Maareynta Jirooyinka Jirka iyo Maqaarka ee Arthritis
Jirrada xanuunka 'psoriatic arthritis' waa nooc ka mid ah xanuunka 'inflammatory arthritis' kaas oo la xiriira cudurka psoriasis, cudur maqaarka ah. Calaamadaha iskubeddel wadaagga ah iyo cudurka psoriasis badanaa marmar ma dhacaan, inkastoo. Inta badan dadka qaba xanuunka 'psoriatic arthritis', calaamadaha cudurka psoriasis ayaa ka hor inta aan calaamadaha arthritis-ku soo baxaan. Si kastaba ha noqotee, qiyaastii boqolkiiba 15 kiisaska, calaamadaha xanuunka 'arthritis' waxay horay u soo baxaan cudurka psoriasis ka hor.
Boqolkiiba 15 dadka bukaanka ah, cudurka psoriasis ee arthritis-ka waxaa lagu ogaadaa isla mar ahaantaa cudurka psoriasis.
Waxaa jira 5 nooc oo cudurka psoriasis ee arthritis-ka : calaamadaha isku dhafan, asmmetrical, faragelinta dhexdhexaadka ah ee isdhexgalka, spondylitis iyo arthritis. Ogaanshaha hore iyo daaweynta waa muhiim si loo yareeyo khatarta joogtada ah ee wadajirka ah. Daaweyntu waxay u hoggaansameysaa kantaroolidda bararka, iyo dhinacyada iyo cudurrada maqaarka, waa in labadaba la xaliyo.
Hawlwadeen loogu talagalay EULAR (Ururka Iskaashatada Dhibaatada Yurub (European Union Against Rheumatism) wuxuu sameeyey falanqayn qotodheer oo ku saabsan suugaanta sayniska si loo qiimeeyo daweynta daawooyinka daaweynta cudurka psoriasis ee arthritis. Asal ahaan, EULAR ayaa soo bandhigtay talooyin 2012-kii. Laakiin illaa 2015-ka, waxaa loo baahnaa in la cusbooneysiiyo sababo cusub iyo helitaanka daroogooyinka cusub. Sanadkii 2012, waxaa jiray laba qaybood oo ka mid ah DMARD (cudur-isbaddelaya daawooyinka ladagaallanka roodhiga): DMARDs loo yaqaan 'synthetic cedDAD', oo ay ku jiraan methotrexate , Arava (leflunomide) , Azulfidine (sulfasalazine) iyo DMARDs biologiska (oo loo soo gaabiyo BDMARDs).
Laga bilaabo 2015, cusboonaysiinta waxaa ku jiray qayb sadexaad oo ah DMARDs, oo lagu magacaabo DMARDs loo yaqaan 'synthetic synDetic' (oo la soo gaabiyey 'tsDMARDs'), kuwaas oo ay ku jiraan PDE (fosfodiesterase inhibitors) iyo JAK hortago (sida, Xeljanz [tofacitinib] ). Tilmaamaha la cusbooneysiiyey ee EULAR waxaa ka mid ah 10 talooyin iyo 5 mabda 'oo ku saabsan daaweynta cudurka psoriasis ee arthritis.
Mabaadii'da Guud
- Cudurka jaaxada (Psoriatic arthritis) waa heterogeneous (ie, waxay ka kooban tahay dhinacyo kala duwan) iyo cudurro halis ah oo u baahan daaweyn kala duwan.
- Daaweynta xanuunka 'psoriatic arthritis' waa in ay ujeeddadeedu noqoto midka ugu fiican iyo waa in ay ku saleysnaato go'aanka guud ee u dhexeeya bukaanka iyo rheumatologistka , iyadoo tixgelinaya waxtarka, amniga, iyo kharashka daaweynta.
- Cilmi-baareyaasha cilmi-nafsiga ayaa ah khabiiro takhasus leh oo ugu muhiimsan in ay daryeeshaan qaybaha muruqyada ee xanuunka 'psoriatic arthritis'. Iyada oo ay jirto joogitaanka maqaarka, rheumatologist iyo dhakhtarka maqaarka waa in uu iskaashi ka geysto ogaanshaha iyo maareynta cudurka.
- Hadafka ugu muhiimsan ee daaweynta cudurka psoriasis ee arthritis waa in la kordhiyo tayada nolosha ee la xiriira caafimaadka, oo lagu fuliyo xakamaynta astaamaha , ka hortagga dhaawaca dhismaha, iyo sidoo kale ilaalinta hawlaha caadiga ah iyo ka qaybgalka bulshada. Yareynta caabuq waa lagama maarmaan si loo gaaro himilooyinka.
- Maareynta bukaanka cudurka psoriasis ee arthritis waa in ay tixgeliyaan muuqaalada dheeraadka ah (tusaale ahaan, kuwa aan ka aheyn xubnaha), cilladda dheef-shiid kiimikaadka, cudurrada wadnaha iyo xaalado kale oo la isku daro .
Talooyin
Daaweynta cudurka psoriasis ee arthritis waa in ay bartilmaameedsadaa ama ay yar tahay waxqabadka jirrada ee hooseeya ee lagu gaaro kormeer joogta ah iyo samaynta isbeddelka daaweynta sida loo baahdo.
- NSAIDs (daawooyinka nonsteroid anti-inflammatory) ayaa loo isticmaali karaa si loo yareeyo calaamadaha iyo calaamadaha muruqyada.
- Bukaannada qaba xanuunka 'peripheral arthritis-ka', gaar ahaan kuwa leh qaybo badan oo barar ah, dhaawaca wadajirka leh ee bararka, sicir bararka sareeya iyo CRP , iyo / ama muuqaal dheeri ah csDMARDs waa in loo tixgeliyaa marxaladda hore, methotrexate ayaa doorbiday bukaanka qaba kaqaybgalka maqaarka.
- Daawooyinka gudaha ee loo yaqaan 'corticosteroids' waa in loo tixgeliyaa inay tahay mid ku haboon (ie, dheeraad ah). Corticosteroids nidaamka qiyaasta ugu hooseysa ayaa loo isticmaali karaa taxadar.
- Bukaannada qaba xanuunka 'peripheral arthritis' oo leh jawaab aan ku filneyn ugu yaraan hal csDMARD, daaweynta bDMARD waa in la bilaabaa. BDMARD caadi ahaan waa TNF xannibeeyaha .
- Bukaannada qaba xanuunka 'peripheral arthritis' oo leh jawaab aan ku filneyn ugu yaraan hal csDarre oo aan isticmaali karin xannibaadaha TNF, bDMARDs oo diirada saaran IL12 / 23 (Tusaale ahaan, Stelara [ustekinumab] ) ama IL17 (tusaale ahaan, secukinumab) ayaa laga yaabaa in la tixgeliyo.
- Bukaannada qaba xanuunka 'peripheral arthritis' oo leh jawaab aan ku filneyn ugu yaraan hal csDAR iyo kuwa aan isticmaali karin bDMARD, waxaa laga yaabaa in la tixgeliyo.
- Bukaannada qaba hindhisyada firfircoon iyo / ama diiqylitis (barar ah tiro idil) oo leh jawaab celin ku filan NSAID ama corticosteroids oo xakameyn ah, bDMARD waa in la tixgeliyaa. Badan TNF waxaa sida caadiga ah lagu tijaabiyaa.
- Bukaannada qaba cudur faafa oo firfircoon, oo leh jawaab aan ku filnayn NSAIDs, waa in bDMARD la tixgeliyaa. Tani inta badan waa la isku deyayaa TNF.
- Bukaannada aan ku fashilmin inay ka jawaabaan bDMARD, u beddelashada bDMARD kale waa in la tixgeliyaa. Beddelida inta u dhexeysa xannibaadaha TNF ee kala duwan waxaa loo tixgelin karaa haboon. Xannibaadayaasha TNF waxaa ka mid ah: Enbrel (etanercept) , Remicade (Infliximab) , Humira (adalimumab) , Simponi (golimumab) iyo Cimzia (certolizumab pegol) .
Ilaha:
Ururka Midowga Yurub ee lagaga hortago Rheumatism (EULAR) talooyin loogu talagalay maareynta cudurka psoriasis ee arthritis-ka ee daaweynta fayo-dhawrka: 2015 cusbooneysiin. Annals of Cudurada Rheumatic. Gossec L. et al. 2016; 75: 499-510 doi: 10.1136 / annrheumdis-2015-208337
http://ard.bmj.com/content/75/3/499.full
Macluumaadka bukaanka: Cudurka jaaxada (Psoriatic arthritis) (Beyond Basics). UpToDate. Gladman iyo Ritchlin. La sii daayo 4/9/15.
http://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics