Rheumatoid arthritis waa cudur dabadheeraad ah oo bararsan oo lagu garto waxyeelo isdaba joog ah, xaddidaad jidheed , iyo naafonimo shaqeyn . Markii aan markii ugu horreysay ka helay cudurka rheumatoid arthritis-ka (1974-kii markay da'da 19 jir ahayd) oo markii hore ka bartay fursadaha daaweynteyda, goolka ayaa si dhakhso ah u muuqday - xakamaynta infakshanka, kor u qaadista cudurada, iyo xanuunka iyo calaamadaha kale ee rheumatoid arthritis .
Waxaan u heesay sidii qorshe ku habboon aniga. Bukaanka cusub ee loo yaqaan 'arthritis arthritis', waxaan rabay inuu bilaabo daaweyn iyo joojiyo habka cudurka.
Waxaan bartay in ay jirto suurtagalnimada in wax laga badalo , sidoo kale, taas oo iga dhigtay dareemo xitaa dhiirigelin badan. Waxa aan si buuxda u ogaanin waqtigii ahaa in xitaa daaweyn, arthritis ay sii xumaan karto. Dhibaatada wadajirta way sii xumaan kartaa. Haa, waa run. Xitaa haddii bukaanku ku jiro maqnaansho, sida lagu qeexay shuruudaha aasaasiga ah, waxay weli muujin karaan horumarinta shucaaca (sida raajada raajada ee sii xumaaneysa sii xumaantii wadarta).
Daaweynta Cadaalad Loo Siiyay Xakamaynta Caabuqa
Muddo tobanaan sano ah, daawooyinka cudurka-isbeddelida daawooyinka antirowmatic (DMARDs), sida methotrexate , Plaquenil , iyo sulfasalazine , ayaa loo isticmaalay in lagu yareeyo ama hoos u dhigo waxqabadka cudurka ee la xiriira rheumatoid arthritis. Iyada oo helitaanka dawooyinka bayolojiga ah ( Enbrel [etanercept] waxay ahayd kii ugu horreeyay sannadkii 1998), bartilmaameedyada ayaa si gaar ah u yeeshay heerka qiyaasaha molecular.
Haatan, waxaa jira istaraatijiyad cusub oo soo baxaya, oo loo yaqaan ' Treat-to-Target therapy' .
Daaweynta-To-Target ayaa hoos u dhigta istaraatiijiyada daaweynta iyada oo ku saleysan heerka bukaanka ee hawlaha cudurka. Hadafku waa in la gaarsiiyo heer aad u hooseeya oo ah waxqabadka cudurka ama xasiloonida muddo cayiman - qorshe kastana waa shakhsiyan.
Si loo dhigo ereyada ugu fudud, isbeddelka daaweynta ayaa la sameeyaa haddii hadafyada firfircoonida beeraha aan la buuxin. Sidee habboon u-daaweynta-ula-socodsiinta si wax ku ool ah looga hortagi karo dhibaatooyinka wadajirka ah ee la arko. Daaweynta waxqabadka cilladda-daaweynta (sida, daaweynta anti-bararka) ma haystaan ka hortagga dhaawaca wadajirka ah ee timaha iskutallaabta. Waxaa la soo jeediyay in xataa xitaa ka dib markii la xakameynayo, waxqabadka unugyada maqaarka ee rheumatoid arthritis-ku wuxuu dhexdhexaadin karaa carjawda iyo burburka lafaha. Si aad si fiican u fahamto, aynu sii eegno sida ay u wadaagaan burburka wadajirka ah iyo horumarka.
Fahmitaanka Sida Dhaawac Isku-dhafka ah u dhaco
Dhibaatada isgaadhsiinta ah waxaa la ogaan karaa bilaha ugu horeeya ee bilowga rheumatoid arthritis. Lafaashka hore ee lafaha iyo nabarrada lafaha waxay la xiriiraan isku duubnaanta unugyada inflammatory-ga ee maqaarka synovial iyo horumarinta pannus (xuubka maqaarka ee sii dari kara lafaha). Waxaa jira lakab loo yaqaan 'synovial lime' oo ka kooban dad badan oo ah unugyada unugyada 'makrophages', unugyada 'T', unugyada 'B', unugyada dendritic, iyo polymorphonuclear nuclear leukocytes, iyo sidoo kale lakab xajmi ah oo ka kooban makrophages iyo fibroblast-like synoviocytes (unugyada synovioc).
Waxaa jira dad badan oo ka mid ah makrofaajooyinka firfircoon iyo synoviocytes kuwaas oo qarsoodi kara enzymes (proteinas) ku lug leh geeddi-socodka nabarrada unugyada.
Fahminta waxqabadka sinibiyeed, gaar ahaan hababka iyo waddooyinka ku lugta leh heerka uu jiro qarsoodi ah unugyada hoos u dhigidda unugyada jirka, waa lagama maarmaan haddii burburka wadajirka ah la xakameeyo ama laga hortago. Tusaale ahaan, heerkulka molecular, Maxaa keena fibroblasts inay noqoto mid dagaal badan iyo waxyeelo?
Sida laga soo xigtay Kelley 'Textbook of Rheumatology , proteinasyada laga soo qaatay saddex ilood ayaa burburiyay cirridka ku dhaca rheumatoid arthritis: dusha maskaxda boodhka ah waxaa lagu burburiyaa borotiimiyeyaasha ku jira dheecaanka synovial; iyada oo loo marayo xiriir toos ah oo u dhaxeeya carjutuqa iyo borotiitiyanik (ie, kartida jebinta borotiinka) synovium ama pannus ama labadaba; ama burburin dhexdhexaad ah (ie, burburinta gudaha) iyada oo ay ku jirto proteinasyada laga soo qaado kondrocytes.
Iyadoo cilmi-baarayaashu ay ka shaqeynayaan si ay u helaan jawaabaha, waxaan udhaxeynaa si dhakhso ah una dhawaansho daaweyn fiican - iyadoo rajo laga qabo in ugu dambeyntii la helo si looga hortago dhaawaca wadajir ah. Inta lagu jiro koorsada rheumatoid arthritis-ka, dhaawaca wadajirka ahi wuxuu si tartiib tartiib ah ugala socon karaa si joogto ah. Xilliga dambe ama midka hore ee rheumatoid arthritis-ka, xiriir xoog leh ayaa ka dhexeeya caddaymaha raajada ee dhaawaca wadajirka ah iyo naafada. Yaraynta waxyeellada wadajir ah waxay gacan ka geysan doontaa ilaalinta hawlaha wadajirka ah
Nidaamka dhaawaca wadajirka ah ee osteoarthritis waa wax ka duwan. Dhacdooyin farsameed oo firfircooni (tusaale ahaan, dhaawac ama dhar-xirasho) ayaa caadi ahaan la xidhiidha habka burburinta naqaska. Xanuunku wuxuu dhacaa, laakiin waa midka labaad ee xaaladaha osteoarthritis. IL-1 (interleukin-1), cytokin , ayaa laga yaabaa inay door muhiim ah ka ciyaaraan is-beddelka naqaska ee la xiriira osteoarthritis. Chondrocytes (unugyada laga helo kilyiyadu) waxay keenaan qadar aad u sarreeya IL-1 iyo caabuqa synovial wuxuu ku darayaa waxqabadka IL-1. Inkasta oo aan isbeddel weyn oo is-bedbeddel ah laga dareemo synovium ee hore ee osteoarthritis, waxaa jira wax soo saarka kicinta ee enzymes by chondrocytes kuwaas oo gacan ka geysanaya burburka burburiyaha. Hase yeeshee, waxa kale oo ay u muuqataa in uu yahay muuqaal gaar ah oo ah osteoarthritis oo sidoo kale jira, nooc ka sii dillaac badan oo ah osteoarthritis , taas oo lagu garto burburka wadajirka ah ee loo gooyey ugu horreyntii by inflammation.
Ilaha:
Horumarinta dhaawaca wadajir ah inkastoo la xakameynayo barar ku dhaca rheumatoid arthritis: doorka kaarbarka dhaawaca ee loo yaqaan "fibroblast activity synovial fibroblast". Floris PJG Lafeber, Willemijn H Van der Laan. Annals of Rheumatic Cudurrada 2012; 71: 793-795 doi: 10.1136 / annrheumdis-2011-200950
http://ard.bmj.com/content/71/6/793.full
Jarjeexo dhaawaca wadajirka ah ee rheumatoid arthritis. Bresnihan B. Journal of Rheumatology. 1999.
http://www.ncbi.nlm.nih.gov/pubmed/10090189
Xidhiidhka ka dhexeeya dhaawaca wadajirka ah iyo naafada ee rheumatoid arthritis. Rheumatology. 2000.
http://rheumatology.oxfordjournals.org/content/39/2/122.abstract
Kelley ee buugta qoraalka ee Rheumatology. Qoraalka sagaalaad. Volume I. Bogagga 111-113.