Doorasho Daaweyn ah oo Waxtar leh Dadka qaarkood
Daawooyinka kala duwan ee DMARD (cudur-is-beddelaya daawooyinka ladagaallanka roodhiga) ayaa loo qori karaa si loo daaweeyo rheumatoid arthritis iyada oo aan ka aheyn DMARD kaliya. Daaweynta Triple, oo ka mid ah xulashooyinka daaweynta, waxaa loola jeedaa isticmaalka saddexda DMARDs kala duwan; mararka qaarkood waxaa laga yaabaa inay tixraacayso laba ka mid ah DMARDs kala duwan iyo mid yar oo ah glukocorticoid dose.
Waa maxay daaweynta saddex-geesoodka ah?
Iskudarka caadiga ah ee DMARD loo isticmaalo sida daaweyn saddex-gees ah oo loogu talagalay rheumatoid arthritis waxaa ka mid ah methotrexate , sulfasalazine (magaca caanka ah Azulfidine), iyo hydroxychloroquine (Plaquenil).
Caadi ahaan, hal DMARD (monotherapy) ayaa marka hore la isku dayi doono, laakiin haddii jawaabtu aysan ku filnayn, dhakhtarka iyo bukaan-socodka ayaa markaas ka fikiraya ikhtiyaarrada kale ee daaweynta.
Yaa Waa In La Qaadaa Therapy Therapy?
Sannadka 2012, tilmaamaha daaweynta ee College College of Rheumatology, iyo sidoo kale Ururka Rheumatology Canadian Association, ayaa kugula taliyay isticmaalka daaweynta isku dhafan ee DMARD-ay ku jiraan daaweyn saddex-gees ah - dadka qaba xanuunka rheumatoidka hore, oo leh dhexdhexaad illaa kuwo firfircoon, iyo saboolka saadaasha. Daaweynta Triple waxaa sidoo kale laga yaabaa in si haboon loogu tixgeliyo kuwa ka soo jawaabay jawaab aan ku filneyn mid ka mid ah DMARD.
La-talinta Midowga Yurub ee La-dagaallanka Jahwareerka (EULAR) ee daaweynta rheumatoid arthritis-ka ee 2013-ka ayaa si aan sax ahayn loo sheegin oo loogu talagalay in bukaannada aan weligood loo qorin DMARD, monotherapy ama daaweynta isku dhafan ayaa haboon. Haddii istaraatiijiga ugu horeeya ee DMARD uu ku guuldareysto, beddelidda DMARD ka duwan ayaa laga yaabaa in la tixgeliyo.
Cilmi-baarista American College of Rheumatology ee loogu talagalay daaweynta rheumatoidka arthritis-ka ee daaweynta rheumatoid arthritis-da waxay muujinaysaa in horeyba loo ogaado xanuunada rheumatoid-ka ah ee dhexdhexaad ah ilaa DMARD monotherapy (oo leh ama aan lahayn glucocorticoid), isku darka DMARD ama TNF inhibitor ama biologi aan ahayn TNF horjoogaha (iyadoon loo baahnayn amarka, iyo ama aan laheyn daawada methotrexate) waa in la tixgeliyaa halkii laga sii wadi lahaa daaweynta monotherapy.
(Fiiro gaar ah: Amarka kala doorbidid la'aanta sababtoo ah baaritaanka madax-ilaa-daroogada ee daroogooyinka ayaa ka maqan yihiin.Xeerarka mustaqbalka ayaa laga yaabaa inay wax ka qabtaan.
Maxaa Daraasado Lagu Sameeyay Daaweynta Saddexleyda?
Daraasadaha ugu horreeya ee muujiyay faa'iidada daaweynta saddex-geeska ah marka la barbar dhigo daaweynta monotherapy ayaa ka muuqday suugaanta sayniska ee 1990-maadkii. Daraasad cilmi-baaris ah 1999 wuxuu qiimeeyey wax-qabadka iyo dulqaadashada daaweyn saddex-gees ah (daawada methotrexate, sulfasalazine, iyo plaquenil) iyo qiyaasta daawada yar-yar ee loo yaqaan 'monotherapy with monotherapy with or without prednisone dadka qaba rheumatoid arthritis hore ama firfircoon. Waxaa la go'aamiyey in daaweyn saddex-gees ah ay ka waxtar badan tahay iyada oo aaney ka badbaado intii ka horreysay daaweynta monotherapyka markii ay tixgelinayso awoodda ay u leedahay in ay soo jiidaan faragelinta .
Daraasad lagu daabacay sannadkii 2002 ayaa gabagabaysay in dadka qaba rheumatoid arthritis, sedex xabbo oo daawada methotrexate, sulfasalazine, iyo plaquenil ay si fiican u dulqaadan tahay oo ka waxtar badan daaweynta isku dhafan ee methotrexate iyo sulfasalazine. Daaweynta Triple wuxuu ahaa "ugu yaraan ka sarreeya" methotrexate iyo hydroxychloroquine.
Sanadkii 2010, dib-u-eegis nidaamsan ee Cochrane iyo falanqaynta mood-baarista, oo loo tixgeliyey daaweynta daaweynta methotrexate ee daaweynta isku dhafan, ayaa soo gabagabaysay in farqi yar oo u dhexeeya xeeladaha.
Guud ahaan, 9 ka mid ah 100kii qofba way joojiyeen qaadashada daawada methotrexate sababtoo ah dhibaatooyinka soo raaca, halka 14 ka mid ah 100kii la joojiyay qaadashada daawada methotrexate oo lagu daray DMARD kale.
Natiijooyinka lagu soo bandhigay shir sannadeedka sanadlaha ah ee kulliyadda kulliyadda Maraykanka ee Rheumatology ayaa shaaca ka qaaday in boqolkiiba sagaashan dadka qaba rheumatoid arthritis ay joojiyaan daaweynta saddex-laab ah hal ama laba sano. Kala soocida sababta sababa badan ee joojinta ma fududa, laakiin hal sabab ayaa laga yaabaa inay dadku doorbidaan kaniinada yar ee qaadashada, kiniinada ka sii badan.
Daaweeyn Saddexleh Ah Ma La Yeeraa?
Inkasta oo ay jirto amni iyo waxtarkeeda, daaweyn saddex-gees ah maaha inta badan daaweynta daaweynta ee kiliinikada marka methotrexate oo kaliya ay tahay mid aan ku filneyn.
Warbixinta (Sparks JA et al.), Laga soo bilaabo 2009 illaa 2014, 0.7 boqolkiiba 25,000 oo roodhexe ah ayaa loo qaaday daaweyn saddex-gees ah oo ka yimid asal ahaan DMARD. Marka la barbardhigo, boqolkiiba 11.1 ee bukaanka ayaa ku daray daroogada bayoolajiga marka lagu daro DMARD. Taasi waa kiiska, inkasta oo natiijooyinka daraasadda ay muujiyeen in saddexleerka daweyntu uu yahay mid wax ku ool ah sida bayoolojiga loogu talagalay rheumatoid arthritis-iyo dhab ahaantii kharash badan.
Daaweynta Triple (Methotrexate, sulfasalazine, plaquenil) ayaa si weyn uga yar qiimaha daawada methotrexate iyo Enbrel (etanercept) - oo kumanaan ka yar bukaanka sanadkiiba. Waxaa la soo jeediyay in daaweyn saddex-gees ah ay tahay in la isku dayey ka hor inta aan la hirgelin biyolojiga, sida Enbrel, taas oo ay ugu wacan tahay qiimaha waxtarka leh. Tallaabada ilaa Enbrel ayaa laga yaabaa in la sameeyo ka dib, bukaanada qaba jawaab celin aan loo baahneyn daaweyn saddex-gees ah.
Inkasta oo waxtarka kharashka daaweynta saddexlaha ah, ee ku yaala rugta caafimaadka, TNF inhibitor waa doorashooyinka la door bidayo haddii daawada methotrexate aysan ku filneyn. Waxaa xiiso leh, oo leh daroogo cusub oo cusub oo la soo saaray, oo loo yaqaano biosimilars , oo laga yaabo inay mar kale isbeddesho. Biosimilar waa badeeco bayooloji ah oo si aad ah u la mid ah daroogada tixraaca ah ee loo yaqaan 'biological reference'. Sida loola jeedo, tani waa inay samaysaa daweyno la heli karo oo ah kuwo waxtar u leh daawooyinka bayoolajiga qiimaha jaban. Waxaa laga yaabaa in biosimilar laga yaabo in ay noqdaan waddada la doorbidaa haddii methotrexate ay kali ku dhacdo.
> Ilo:
> Katchamart, W et al. Dib u eegida Cochrane. Methotrexate oo kali ah oo ka soo horjeeda daawada methotrexate oo lagu daro daawooyinka kale ee rheumatoid arthritis. Abriil 14, 2010.
> Mottonen, TT et al. Isugeynta DMARD Therapy oo ay ka mid tahay Corticosteroids ee Xanuunka Arthritis-ka Early. Reynoloji-klinikada iyo tijaabinta. 1999.
> O'Dell, JR, et al. Daaweynta Xanuunka Rheumatoid Arthritis Ka Dib Dhaawaca Methotrexate. Somali Journal of Medicine. July 25, 2013.
> O'Dell, JR, et al. Daaweynta rheumatoid arthritis leh daawada methotrexate iyo hydroxychloroquine, methotrexate iyo sulfasalazine, ama isku-dar ah saddexda daawo. Natiijooyin ah laba sano oo la kala soocay, laba-indho la ', indho-indhayn oo la xakameynayo. Arthritis & Rheumatology 46: 1164-1170. 2002.
> Sparks, JA, iyo al. Warbixinta Kooban: Iskudhinta Daaweynta Saddexleyda Kadib Daaweeynta Cudurrada Cudurrada aan Cudurka lahayn - Is-beddelidda Mukhaadaraadka Nafaqada ee Rheumatoid Asthuufta ee Maraykanka laga bilaabo 2009 ilaa 2014. Arthritis iyo Rheumatology. Juun 24, 2016.