Talooyinka loogu talagalay Isticmaalka DMARD iyo Mukhaadaraadka Biyoolojiga
Sanadkii 2012, Koleejka Maraykanka ee Rheumatology (ACR) wuxuu soo cusbooneysiiyay talooyin ku saabsan daaweynta rheumatoid arthritis . Talooyinka ACR 2012 ee loogu talagalay isticmaalka daaweynta-daaweynta anti-rheumatic (DMARDs) iyo daawooyinka bayoolajiga ee rheumatoid arthritis waa cusbooneysiin talooyinka soo jeedinta 2008.
Tilmaamaha cusub 2012:
- astaamaha lagu bilaabayo ama lagu beddelayo DMARD iyo daroogada bayoolojiga
- isticmaalka bayoolojiga ee bukaanka halista badan leh, oo ay ku jiraan kuwa qaba cagaarshow, wadnaha oo ku fashilmay wadnaha, iyo malignancy
- baaritaanka qaaxada ee bukaanjiifka oo bilaabaya ama hadda qaadaya daawooyinka nafleyda
- tallaalka bukaanka ka billaabaya ama hadda qaadanaya DMARD ama daawooyinka bayoolojiga ah
Talooyinka waxay ku saleysneyn raadinta suugaanta ee PubMed iyo Daraasada Cochrane ee Dib-u-eegista Habraaca, imtixaanka kiliiniga ee kiliinikada, iyo ra'yi khabiir. Qoraalkan waxaa la baadhay 8 DMARDs: Azathioprine (Imuran), Cyclosporine , hydroxychloroquine (Plaquenil), Leflunomide (Arava), methotrexate , minocycline (Minocin), dahab , iyo sulfasalazine (Azulfidine) iyo 9 daroogada bayoolojiga: abatacept (Orencia) , adalimumab (Humira), Anakinra (Kineret), Caddaan (Cimzia), Edanercept (Enbrel), Dhammaanba (Simponi), Infliximab (Remicade), Rituximab (Rituxan), iyo tocilizumab (Actemra). Iyadoo ay ugu wacan tahay isticmaalka daroogada iyo warbixinta cusub ee laga helay baadhitaanada, azathioprine, cyclosporine, dahab, iyo anakinra laguma darin talooyinka.
Orencia, Rituxan, Kineret, iyo Actemra waa non-TNF daawooyinka biologiska. Enbrel, Remicade, Humira, Simponi, iyo Cimzia waa TNF-blockers.
Bukaanka qaba xanuunka rheumatoidaha hore (oo lagu qeexay sida rheumatoid arthritis-ka ee ka yar 6 bilood) iyo bukaanka qaba rheumatoid arthritis-ka oo lagu daaweynayo DMARD ama daroogada bayoolajiga ah, ujeeddada daaweyntu waa waxqabadka cudurka ama xasiloonida.
Bilaabidda ama Beddelidda DMARD iyo Mukhaadaraadka Biyoolojiga
- Daaweynta monotherapy DMARD (daaweynta hal daroogo hal) ayaa lagu taliyey bukaanka hore ee rheumatoid arthritis oo leh hawlo hooseeya ama hawlo dhexdhexaad ah / sare ah oo ka maqan la'aanta sifooyinka xun ee prognostic (sida.
- Daweynta isku dhafka ee DMARD waxaa lagula taliyay dadka bukaanka ah ee rheumatoidka hore ee leh hawlo jirran ama dhexdhexaad ah iyo sifooyin qotodheer.
- Isticmaalka TNF-ga xannibay ama aan laheyn daawada methotrexate waxaa loogu taliyey bukaanka hore ee rheumatoid arthritis oo leh hawlo cudur oo aad u sarreeya iyo sifooyin qotodheer. Hase yeeshe, haddii TNF-gu xidhaa infilshow (Remicade), waa in loo isticmaalo daawada methotrexate.
- Bukaanka qaba rheumatoid arthritis-ka ah, haddii ka dib 3 bilood oo daaweynta DMARD ka dib, bukaanku wuu ka yareeyaa dhaqdhaqaaqa jirrooyinka hooseeya ama firfircoonida cudurka, methotrexate, hydroxychloroquine, ama leflunomide (Arava) waa in lagu daraa.
- Ka dib 3 bilood oo daawada methotrexate ama methotrexate / DMARD therapy, ku dar daawo kale oo aan DMARD ahayn ama u beddesho mid kale oo aan DMARD-daadin ahayn haddii bukaanka la dhigay oo wali jira mid dhexdhexaad ah oo ka mid ah firfircoonida cudurka - ama ku dar ama u beddelaan TNF xannibaad, Orencia), ama rituximab (Rituxan).
- Ka dib 3 bilood oo daweyn leh TNF xannibaadaha, haddii bukaanku leeyahay hawlo dhexdhexaad ah ama sarreeya oo la xariira maqnaan la'aanta ama luminta faa'iidada daaweynta, u beddelidda xannibaad kale oo TNF ah ama mid aan ahayn TNF biologic ayaa lagu talinayaa.
- Haddii ay jirto waxqabadyada cudurka dhexdhexaadka ah / sareeya ka dib 6 bilood oo daaweyneed oo ay la socoto biologi aan ahayn TNF sababtoo ah la'aanta jawaab ama luminta faa'idada, bukaanku waa in loo beddelaa mid kale oo aan ahayn TNF biologic ama TNF blocker.
- Haddii bukaanku leeyahay hawlo ba'an oo uu ku guuldaraysto TNF xannibaad sababtoo ah dhacdo xun oo halis ah, u beddelida biologi aan ahayn TNF biological ayaa lagu talinayaa.
- Haddii uu bukaanku leeyahay hawlo qafiif ah / sare ah oo uu ku guuldaraysto TNF xiritaanka sababtoo ah dhacdo aan halis ahayn, u beddelid xannibaad kale oo TNF ah ama mid aan TNF ahayn biological ayaa lagu talinayaa.
- Haddii bukaanku leeyahay hawlo dhexdhexaad ah / sareeya ka dib markii uu ku dhacey biological-ka aan ahayn TNF sababtoo ah dhacdo aan fiicnayn, u beddelashada kale oo aan ahayn TNF-blocker ama TNF blocker ayaa lagula talinayaa.
Isticmaalka Biyoolojiyada ee Rheumatoid Arthritis Bukaanka qaba Cagaarshow, Malignancy, ama Dhibaatada Wadnaha ee Congestive
- Etanercept (Enbrel) waxaa lagula talinayaa dadka bukaanka ah ee rheumatoid arthritis-ka qaba cagaarshow C.
- Daawooyinka bayoolojiga ah laguma talin dadka bukaanka ah ee qaba rheumatoid arthritis-ka iyada oo aan la daaweynin cagaarshowga B ee aan joogtada aheyn ama dadka loo yaqaan 'hepatitis B chronic C patient.
- Bilaabidda ama dib u bilaabista daaweynta bayoolajiga ayaa lagula talinayaa in bukaanada loo daweeyo malawadka adag oo ka badan 5 sano ka hor ama kuwa bukaanka lagu daaweeyo kansarka maqaarka aan ka badnayn 5 sano ka hor.
- Dadka TNF-da ee laguma talinayo bukaanka rheumatoid ee arthritis-ku leh qaliin wadnaha ah oo daran ama daran.
Baaritaanka Qaaxada (TB)
- Baaritaanka qaaxada ee qarsoon waxaa lagula talinayaa bukaanka rheumatoid arthritis iyadoo la tixgelinayo daaweynta bayoolajiga.
- Iyadoo aan loo eegin arrimaha keena cudurka qaaxada ee qarsoon, baaritaanka maqaarka ee tuberculin ama baaritaanka interferon-gamma-release - waa in lagu sameeyaa bukaanka diyaar u ah inay bilaabaan daaweynta bayoolojiga.
Tallaalka loogu talagalay bukaanada Bilaabidda ama Helitaanka DMARD ama Mukhaadaraadka Biyoolojiga
- Tallaallada la dilay (pneumococcal, influenza, iyo cagaarshow B), cusbada (papillomavirus), iyo in la tallaalay (herpes zoster) waa in la siiyaa ka hor inta aan la bilaabin DMARD ama daroogada bayoolajiga.
- Haddii aan hore loo dhicin, tallaalka la dilay ama dib loo habeeyay waa in la siiyaa bukaanka mar hore qaata DMARD ama daroogada bayoolajiga.
- Tallaalka herpes zoster ayaa la siin karaa kuwa horey u qaadanayey DMARD.
UPDATE - Tilmaamaha ACR ee 2015 ee Daweynta Xanuunka Rheumatoid (Arthritis)
Tilmaamaha ayaa mar labaad la daabacay sannadka 2015-ka si loo cusbooneysiiyo tilmaamaha 2012-ka. Tilmaamaha 2015 waxay daboolayaan isticmaalka daawooyinka dhaqameed-dhaqameedka ah (DMARDs), wakiilada bayoolojiga, Xeljanz (tofacitinib) , iyo glucocorticoids hore (ka yar 6 bilood) oo la aasaasay (6 bilood ama ka badan) rheumatoid arthritis. Waxa kale oo lagu bixiyaa talooyinka 2015-ka ah talooyin ku saabsan isticmaalka hab -dawleed-ku-beegsan , isdaba-saarista iyo joojinta daawooyinka, iyo isticmaalka wakiilada bayoolojiga iyo DMARD ee bukaan-socodka qaba cagaarshow, wadno-qabsasho wadnaha ah, malignancy, iyo infekshan halis ah.
Tilmaamuhu wuxuu ka hadlayaa isticmaalka tallaalada ee bukaannada bilaabaya ama qaadanaya DMARD ama daawooyinka bayoolajiga, baaritaanka qaaxada ee bukaanada bilaabaya ama qaadanaya walxaha nafleyda ama tofacitinib, iyo kormeerka sheybaarka ee DMARDs dhaqameed. Tilmaamahan waxaa ka mid ah 74 talooyin taas oo 23% loo aqoonsan yahay mid xoog leh, 77% waa shuruud. Waxaad halkan ka heli kartaa: 2015 Jaamacadda American College of Rheumatology Tilmaansiinta Daaweynta Rheumatoid Arthritis.
Xigasho:
Cusbooneysiinta talobixinta ACR-2008 ee loogu talagalay Isticmaalka DMARD iyo Biologics ee Daaweynta Rheumatoid Arthritis. Arthritis Care & Research pp. 625-639. Singh JA et al. May 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract
2015 Caamka American of Rheumatology Tilmaamaha Daaweynta Rheumatoid Arthritis Singh JA et al. Arthritis Care & Research DOI 10.1002 / acr.22783
http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf