E nīnau i ka loea: Rheumatoid Arthritis

Anter

• ʻO David Curtis, M.D.
• Q: He 51 koʻu mau makahiki a loaʻa iā OA lāua ʻo RA. E kōkua anei ʻo Enbrel i ka kaohi ʻana i kaʻu OA a no nā hōʻailona RA paha?
• Q: He koʻikoʻi koʻikoʻi wau no OA a ua ʻike ʻia me ka maʻi gout. Hana paha ka papaʻai i ka hana ma OA?
• Q: Ke loaʻa nei wau i nā infusions o Actemra no 3 mau mahina, akā ʻaʻole wau e ʻoluʻolu iki. Makemake kaʻu kauka e kauoha i kahi hōʻike Vectra DA e ʻike inā e holo nei kēia lāʻau. He aha kēia hōʻike a pehea ka hilinaʻi?
• Q: He aha nā makaʻi o ka haʻalele loa ʻana i nā lāʻau?
• Q: He OA kaʻu i koʻu manamana nui a me RA i koʻu poʻohiwi a me koʻu mau kuli. Aia kekahi ala e hoʻohuli i ka poino i hana mua ʻia? A he aha kaʻu e hana ai e mālama i ka luhi i nā mākala?
• Q: Ma ka manawa hea e ʻae ʻia ai e hele i ka ER no ka ʻeha? He aha nā hōʻailona e pono ai wau e hōʻike?
• Q: Ua ʻōlelo kuʻu rheumatologist ʻaʻole pili ka hormona i nā ʻōuli, akā i kēlā me kēia mahina ke kūlike kaʻu lapalapa me kuʻu menstrual cycle. He aha kou manaʻo ma kēia?
• Hui pū i ke kamaʻilio ʻana

ʻO David Curtis, M.D.

ʻO Rheumatoid arthritis (RA) kahi maʻi maʻi autoimmune mau. Hoʻohālikelike ʻia ia e ka ʻeha pū, ka pehu, ʻoʻoleʻa, a me ka nalo ʻana o ka hana.

ʻOiai ʻoi aku ma mua o 1.3 miliona mau ʻAmelika e ʻehaʻeha iā RA, ʻaʻohe kanaka ʻelua e loaʻa i nā ʻōuli like a i ʻole ka ʻike like. Ma muli o kēia, paʻakikī ka loaʻa ʻana o nā pane āu e makemake ai i kekahi manawa. ʻO ka mea pōmaikaʻi, ʻo Kauka David Curtis, MD, kahi rheumatologist laikini i hoʻokumu ʻia ma Kapalakiko e hele mai e kōkua.

E heluhelu i kāna pane i nā nīnau ʻehiku i nīnau ʻia e nā mea maʻi RA maoli.

Q: He 51 koʻu mau makahiki a loaʻa iā OA lāua ʻo RA. E kōkua anei ʻo Enbrel i ka kaohi ʻana i kaʻu OA a no nā hōʻailona RA paha?

ʻO ka noho pū ʻana o ka osteoarthritis a me ka rheumatoid arthritis ka mea maʻamau ʻoiai mākou āpau e hoʻomohala iā OA i kekahi kekelē i kekahi, inā ʻaʻole ka hapa nui, o kā mākou hono i kekahi manawa i ko mākou ola.

Ua ʻae ʻia ʻo Enbrel (etanercept) no ka hoʻohana ʻana ma RA a me nā maʻi ʻino ʻē aʻe, autoimmune kahi i ʻike ʻia ai he kuleana koʻikoʻi ka cytokine TNF-alpha i ka hoʻokele ʻana i ka lū (ka ʻeha, ka pehu ʻana, a me ka ʻulaʻula) a me nā mea luku ma iwi a me ka iwi iwi. ʻOiai ʻo OA kekahi mau mea o ka “mumū” ma ke ʻano he ʻāpana o kāna pathology, ʻaʻole mea nui ka cytokine TNF-alpha i kēia kaʻina hana a no laila ʻaʻole makemake ʻia a hoʻopaʻa ʻia ʻo TNF e Enbrel e hoʻomaikaʻi i nā hōʻailona a i ʻole nā ​​hōʻailona o OA .

I kēia manawa, ʻaʻohe o mākou "maʻi hoʻololi i nā lāʻau" a i ʻole biologics no ka osteoarthritis. Hoʻoikaika nui ka noiʻi ʻana i nā hoʻoponopono OA a hiki iā mākou āpau ke hilinaʻi i ka wā e hiki mai ana e loaʻa iā mākou nā mana ikaika no OA, e like me kā mākou e hana nei no RA.

Q: He koʻikoʻi koʻikoʻi wau no OA a ua ʻike ʻia me ka maʻi gout. Hana paha ka papaʻai i ka hana ma OA?

ʻO ka papaʻai a me ka meaʻai ke kuleana nui i nā ʻano āpau o ko mākou olakino a olakino. He mea paʻakikī paha iā ʻoe nā ʻōlelo hoʻokūkū hoʻokūkū no kēia mau ʻano ʻokoʻa. Hiki ke hoʻopōmaikaʻi ʻia nā pilikia olakino āpau mai ka papaʻai "prudent".

ʻOiai ʻo ka mea akahele hiki a ʻokoʻa hoʻi me ka ʻike olakino, a ʻo nā ʻōlelo aʻoaʻo a nā kauka a me nā mea lapaʻau hiki ke loli i ka hala ʻana o ka manawa, palekana ke ʻōlelo ʻana he papaʻai maikaʻi ka mea e kōkua iā ʻoe e mālama a hoʻokō i kahi kaupaona kino kūpono, e hilinaʻi ʻia i ka hana ʻole ʻia. nā meaʻai, waiwai i nā huaʻai, nā mea kanu, a me nā kīʻaha holoʻokoʻa, a keakea i nā momona holoholona. ʻO ka protein pono, nā minelala, a me nā wikamina (me ka calcium a me ka huaʻa D no nā iwi olakino) pono e lilo i ʻāpana o kēlā me kēia papaʻai.

ʻOiai ʻo ka hōʻalo loa ʻana i nā purine ʻaʻole pono a koi ʻia paha, hiki i nā mea maʻi e lawe ana i ka lāʻau no ka gout ke kaohi i ka lawe ʻana o purine. Paipai ʻia e hoʻopau i nā meaʻai i kiʻekiʻe i nā purine a hoʻoliʻiliʻi i ka lawe ʻana o nā meaʻai me ka maʻi purine kaulike. I ka pōkole, ʻoi aku ka maikaʻi no nā mea maʻi e ʻai i ka papaʻai i hoʻopili ʻia me nā meaʻai haʻahaʻa-purine. ʻO ka hoʻopau loa ʻana i nā purine, ʻaʻole ia e koi ʻia.

Q: Ke loaʻa nei wau i nā infusions o Actemra no 3 mau mahina, akā ʻaʻole wau e ʻoluʻolu iki. Makemake kaʻu kauka e kauoha i kahi hōʻike Vectra DA e ʻike inā e holo nei kēia lāʻau. He aha kēia hōʻike a pehea ka hilinaʻi?

Hoʻohana nā Rheumatologists i ka hoʻokolohua hoʻokolohua, ka mōʻaukala olakino, nā ʻōuli, a me nā hoʻokolohua hoʻokolohua maʻamau e loiloi i ka hana maʻi. ʻO kahi hoʻokolohua hou i kapa ʻia ʻo Vectra DA e ana i ka hōʻiliʻili o nā kumu hou aʻe o ke koko. Kōkua kēia mau mea pili koko i ka pane ʻana o ka ʻōnaehana pale i ka hana maʻi.

ʻO nā kānaka me ka rheumatoid arthritis (RA) kū ʻole i ka Actemra (tocilizumab Injection) e hoʻonui i nā pae o interleukin 6 (IL-6). ʻO kēia marker inflammatory kahi mea nui i ka hōʻike Vectra DA.

Palaka ʻo Actemra i ka mea loaʻa no ka IL-6 e mālama i ka mumū o RA. Piʻi ka pae o ka IL-6 i ke koko ke pale ʻia ka mea loaʻa no IL-6. ʻO kēia no ka mea ʻaʻole ia e paʻa hou i kāna mea loaʻa. ʻAʻole kū kiʻekiʻe nā pae IL-6 kiʻekiʻe i ka hana maʻi i nā mea hoʻohana ʻo Actemra. ʻO lākou. Hōʻike wale ia ua mālama ʻia kekahi kanaka me Actemra.

ʻAʻole ʻae nui nā Rheumatologists iā Vectra DA ma ke ʻano he ala kūpono e loiloi i ka hana maʻi. ʻAʻole kōkua ka hoʻāʻo ʻana ʻo Vectra DA i ka nānā ʻana i kāu pane i ka Actemra therapy. E hilinaʻi kāu rheumatologist i nā hana kuʻuna e nānā i kāu pane iā Actemra.

Q: He aha nā makaʻi o ka haʻalele loa ʻana i nā lāʻau?

ʻO Seropositive (ʻo ia hoʻi he maikaʻi ka mea rheumatoid) aneane he maʻi mau a me kahi maʻi holomua hiki ke alakaʻi i ke kīnā a me ka luku pū inā haʻalele ʻia ʻole. Eia nō naʻe, nui ka hoihoi (ma ka ʻaoʻao o nā mea maʻi a mālama i nā kauka) i ka wā a pehea e hōʻemi ai a kū hoʻi i nā lāʻau.

Aia kahi ʻae āpau e mālama ʻia ka hoʻomaʻamaʻa mua ʻana i ka rheumatoid arthritis i nā hopena maʻi maikaʻi me ka hōʻemi ʻia ʻana o ka hana, ka hōʻoluʻolu o ka mea maʻi a me ka pale ʻana i ka luku pū. Aia ka liʻiliʻi o ka ʻae i ka pehea a i ka manawa e hōʻemi a hōʻoki paha i ka lāʻau i nā mea maʻi e hana maikaʻi ana i ka therapy o kēia manawa. Kūleʻa ka lapalapa o ka maʻi ke hoʻemi ʻia a hōʻoki ʻia nā lāʻau lapaʻau, keu hoʻi inā e hoʻohana ʻia nā lāʻau lapaʻau hoʻokahi a maikaʻi ka hana a ka mea maʻi. He ʻoluʻolu nā mea he nui e mālama ana i nā rheumatologists a me nā mea maʻi e hōʻemi a hoʻopau iā DMARDS (e like me ka methotrexate) ke hana maikaʻi ka mea hoʻomanawanui no kahi manawa lōʻihi loa a aia pū kekahi me kahi biologic (ʻo kahi laʻana, he mea kāohi TNF)

Hōʻike ka ʻike hoʻokolohua e hana maikaʻi nā mea maʻi inā lōʻihi lākou e noho ai i kekahi therapy akā loaʻa pinepine nā lapalapa ahi inā kū lākou i nā lāʻau āpau. Hana maikaʻi nā mea maʻi seronegative he nui i ka hoʻōki ʻana i nā lāʻau āpau, ma ka liʻiliʻi no kahi manawa, e ʻōlelo ana he ʻano ʻokoʻa ko kēia ʻano o nā mea maʻi ma mua o nā maʻi rheumatoid arthritis seropositive. He akahele ia e hōʻemi a hōʻoki paha i nā lāʻau rheumatoid wale nō me ka ʻaelike a me ka nānā ʻana o kāu rheumatologist mālama.

Q: He OA kaʻu i koʻu manamana nui a me RA i koʻu poʻohiwi a me koʻu mau kuli. Aia kekahi ala e hoʻohuli i ka poino i hana mua ʻia? A he aha kaʻu e hana ai e mālama i ka luhi i nā mākala?

ʻO ka Osteoarthritis (OA) i ka hui manamana nui he mea maʻamau a pili i nā mea āpau i kekahi manawa i ka makahiki 60.

Rheumatoid arthritis (RA) hiki ke hoʻopili i kēia hui pū kekahi. ʻO ka hoʻohaunaele o ka pale o kahi hui i kapa ʻia he synovitis. Hiki i nā ʻano ʻelua o ka arthritis ke hopena ma ka synovitis.

No laila, he nui ka poʻe me RA i loaʻa kekahi o nā kumu OA i loko o kēia hui e loaʻa i kahi hoʻomaha nui mai nā hōʻailona me ka RA RA maikaʻi, e like me nā lāʻau.

I ka hoʻokū ʻana a i ʻole ka hoʻēmi ʻana i ka synovitis, hoʻemi ʻia ka hōʻino ʻia o ka cartilage a me ka iwi. Hiki i ka mumū mau ke hopena i nā loli mau i ke ʻano o nā iwi. Kūlike kēia mau iwi a me nā iwi i nā loli i hana ʻia e OA. I nā kūlana ʻelua, ʻaʻole "hiki ke hoʻohuli" i nā loli me nā lapaʻau e kū nei i kēia lā.

Hiki ke wali a wane nā ʻōuli o ka OA, lilo i mea ʻoi aku ka hewa i ka hala ʻana o ka manawa, a hoʻonui ʻia e ka ʻeha. ʻO ke olakino kino, ka lāʻau kumuhana a me ka waha, a me nā corticosteroids hiki ke kōkua i ka hōʻoluʻolu nui ʻana i nā ʻōuli. Eia nō naʻe, ʻaʻole e hoʻohuli ka lawe ʻana i nā mea hoʻohui calcium i ke kaʻina OA.

Hiki ke hoʻopili ʻia ka luhi me nā lāʻau a me nā ʻano olakino like ʻole, me RA. Hiki i kāu kauka ke kōkua i ka wehewehe ʻana i kāu mau hōʻailona a kōkua iā ʻoe e hoʻolālā i ka lāʻau lapaʻau maikaʻi loa.

Q: Ma ka manawa hea e ʻae ʻia ai e hele i ka ER no ka ʻeha? He aha nā hōʻailona e pono ai wau e hōʻike?

ʻO ka hele ʻana i kahi lumi pilikia o ka haukapila hiki ke lilo i kumu kūʻai, hoʻolōʻihi manawa, a me ka naʻau pōpilikia. Eia nō naʻe, pono ka ER no ka poʻe maʻi nui a i ʻole nā ​​maʻi hoʻoweliweli i ke ola.

ʻAʻole loaʻa pinepine ʻo RA i nā ʻōuli hoʻoweliweli. ʻOiai ke loaʻa nei kēia mau hōʻailona, ​​kākaʻikahi loa lākou. ʻO nā hōʻailona RA koʻikoʻi e like me aspericarditis, pleurisy, a scleritis paha kākaʻikahi ka "koʻikoʻi." ʻO ia ka manaʻo ʻaʻole lākou e hele wikiwiki (ma kahi o nā hola) a koʻikoʻi loa. Ma ka hakahaka, akahai kēia mau hiʻohiʻona o RA a hele mālie. Hāʻawi kēia iā ʻoe i ka manawa e hoʻokaʻaʻike aku i kāu kauka mua a i ʻole rheumatologist no ka ʻōlelo aʻoaʻo a i ʻole ke kipa keʻena.

ʻO ka hapa nui o nā pilikia i ka poʻe me RA e pili pū me nā maʻi comorbid e like me ka maʻi o ke aʻa a me ka maʻi diabet. Nā hopena ʻaoʻao o nā lāʻau RA āu e lawe nei - e like me ka hopena maʻi maʻi - hiki ke hōʻoia i kahi huakaʻi i ka ER. Heʻoiaʻiʻo loa kēia inā koʻikoʻi ka hopena. ʻO nā ʻōuli pū kekahi me ke kuni kiʻekiʻe, ka ʻūlū nui, ka pū ʻana o ka ʻāʻī, a me ka hanu pilikia ʻana.

ʻO kekahi pilikia kūpilikiʻi kahi maʻi kūpilikiʻi o ka hoʻoponopono ʻana i ka maʻi a me nā lāʻau biologic. ʻO ka maʻi ponia, ka maʻi ʻōpū, ka maʻi ʻōpū, a me ka maʻi ʻōpū kikowaena nā hiʻohiʻona o nā maʻi koʻikoʻi i kumu no ka loiloi ER.

He hōʻailona wela paha kahi hōʻailona o ka maʻi a me ke kumu e kāhea ai i kāu kauka. ʻO ka hele pololei ʻana i kahi ER he naʻauao inā loaʻa nā ʻōuli ʻē aʻe, e like me ka nāwaliwali, pilikia i ka hanu ʻana, a me ka ʻeha o ka umauma me ke kuni kiʻekiʻe. ʻO kahi manaʻo maikaʻi maʻamau ke kāhea ʻana i kāu kauka no nā ʻōlelo aʻoaʻo ma mua o ka hele ʻana i kahi ER, akā ke kānalua ʻoe, ʻoi aku ka maikaʻi e hele i ka ER no ka loiloi wikiwiki.

Q: Ua ʻōlelo kuʻu rheumatologist ʻaʻole pili ka hormona i nā ʻōuli, akā i kēlā me kēia mahina ke kūlike kaʻu lapalapa me kuʻu menstrual cycle. He aha kou manaʻo ma kēia?

Hiki i nā hormones wahine ke hoʻololi i nā maʻi e pili ana i ka autoimmune, me RA. ʻAʻole maopopo iki ke kaiaulu olakino i kēia pilina. Akā ʻike mākou hoʻonui pinepine nā ʻōuli ma mua o ka menstruation. ʻO ke kala ʻana ʻo RA i ka wā hāpai a me nā mumū ma hope o ka hāpai ʻana ʻo ia hoʻi ka hapanui o ka nānā.

Ua hōʻike nā noiʻi kahiko i ka emi ʻana o ka hanana RA i nā wahine i lawe i nā lāʻau kaohi hānau. Eia naʻe, ʻaʻole i loaʻa kahi noiʻi o kēia manawa i nā hōʻike hōʻoiaʻiʻo e hiki ai i ka hoʻōla hormonone ke pale iā RA. Ua ʻōlelo ʻia kekahi mau noiʻi he paʻakikī paha e hoʻokaʻawale i waena o nā ʻōuli pre-menstrual maʻamau a me kahi hoʻouluulu RA. Akā ʻo ka hui pū ʻana i kahi lapalapa me kāu pōʻai menstrual paha ʻoi aku paha ma mua o kahi hanana. ʻIke kekahi poʻe he mea kōkua ia e hoʻonui i kā lākou mau lāʻau lapaʻau pōkole, e like me ka lāʻau anti-inflammatory nonsteroidal, i ke kakali ʻana i ka lapalapa ʻana.

Hui pū i ke kamaʻilio ʻana

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