Hoʻokomo ʻia ka lāʻau lupus erythematosus

ʻO ka lupus erythematosus i hoʻokomo ʻia i ka lāʻau lapaʻau kahi maʻi autoimmune i hoʻomaka ʻia e ka hopena i kahi lāʻau.

ʻAno like ʻo lupus erythematosus i hoʻokomo ʻia i ka lāʻau ʻaʻohe like me ka ʻōnaehana lupus erythematosus (SLE). He maʻi maʻi autoimmune ia. ʻO ke kumu o kēia e hōʻeha hewa kou kino i nā mea olakino. Hoʻokumu ʻia ia e ka hopena i kahi lāʻau. Pili nā kūlana pili i nā lāʻau lupus i hoʻokomo ʻia i ka lāʻau a me ka ANCA vasculitis.

ʻO nā lāʻau lapaʻau maʻamau i ʻike ʻia e hoʻokumu i nā lāʻau lupus erythematosus i hoʻokomo ʻia i loko o ka lāʻau.

• Isoniazid
• Hydralazine
• Procainamide
• Tumor-nekrosis factor (TNF) alpha mea kāohi (e like me etanercept, infliximab a me adalimumab)
• Minocycline
• Quinidine

ʻO nā lāʻau lapaʻau ʻē aʻe i emi ʻole ka hopena ke kumu i kēia ʻano. Pākuʻi ʻia kēia mau mea:

• Nā lāʻau lapaʻau kūpale
• ʻO Capoten
• ʻO Chlorpromazine
• Methyldopa
• Sulfasalazine
• ʻO Levamisole, ʻo ia hoʻi ma ke ʻano he haumia o ka cocaine

Hiki i nā lāʻau lapaʻau immunotherapy e like me pembrolizumab ke kumu pū kekahi i nā ʻano autoimmune e like me ka lupus i hoʻokomo ʻia e ka lāʻau.

ʻO nā ʻōuli o ka lāʻau lāʻau i hoʻoulu ʻia e ka lāʻau i kū ma hope o ka lawe ʻana i ka lāʻau no 3 a 6 mau mahina paha.

Pākuʻi ʻia paha nā ʻōuli:

• Fiva
• ʻO ka manaʻo maʻi maʻamau (malaise)
• ʻEha hui
• Huʻi hui
• Loaʻa ka ʻai ʻole
• ʻEha umauma Pleuritic
• ʻO kaʻili o ka ʻili ma nā wahi i kū i ka lā

E hana ka mea mālama ola i kahi hoʻokolohua kino a hoʻolohe i kou umauma me kahi stethoscope. Lohe paha ka mea hāʻawi i kahi kani i kapa ʻia ʻo ka rub friction puʻuwai a i ʻole ka rubury friction pleural.

Hōʻike kahi hōʻike ʻili i kahi wīwī.

Pehu a palupalu paha nā hui.

ʻO nā hoʻāʻo e hana ʻia ana paha:

• Antihistone antibody
• Pākuʻi antinuclear antibody (ANA)
• ʻO Antineutrophil cytoplasmic antibody (ANCA) panela
  
• Helu piha ke koko (CBC) me ka ʻokoʻa
• Panela kemika piha
• Urinalysis

Hiki i kahi umauma x-ray ke hōʻike i nā hōʻailona o ka pleuritis a i ʻole pericarditis (pume e pili ana i ka uhi o ka māmā a puʻuwai paha). Hōʻike paha kahi ECG e pili ana ka puʻuwai.

ʻO ka hapa nui o nā manawa, hele aku nā ʻōuli i loko o kekahi mau lā i mau pule ma hope o ka hoʻōki ʻana i ka lāʻau i kumu i ke ʻano.

Hiki ke hoʻopili ʻia i ka mālama ʻana:

• Nā lāʻau anti-inflammatory Nonsteroidal (NSAIDs) e mālama ai i ka maʻi kōkō a me ka pleurisy
• ʻO nā kalima Corticosteroid e mālama i nā huehue o ka ʻili
• Nā lāʻau Antimalarial (hydroxychloroquine) e mālama i nā ʻōuli o ka ʻili a me ka maʻi ʻōpū

Inā pili kēia ʻano i kou puʻuwai, hakuʻala, a i ʻole ʻōnaehana, e kauoha ʻia paha ʻoe i nā kiʻina kiʻekiʻe o nā corticosteroids (prednisone, methylprednisolone) a me nā mea pale pale ʻōnaehana pale (azathioprine a cyclophosphamide). Kākaʻikahi kēia.

Ke hana nei ka maʻi, pono ʻoe e ʻaʻahu i nā kapa pale a me nā aniani aniani e kiaʻi ai i ka nui o ka lā.

ʻO ka hapa nui o ka manawa, ʻaʻole koʻikoʻi ka lāʻau lupus erythematosus i hoʻokomo ʻia i ka lāʻau e like me SLE. Hele pinepine nā ʻōuli i loko o kekahi mau lā i mau pule ma hope o ka hoʻōki ʻana i ka lāʻau āu e lawe nei. Kākaʻikahi, hiki ke hoʻomohala ka ʻōpala (nephritis) me ka lupus i hoʻokomo ʻia e ka lāʻau i hoʻokumu ʻia e nā mea hoʻopuka TNF a i ʻole me ANCA vasculitis ma muli o hydralazine a i ʻole levamisole. Koi aku ʻo Nefitis i ka lāʻau me ka prednisone a me nā lāʻau immunosuppressive.

Hōʻalo i ka lawe ʻana i ka lāʻau i hoʻokumu i ka hopena i ka wā e hiki mai ana. E hoʻi paha nā ʻōuli inā hana ʻoe pēlā.

Komo pū nā pilikia:

• Maʻi kīnā
• Thrombositopenia purpura - kahe ke kahe kokoke i kaʻili o kaʻili, ka hopena mai kahi helu haʻahaʻa o nā platelet i ke koko
• Hemolytic anemia
• Myocarditis
• Pericarditis
• Nefitis

Kāhea i kāu mea hāʻawi inā:

• Hoʻokumu ʻoe i nā ʻōuli hou i ka lawe ʻana i kekahi o nā lāʻau i helu ʻia ma luna.
• ʻAʻole maikaʻi kāu mau ʻōuli ma hope o kou hōʻoki ʻana i ka lawe ʻana i ka lāʻau i kumu i ke ʻano.

E nānā i nā hōʻailona o ka hopena inā lawe ʻoe i kekahi o nā lāʻau i hiki ke kumu i kēia pilikia.

Lupus - hoʻokomo ʻia ka lāʻau

• Lupus, discoid - ʻike i nā leona ma ka umauma
• Nā Antibodies

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Dooley MA. Lupus i hoʻokomo ʻia i ka lāʻau. I: Tsokos GC, hoʻoponopono. ʻO Lupus Erythematosus ʻōnaehana. Cambridge, MA: Elsevier Academic Press; 2016: chap 54.

Radhakrishnan J, Perazella MA. ʻO ka maʻi glomerular i hoʻokomo ʻia i lāʻau lāʻau: koi ʻia ka noʻonoʻo! ʻO Clin J Am Soc Nefrol. 2015; 10 (7): 1287-1290. PMID: 25876771 www.ncbi.nlm.nih.gov/pubmed/25876771.

Richardson BC. Lupus i hoʻokomo ʻia i ka lāʻau. I: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. ʻEpekema 7 Piladelapia, PA: Elsevier; 2019: chap 141.

ʻO Rubin RL. Lupus i hoʻokomo ʻia i ka lāʻau. ʻO Opin lāʻau lapaʻau Saf. 2015; 14 (3): 361-378. PMID: 25554102 www.ncbi.nlm.nih.gov/pubmed/25554102.

Vaglio A, Grayson PC, Fenaroli P, et al. Lupus i hoʻokomo ʻia i ka lāʻau: nā ʻano kuʻuna a me nā manaʻo hou. ʻO Autoimmun Rev.. 2018; 17 (9): 912-918. PMID: 30005854 www.ncbi.nlm.nih.gov/pubmed/30005854.