lug leh geedi-socodka bararka, sidaas awgeed iyada oo la xakameeyo wax-soo-saarkeeda, bararka jirka ayaa hoos loo dhigaa.
Warka wanaagsan ee ku saabsan xannibaadayaasha TNF waxaa jira caddayn cilmi ah oo cilmi-baaris ku filan oo lagu taageerayo faa'iidadooda hoos u dhigista dhaqdhaqaaqa cudurada ankylosing spondylitis - si kale haddii loo yareeyo, hoos u dhigista caabuqa jirka. Hase yeeshee, TNF-blockers maaha daweyn calaamado ah. Waxay leeyihiin halis, waana in si taxaddar leh loogu fiiriyaa qof kasta.
Sababtoo ah xaqiiqada ah in xannibaadayaasha TNF ay xakameynayaan nidaamka difaaca jirka (inkastoo ay tahay mid aan firfircoonayn kiisaska dadka qaba ankylosing spondylitis), waxay kordhin karaan halista infekshanka fudud iyo infekshanka khatarta ah.
Tusaale ahaan infekshanka fudud waa qabow caadi ah. Dhanka kale, cudurro halis ah oo dhakhaatiirtu si gaar ah uga walwalaan marka qofku qaato daawada TNF waa qaaxo. Iyadoo ay jirto khatarta cudurka qaaxada (TB), baaritaanka qaaxada waxaa loo baahan yahay ka hor inta aan la bilaabin daaweynta TNF xannibaadaha. Marar dhif ah, TNF-blockers ayaa lala xiriiriyay inay sii kordhayaan fursadaha ay ku kobcinayaan kansarrada qaarkood.
Waxa kale oo muhiim ah in la ogaado in dadka qaarkood aysan musharrax u ahayn inay qaataan xannibaadayaasha TNF sida kuwa:
- Dhibaatooyinka Tijidka ah (TNF) ayaa si dhif ah uga sii daraya luminta maskaxda ee maskaxda iyo xangulada laf-dhabarta)
- Qalabka wadnaha
- Infekshin firfircoon sida cudurka pneumonia
Dumarka uurka leh ama naas-nuujinaya sidoo kale maaha musharaxiin loogu talagalay daaweynta xannibaadaha TNF.
Tusaalooyinka TNF Blockers
Sannadkii 2010, Qiimaynta SpondyloArthritis Society (ASAS) ayaa daabacday shuruudo loogu talagalay isticmaalka xannibaadaha TNF ee bukaannada qaba daawada ankylosing spondylitis. Tilmaamahan waxay ka caawiyaan dhakhaatiirta inay go'aamiyaan cidda u qalantaa daaweynta TNF xannibista.
Tusaale ahaan, marka loo eego shuruudaha ASAS, qof waa in loo tixgeliyaa oo kaliya tixgeliyaha TNF haddii cudurkoodu aanu ku wanaajin ugu yaraan laba nooc oo NSAID ah (oo ah qadar ugu sarreeya).
Xannibaadayaasha TNF ee loo isticmaalo daweynta spondylitis-ka ankylosing waa:
- Gundhig
- Remicade iyo Renflexis (Infliximab)
- Humira (adalimumab)
- Simponi (golbalab)
- Cimzia (certolizumab)
Remicade iyo Renflexis (infliximab) waxaa loo siiyaa sida faleebo iyada oo loo marayo xididada marka loo yaqaan Enbrel (etanercept), Humira (adalimumab), Simponi (golligab), iyo Cimzia (certolizumab) ayaa lagu siiyaa sida subcutaneous (unugyada naaska).
Cosentyx (Secukinumab)
Haddii qofku uusan si fiican uga jawaabin TNFi, dhakhtarkoodu wuxuu tixgelin karaa Cosentyx (secukinumab). Cosentyx waxaa ansixiyay Maamulka Maraykanka ee Cuntada iyo Maandooriyaha (FDA) sannadka 2016 si loogu daaweeyo jeermiska qaaxada ee ankylosing spondylitis.
Waxay ka shaqeysaa joojinta IL-17A, taas oo ah cytokine proinflammatory cyokokine (wargeeye molecular taasoo keenta jawaab celinta jirka). IL-17A waxaa loo yaqaanaa inuu kaalin weyn ka ciyaaro horumarinta AS.
Cosentyx waxaa la siiyaa hal mar toddobaadkii hal usbuuc afar toddobaad, ka dibna afartii toddobaadba mar. Cilmi baadhis ayaa soo jeedineysa in ay u dulqaadan tahay, oo leh saameynta ugu caansan inay tahay calaamadaha hargabka, sida sanka oo duuf iyo cuno xanuun.
Cilmi-baaristu wali waa isbeddeleysaa Cosentyx. Si kastaba ha noqotee, waa mid xiiso leh hadda waxaa jira ikhtiyaarka dadka cudurkoodu sii wadi karo horumarka TNF inhibitor ama aan qaadan karin joojiyaha TNF.
Daaweynta Jirka
Marka lagu daro daawada, Koleejka American Rheumatology wuxuu kugula talinayaa daaweynta jireed ee loogu talagalay dadka firfircoon ee AS (macneheedu waa calaamadaha caabuqa sida xanuunka wadajirka iyo qulqulka). Taladani waxay ku salaysan tahay tiro daraasado ah oo lagu helo daweyn jireed oo faa'iido u leh dhimista xanuunka iyo hagaajinta dhaqdhaqaaqa lafdhabarta, jimicsiga, dabacsanaanta, shaqada jireed, iyo fayoobaanta.
Warka wanaagsani waa wax yar oo waxyeelo leh oo la xidhiidha daaweynta jirka. Sidoo kale, qofku wuxuu ku lug yeelan karaa jimicsi wuxuuna ku fidiyaa guriga ama goob kooxeed. Taasi waxay tidhi, cilmi-baaris ayaa soo jeedinaysa in kooxda daaweynta jirka ee kormeertu ay ka faa'iideysan karto leyliska guriga.
Maxay noqon kartaa raaxo dheeraad ah (iyo raaxo leh) kuwa qaba AS waa nooca daaweynta loo yaqaan 'spa-exercise therapy'. Noocaas daaweynta waxaa ka mid ah jimicsi biyo diirran, iyada oo loo marayo baqshiinka ka yimaada duuliyeyaasha hydrotherapy, iyo in lagu nasto sauna isku mid ah. Dhab ahaan, cilmi-baaris ayaa lagu ogaaday in daaweynta jimicsiga isboortiga ee la socota daweynta jirka ee kooxeed ay ka fiican tahay daaweynta jirka ee kooxeed kali ah.
Qalliin
Marar dhif ah, qalliin ayaa loo baahan yahay si loo daaweeyo spondylitis ankylosing. Tan waxaa badanaa loogu talagalay dadka qaba suuxdinta daran ee wadarta iyo xanuunka. Xaaladahaan, beddelka bedelka misigta ayaa badanaa lagula taliyaa qalliin la'aan. Qalliinnada halista ah sida kuwa ku lug leh lafdhabarta ayaa ah mid aad u yar waxaana la sameeyaa marka uu jiro qulqulo hoos u dhac ku yimaada laf-dhabarka ("boosteejada hunchback").
Ereyga
Spondylitis Ankylosing spondylitis waa cudur dabadheeraad ah, oo aan weli daawo lahayn. Laakiin waxaa jira siyaabo aad ku maareyn kartid. Iyada oo habka daaweynta saxda ah (taas oo u baahan doonta waqti yar marka loo eego hagaha dhaqtarkaaga), waxaad si fiican ugu noolaan kartaa AS.
> Ilo:
> Blair Ha, Dhillon S. S. Secukinumab: Dib-u-eegis ku sameysma spondylitis ankylosing. Daroogooyinka . 2016 Jul; 76 (10): 1023-30.
> Callhoff J et al. Waxtarka TNFa ee xannibayaasha ku jira bukaanada leh antonsoling spondylitis iyo non-radiographic spondyloarthritis fayruska: a falanqayn meta. Ann Rheum Dis . 2015 Jun; 74 (6): 1241-8.
> Dagfinrud H, Kvien TK, Hagen KB. Waxqabadyada jimicsiga jirka oo loogu talagalay daawada ankylosing spondylitis. Macluumaadka Cochrane Syst Rev. 2008 Jan 23; (1): CD002822.
> van der Heijde D et al. 2010 Soo cusbooneysiinta talooyinka caalamiga ah ee ASAS ee isticmaalka wakiilada anti-TNF ee bukaanka qaba daawada "spondyloarthritis". Ann Rheum Dis . 2011 Jun; 70 (6): 905-8.
> Ward MM et al. Kulliyadda Maraykanka ee Rheumatology / Spondylitis Association of America / Spondyloarthritis Cilmi-baaris iyo Daaweyn Daaweyn 2015 Talooyin loogu talagalay Daaweynta Ankylosing Spondylitis iyo Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol . 2016 Feb; 68 (2): 282-98.