Rheumatoid arthritis

ʻO Rheumatoid arthritis (RA) kahi maʻi e hiki ai i ka mumū o nā hono a me nā aʻa e puni ana. He maʻi maʻi lōʻihi ia. Hiki iā ia ke hoʻololi i nā lālā ʻē aʻe.

ʻAʻole ʻike ʻia ke kumu o RA. He maʻi maʻi autoimmune ia. ʻO ke kumu o ka hōʻeha hewa ʻana o ke kino i ke kino olakino.

Hiki i ka RA ke hana i kēlā me kēia makahiki, akā ʻoi aku ka nui o nā makahiki i waena. Loaʻa pinepine ka wahine iā RA ma mua o nā kāne.

Hiki ke hoʻopili ʻia ka maʻi, nā genes, a me nā loli hormonone i kēia maʻi. Pili pū paha ka puhihihi iā RA.

ʻOi aku ka liʻiliʻi ma mua o ka osteoarthritis (OA). ʻO OA kahi kūlana e kū i nā poʻe he nui ma muli o ke kau a haehae ma nā hono i ko lākou mau makahiki.

ʻO ka hapa nui o ka manawa, pili ka RA i nā hono ma nā ʻaoʻao ʻelua o ke kino like. ʻO nā manamana lima, nā pūlima, nā kuli, nā wāwae, kuʻekuʻe wāwae, nā kuʻekuʻe wāwae, nā pūhaka a me nā poʻohiwi ka mea i laha pinepine ʻia.

Hoʻomoe mālie ka maʻi. Pākuʻi ʻia paha nā ʻōuli mua:

• ʻEha puʻupuʻu liʻiliʻi
• ʻOʻoleʻa
• Ka luhi

Pākuʻi ʻia paha nā ʻōuli hoʻohui:

• ʻO ka ʻoʻoleʻa o ke kakahiaka, ʻoi aku ka lōʻihi ma mua o 1 hola, maʻamau.
• Hiki ke mahana, palupalu, a ʻoʻoleʻa nā hui ke hoʻohana ʻole ʻia no hoʻokahi hola.
• ʻIke pinepine ka ʻeha hui i ka hui like ma nā ʻaoʻao ʻelua o ke kino.
• Pehu pinepine ka hui ʻana.
• I ka hala ʻana o ka manawa, nalowale paha nā hono i kā lākou neʻe a lilo paha i kino.

ʻO nā ʻōuli ʻē aʻe e like me:

• ʻEhaʻeha o ka umauma ke lawe i kahi hanu (pleurisy)
• Nā maka maloʻo a me ka waha (Sjögren Syndrome)
• Puhi ka maka, ʻili, a hoʻokuʻu
• Nodules ma lalo o ka ʻili (ka pinepine o ka hōʻailona o ka maʻi nui loa)
• Numbness, tingling, a i ʻole ʻā ʻana i nā lima a me nā wāwae
• Pilikia moe

Hana ʻia ke kuhi o RA ke:

• Loaʻa iā ʻoe ka ʻeha a me ka pehu ʻana ma 3 a ʻoi paha o nā hono.
• Ua noho ʻo Arthritis ma mua o 6 mau pule.
• He hōʻoia maikaʻi kāu no ka mea rheumatoid a i ʻole anti anti CCP.
• Ua hoʻokiʻekiʻe ʻoe iā ESR a i ʻole CRP.
• Ua kāpae ʻia nā ʻano ʻāpala ʻē aʻe.

I kekahi manawa ua hana ʻia ke kuhi o RA me ka ʻole o nā ʻano a pau i hōʻike ʻia ma luna inā he ʻano maʻamau ke kolohe no RA.

ʻAʻohe hōʻike e hiki ke hoʻoholo inā he RA kāu. ʻO ka hapanui o ka poʻe me RA e loaʻa i kekahi nā hopena hōʻike abnormal. Eia nō naʻe, e loaʻa i kekahi poʻe nā hopena maʻamau no nā hoʻokolohua āpau.

ʻElua mau hoʻokolohua lab i maikaʻi i ka hapanui o ka poʻe a kōkua pinepine i ke kuhi.

• ʻLelo Rheumatoid
• Pākuʻi anti-CCP

Kūpono kēia mau hoʻokolohua i ka hapanui o nā mea maʻi me RA. ʻOi aku ka kikoʻī o ka hōʻoia anti-CCP antibody no RA.

Nā hoʻokolohua ʻē aʻe i hana ʻia e hoʻopili ʻia:

• Helu piha koko
• Papa metabolic a me ka uric acid
• C-reactive protein (CRP)
• Ka helu sedimentation ʻErythrocyte (ESR)
• Antinuclear antibody
• Nā hoʻāʻo ʻana no ka maʻi hepa
• Pākuʻi x-kukuna
• Hoʻohui ultrasound a i ʻole MRI
• Nānā wai hui

Koi pinepine ʻo RA i ka lapaʻau wā lōʻihi e ka loea i ka maʻi kōwao i kapa ʻia he rheumatologist. Hoʻolālā pū kekahi:

• Nā Lapaʻau
• Hoʻoikaika kino
• Hoʻoikaika kino
• ʻO ke aʻo e kōkua iā ʻoe e hoʻomaopopo i ke ʻano o RA, kāu mau koho lapaʻau, a me ka pono no ka ukali maʻamau.
• ʻOki kino, inā koi

ʻO ka mālama mua ʻana no RA me nā lāʻau i kapa ʻia ʻo nā lāʻau antirheumatic (DMARDS) e hoʻohana i nā maʻi āpau. E hoʻolohi kēia i ka luku pū a pale i nā deformities. Pono e nānā i ka hana o ka RA ma nā kipa mau ʻana e ʻike i ka kaohi o ka maʻi. ʻO ka pahuhopu o ka mālama ʻana e hōʻoki i ka holomua o ka RA.

NA LAAU LAPAAU

Nā lāʻau anti-inflammatory: Hoʻopili kēia i ka aspirin a me nā lāʻau anti-inflammatory nonsteroidal (NSAIDs), e like me ibuprofen, naproxen a me celecoxib.

• Hana maikaʻi loa kēia mau lāʻau e hōʻemi i ka huʻi pū a me ka mumū, akā hiki iā lākou ke loaʻa nā hopena hopena lōʻihi. No laila, lawe ʻia lākou no kahi manawa pōkole wale nō a ma nā kaha haʻahaʻa ke hiki.
• ʻOiai ʻaʻole lākou e pale i ka hōʻino pū inā hoʻohana wale ʻia, e hoʻohana pū ʻia ʻo DMARDS.

Hoʻololi nā maʻi i nā lāʻau antirheumatic (DMARD): ʻO kēia nā lāʻau i hoʻāʻo mua ʻia i ka poʻe me RA. Kau ʻia lākou me ka hoʻomaha, hoʻoikaika i ka hoʻoikaika kino, a me nā lāʻau anti-inflammatory.

• ʻO Methotrexate ka DMARD i hoʻohana mau ʻia no ka rheumatoid arthritis. Leflunomide a me hydroxychloroquine e hoʻohana pū ʻia.
• ʻO Sulfasalazine kahi lāʻau i hoʻohui pinepine ʻia me ka methotrexate a me ka hydroxychloroquine (triple therapy).
• He mau pule a mahina paha kēia ma mua o kou ʻike ʻana i kahi pōmaikaʻi mai kēia mau lāʻau.
• He hopena ʻino paha kā kēia mau lāʻau, no laila pono ʻoe i nā hoʻokolohua koko pinepine i ka lawe ʻana iā lākou.
• Nā lāʻau Antimalarial - Loaʻa kēia hui o nā lāʻau i ka hydroxychloroquine (Plaquenil). Hoʻohana pinepine ʻia lākou me ka methotrexate. He mau pule a mahina paha kēia ma mua o kou ʻike ʻana i kahi pōmaikaʻi mai kēia mau lāʻau.

Corticosteroids - Hana maikaʻi kēia mau lāʻau i mea e hōʻemi ai i ka pehu ʻana a me ka mumuna, akā hiki iā lākou ke loaʻa nā hopena ʻaoʻao lōʻihi. No laila, lawe wale ʻia lākou no kahi manawa pōkole a ma nā kaha haʻahaʻa ke hiki.

Nā Agena DMARD Biologic - Hoʻonohonoho ʻia kēia mau lāʻau e hoʻohuli i nā ʻāpana o ka ʻōnaehana paleʻea e pāʻani i ka hana maʻi o RA.

• Hāʻawi ʻia iā lākou ke hana ʻole nā ​​lāʻau ʻē aʻe, methotrexate maʻamau. Hoʻohui pinepine ʻia nā lāʻau biologic i ka methotrexate. Eia nō naʻe, no ke kumu kūʻai nui loa ia, koi nui ʻia ka ʻae ʻinikua.
• Hāʻawi ʻia ka hapa nui o lākou ma lalo o ka ʻili a i ʻole i kahi aa. Nui a hewahewa nā ʻano biologic agents i kēia manawa.

Hiki ke kōkua nui i nā mea biologic a me nā mea synthetic i ka mālama ʻana iā RA. Eia nō naʻe, pono e nānā pono ka poʻe e lawe nei i kēia mau lāʻau no ka mea maʻamau ʻole, akā nā hopena maikaʻi ʻole.

• Nā maʻi mai nā koʻohune, nā mea hoʻomaʻi, a me nā fungi
• Ka maʻi ʻaʻai o ka ʻili, akā ʻaʻole melanoma
• Nā hopena ʻili
• Nā hopena āpau
• Hewa ʻole ka puʻuwai
• Poino i nā aʻalolo
• Helu keʻokeʻo haʻahaʻa keʻokeʻo haʻahaʻa

NA MEA HANA

Pono paha ke ʻoki e hoʻoponopono i nā hono i poino loa. Hiki i ke ʻoki kino ke:

• Ka hemo ʻana o ka uhi lining (synovectomy)
• ʻO ka huina o ka hui kuʻina, i nā hihia koʻikoʻi, hiki ke hoʻopili ʻia me ke kuli holoʻokoʻa (TKR) a me ka hope o ka hakahaka.

THERAPY KINO

Hiki i nā hoʻolālā ākea a me nā papahana hoʻoikaika kino i kuhikuhi ʻia e ka mea hoʻoponopono kino ke hoʻolohi i ka nalo ʻana o ka hana hui a kōkua i ka mālama ʻana i nā mākala.

I kekahi manawa, e hoʻohana nā mea hoʻolale i nā mīkini kūikawā e hoʻopili ai i ka wela hohonu a i ʻole ka hoʻoulu uila e hoʻoliʻiliʻi i ka ʻeha a hoʻomaikaʻi i ka neʻe pū.

ʻO nā hoʻoponopono ʻē aʻe i hiki ke kōkua i ka hōʻoluʻolu i nā ʻeha pū me:

• Nā hana pale pale
• Nā hoʻoponopono wela a me nā anu
• Pākuʻi a i ʻole nā ​​hāmeʻa orthotic e kākoʻo a hoʻopili i nā hono
• ʻO nā wā hoʻomaha maha ma waena o nā hana, a ʻo 8 a 10 mau hola o ka hiamoe i kēlā me kēia pō

NUTRITION

Loaʻa i kekahi poʻe me RA ka hoʻomanawanui a i ʻole nā ​​maʻi āpau i kekahi mau meaʻai. Paipai ʻia kahi papaʻai nutritious kaulike. He mea kōkua paha ke ʻai i nā meaʻai i piha i nā aila iʻa (omega-3 fatty acid). Pono e kāpae i nā kūpaka. Pono hoʻi e hōʻalo i ka waiʻona nui.

Pōmaikaʻi paha kekahi poʻe i ka lawe ʻana i kahi hui kākoʻo arthritis.

Ke holo nei kāu RA a ʻaʻole paha e pili ana i ke koʻikoʻi o kāu mau ʻōuli a me kāu pane i ka lāʻau. He mea nui e hoʻomaka i ka lāʻau i ka wā hiki. ʻO nā kipa ukali maʻamau me kahi rheumatologist e pono ai e hoʻoponopono i ka lāʻau.

Hiki ke hana i nā hōʻino paʻa paʻa me ka ʻole o ka lāʻau kūpono. ʻO ka hoʻomaʻamaʻa mua ʻana me kahi hui DMAR ʻekolu lapaʻau i ʻike ʻia ʻo "triple therapy," a i ʻole me nā biologic a i ʻole nā ​​lāʻau synthetic i kiki ʻia e hiki ke pale aku i ka ʻeha pū a me ka hōʻino.

Inā mālama maikaʻi ʻole ʻia, hiki i ka RA ke hoʻopili i nā ʻāpana āpau o ke kino. Komo pū nā pilikia:

• Hoʻopōʻino i kaʻiʻo māmā.
• Hoʻonui i ka pilikia o ka paʻakikī o nā aʻa, e alakaʻi ana i ka maʻi maʻi maʻi.
• Ka ʻeha o ke kuamoʻo ke lilo nā iwi o ka ʻāʻī i mea hōʻino.
• ʻO ka hoʻowahāwahā o nā kīʻaha koko (rheumatoid vasculitis), hiki ke alakaʻi i nā ʻili, nā aʻalolo, ka puʻuwai, a me nā pilikia o ka lolo.
• ʻO ka pehu a me ka mumū o ka uhi waho o ka puʻuwai (pericarditis) a me ka puʻuwai o ka puʻuwai (myocarditis), i hiki ke alakaʻi i ka puʻuwai puʻuwai congestive.

Eia nō naʻe, hiki ke hōʻalo i kēia mau pilikia me ka lāʻau kūpono. Hiki i nā mālama ʻana no RA ke kumu i nā hopena ʻino. E kamaʻilio i kāu mea hoʻolako e pili ana i nā hopena ʻē aʻe o ka mālama ʻana a me ka mea e hana ai inā kū lākou.

Kāhea i kāu mea hāʻawi inā manaʻo ʻoe he ʻōuli kou o ka rheumatoid arthritis.

ʻAʻohe pale e ʻike ʻia. Hōʻike ka puhi paka i ka RA, no laila he mea nui e hōʻalo i ka paka. Hiki i ka mālama ʻana i ke kakahiaka kūpono ke pale i ka hōʻino hou pū ʻia.

RA; Pākuʻi - rheumatoid

• Hana hou ʻo ACL - hoʻokuʻu
• Hoʻololi kuʻekuʻe wāwae - hoʻokuʻu
• Hoʻololi kuʻekuʻe - hoʻokuʻu

• Rheumatoid arthritis
• Rheumatoid arthritis
• Rheumatoid arthritis

Aronson JK. Methotrexate. I: Aronson JK, hoʻoponopono. Nā hopena a Meyler o nā lāʻau. 16th ed. Waltham, MA: Elsevier B.V; 2016: 886-911.

Fleischmann R, Pangan AL, Song IH, et al. Upadacitinib versus placebo a adalimumab paha i nā mea maʻi me ka rheumatoid arthritis a me ka lawa ʻole o ka pane i ka methotrexate: Nā hopena o kahi pae III, ka makapō makapō, ka hoʻokolohua hoʻomalu kaulike ʻia. Rumatika rumitis. 2019; 71 (11): 1788. PMID: 31287230 pubmed.ncbi.nlm.nih.gov/31287230.

Kremer JM, Rigby W, Singer NG, et al. ʻO ka pane i hoʻomau ʻia ma hope o ka pau ʻana o ka methotrexate i nā mea maʻi me ka rheumatoid arthritis i mālama ʻia me ka subcutaneus tocilizumab: nā hopena mai kahi hoʻokolohua hoʻokolohua. Rumatika rumitis. 2018; 70 (8): 1200-1208. PMID: 29575803pubmed.ncbi.nlm.nih.gov/29575803.

ʻO Mcinnes I, O'Dell JR. Rheumatoid arthritis. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 248.

O'Dell JR, Mikuls TR, Taylor TH, et al. Nā lāʻau lapaʻau no ka rheumatoid arthritis ʻeleu ma hope o ka pau ʻole o ka methotrexate. N Engl J Med. 2013; 369 (4): 307-318. PMID: 23755969 pubmed.ncbi.nlm.nih.gov/23755969.

O'Dell JR. Iapaau ana o rheumatoid arthritis. I: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, nā hua. ʻO Kelley lāua ʻo Firestein's Bookbook of Rheumatology. 10 o ka lā. Piladelapia, PA: Elsevier; 2017: chap 71.

Singh JA, Saag KG, Bridges SL, et al. 2015 Ke Kulanui ʻAmelika o Rheumatology alakaʻi no ka mālama ʻana i ka rheumatoid arthritis. Rumatika rumitis. 2016; 68 (1): 1-26. PMID: 26545940 pubmed.ncbi.nlm.nih.gov/26545940.