Ke hoʻohana nei i ka Methotrexate e mālama iā Psoriatic Arthritis

Anter

• Pehea e hana ai ka methotrexate ma ke ʻano he lapaʻau no ka psoriatic arthritis
• Nā pono o ka methotrexate no ka psoriatic arthritis
• Nā hopena o ka methotrexate no ka psoriatic arthritis
• Hoʻomohala fetal
• Poino ke ake
• Nā hopena ʻē aʻe
• Nā launa lāʻau
• Hana ʻia o methotrexate i hoʻohana ʻia no ka psoriatic arthritis
• Nā koho ʻē aʻe i methotrexate no ka mālama ʻana i ka psoriatic arthritis
• Nā DMARD maʻamau
• ʻO Biologics
• ʻO ka lawe lawe ʻana

Hōʻike Overview

ʻO ka Methotrexate (MTX) kahi lāʻau i hoʻohana ʻia e mālama i ka psoriatic arthritis ma mua o ka. ʻO ʻoe a i ʻole hui pū ʻia me nā lāʻau ʻē aʻe, manaʻo ʻia ʻo MTX kahi lapaʻau laina mua no ka maʻi kaulike a koʻikoʻi psoriatic (PsA). I kēia lā, hoʻohana mau ʻia ia me ka hoʻohui me nā lāʻau biologic hou no PsA.

He hopena ʻino paha kā MTX. Ma ka ʻaoʻao maikaʻi, MTX:

• he kumu kūʻai ʻole
• kōkua i ka hoʻoliʻiliʻi
• hoʻomaʻemaʻe i nā ʻōuli o ka ʻili

Akā ʻaʻole pale ʻo MTX i ka luku pū ʻia ke hoʻohana wale ʻia.

Kūkākūkā me kāu kauka inā ʻo MTX wale nō a i ʻole ka hui pū ʻana me nā lāʻau ʻē aʻe he lapaʻau maikaʻi paha nāu.

Pehea e hana ai ka methotrexate ma ke ʻano he lapaʻau no ka psoriatic arthritis

ʻO MTX kahi lāʻau antimetabolite, ʻo ia hoʻi keakea ia i ka hana maʻamau o nā hunaola, ke kāohi iā lākou mai ka hoʻokaʻawale. Kapa ʻia ia he lāʻau antirheumatic (DMARD) e hoʻololi nei i ka maʻi no ka mea e hoʻoliʻiliʻi ia i ka huʻi pū.

ʻO ka hoʻohana mua ʻia ʻana, mai ka hopena o 1940s, i loko o nā kaona kiʻekiʻe e mālama ai i ka leukemia kamaliʻi. I nā mahele haʻahaʻa, kāohi ʻo MTX i ka ʻōnaehana pale a kāohi i ka hana ʻana o nā mea lymphoid i pili iā PsA.

Ua ʻae ʻia ʻo MTX e ka US Food and Drug Administration (FDA) i ka makahiki 1972 no ka hoʻohana ʻana me ka psoriasis koʻikoʻi (i pili pinepine ʻia me ka psoriatic arthritis), akā ua hoʻohana nui ʻia ia "off label" no PsA. "Lapaʻa waho" hiki i kāu kauka ke kuhikuhi iā ia no nā maʻi ʻē aʻe ma mua o ka mea i ʻae ʻia e ka FDA.

ʻAʻole i aʻo ʻia ka maikaʻi o MTX no PsA i nā hoʻokolohua hoʻokolohua nui, e like me ka American Academy of Dermatology (AAD). Ma ka hakahaka, hoʻokumu ʻia nā ʻōlelo aʻoaʻo AAD no MTX ma ka ʻike lōʻihi lōʻihi a me nā hopena o nā kauka nāna i kuhikuhi iā ia no PsA.

Kuhi kahi ʻatikala loiloi 2016 i ka nānā ʻole ʻia ʻana o kahi hoʻomalu i hōʻike ʻia me MTX ma kahi o kahi placebo. ʻO ka hoʻokolokolo hoʻokolokolo ʻeono mahina 2012 o 221 poʻe ma luna o ʻeono mau mahina i loaʻa ʻole kahi hōʻike e hoʻomaʻamaʻa ʻo MTX wale nō ka hoʻomaikaʻi ʻana i ka pehu ami (synovitis) ma PsA.

Akā aia kahi hopena hou nui. Ua loaʻa ka noiʻi 2012 i ka mālama ʻana o MTX hana hoʻonui maikaʻi i ka loiloi holoʻokoʻa o nā ʻōuli e nā kauka a me nā poʻe me PsA i pili i ka hoʻopaʻa. Eia kekahi, ua hoʻomaikaʻi ʻia nā ʻōuli o ka ʻili me MTX.

ʻO kahi noiʻi ʻē aʻe, i hōʻike ʻia i ka makahiki 2008, ua ʻike inā mālama ʻia ka poʻe me PsA i ka wā ma mua o ka maʻi ma ka hoʻonui ʻia o ka mahele o MTX, ʻoi aku ka maikaʻi o kā lākou hopena. No nā poʻe 59 i loko o ke aʻo ʻana:

• 68 pakeneka i loaʻa he 40 pākēneka hoʻemi i ka hana inflamed ami helu
• 66 pākēneka i loaʻa he 40 pākēneka hoʻemi i ka pehu ami helu
• 57 pākēneka i hoʻonui i ka maikaʻi Ps area Area a me Severity Index (PASI)

Ua hana ʻia kēia noiʻi 2008 ma kahi keʻena kino ʻo Toronto kahi kahi noiʻi i loaʻa ma mua i loaʻa ʻole kahi pōmaikaʻi no ka hoʻomaʻamaʻa MTX no ka huʻi pū.

Nā pono o ka methotrexate no ka psoriatic arthritis

Hana ʻo MTX ma ke ʻano he anti-inflammatory a hiki ke lilo i pono nona iho no nā hihia akahai o PsA.

Ua loaʻa kahi noiʻi ma 2015 i ka 22 pākēneka o ka poʻe me PsA i mālama wale ʻia me MTX i loaʻa i ka hana maʻi liʻiliʻi.

Maikaʻi ka MTX i ka hoʻomaʻemaʻe i ka pili o ka ʻili. No kēia kumu, hoʻomaka paha kāu kauka i kāu lapaʻau me MTX. ʻOi aku ka liʻiliʻi o ke kumukūʻai ma mua o nā lāʻau biologic hou i hoʻomohala ʻia i nā 2000 mau mua.

Akā ʻaʻole pale ʻo MTX i ka luku pū ʻia ma PsA. No laila inā pilikia ʻoe no ka luku iwi, hiki i kāu kauka ke hoʻohui i kekahi o nā biologics. ʻO kēia mau lāʻau lapaʻau e kāohi i ka hana ʻana o ka tumrosis factor (TNF), kahi lāʻau hoʻomāhuahua i loko o ke koko.

Nā hopena o ka methotrexate no ka psoriatic arthritis

ʻO nā hopena ʻaoʻao o ka MTX hoʻohana no nā poʻe me PsA hiki ke lilo i mea nui. Manaʻo ʻia he genetics paha i kēlā me kēia ʻano pane i MTX.

Hoʻomohala fetal

ʻIke ʻia ʻo MTX he mea hōʻino no ka ulu ʻana o ka fetal. Inā ʻoe e hoʻāʻo nei e hāpai, a inā hāpai ʻoe, e haʻalele iā MTX.

Poino ke ake

ʻO ka makaʻu nui ka hōʻino ʻia o ke ake. Ma kahi o 1 i ka 200 mau poʻe e lawe ana iā MTX i nā hōʻino ate. Akā hiki ke hoʻihoʻi i ka ʻino ke kū ʻoe iā MTX. Wahi a ka National Psoriasis Foundation, hoʻomaka ka makaʻu ma hope o kou hōʻea ʻana i kahi hōʻuluʻulu ola ʻana o 1.5 gram o MTX.

E nānā kāu kauka i kāu hana ate ke lawe nei ʻoe iā MTX.

Hoʻonui ka hopena o ka hōʻino o ke ake inā ʻoe:

• inu rama
• ua momona
• he maʻi kō
• he hana hakuʻala maikaʻi ʻole

Nā hopena ʻē aʻe

ʻAʻole like nā hopena ʻē aʻe i ke koʻikoʻi, ʻoluʻolu ʻole a mālama pinepine ʻia. Pākuʻi ʻia kēia mau mea:

• nausea a luaʻi paha
• luhi
• ʻeha nā waha
• pāhoehoe
• poho lauoho
• ʻūpā
• ʻeha poʻo
• haʻalulu
• hoʻonui i ka makaʻu o ka maʻi
• ʻike maka i ka lā
• ʻaʻano wela i nā liona ʻili

Nā launa lāʻau

ʻO kekahi mau lāʻau ʻehaʻeha loa e like me aspirin (Bufferin) a i ʻole ibuprofen (Advil) hiki ke hoʻonui i nā hopena ʻaoʻao o MTX. Hiki i kekahi mau antibiotic ke launa pū e hōʻemi i ka pono MTX a i ʻole pōʻino paha. E kamaʻilio me kāu kauka e pili ana i kāu mau lāʻau a hiki i ka launa pū ʻana me MTX.

Hana ʻia o methotrexate i hoʻohana ʻia no ka psoriatic arthritis

ʻO ka hopena hoʻomaka o MTX no PsA he 5 a 10 mau milligrams (mg) i kēlā me kēia pule no ka pule mua a ʻelua paha. Kaukaʻi ʻia i kāu pane, e hoʻonui mālie ke kauka i ka lāʻau a hiki i 15 a 25 mg i kēlā me kēia pule, i manaʻo ʻia ʻo ia ka maʻamau maʻamau.

Lawe ʻia ʻo MTX i hoʻokahi manawa i ka pule, e ka waha a i ʻole ke kuikui. ʻO ka MTX waha paha ma ka pila a ʻano wai paha. Hiki i kekahi poʻe ke uhaʻi i ka lāʻau i ʻekolu mau ʻāpana i ka lā a lākou e lawe ai ia e kōkua ai i nā hopena ʻaoʻao.

Kau kauka paha i kau kauka folic acid supplement, no ka mea, ʻike ʻia ʻo MTX e hoʻemi i nā pae folate pono.

Nā koho ʻē aʻe i methotrexate no ka mālama ʻana i ka psoriatic arthritis

Aia kekahi mau lāʻau lapaʻau ʻokoʻa no PsA no ka poʻe hiki ʻole a makemake ʻole paha e lawe iā MTX.

Inā loaʻa iā ʻoe kahi PsA akahai loa, hiki paha iā ʻoe ke hoʻokuʻu i nā hōʻailona me nā lāʻau anti-inflammatory nonsteroidal (NSAIDs) wale nō. Akā ʻo NSAID me nā maʻi ʻili. Pēlā nō ia no nā kūpuna kūloko o corticosteroids, i hiki ke kōkua me kekahi mau ʻōuli.

Nā DMARD maʻamau

ʻO nā DMARD maʻamau i ka hui like me MTX:

• sulfasalazine (Azulfidine), kahi e hoʻomaikaʻi ai i nā ʻōuli o ka arthritic akā ʻaʻole ia e hoʻōki i ka hōʻino pū
• leflunomide (Arava), kahi e hoʻomaikaʻi ai i nā ʻōuli a me nā ʻili
• cyclosporine (Neoral) a me tacrolimus (Prograf), kahi e hana nei ma ka pāpā ʻana i ka hana cineineurin a me ka hana T-lymphocyte

Hoʻohana ʻia kēia DMARDS i kekahi manawa me ka hoʻohui me nā lāʻau ʻē aʻe.

ʻO Biologics

Loaʻa nā lāʻau hou he nui, akā ʻoi aku ka pipiʻi o kēia. Ke hoʻomau nei ka noiʻi, a malia paha e loaʻa paha nā ʻano lāʻau hou ʻē aʻe i ka wā e hiki mai ana.

ʻO nā biologics e kāohi i ka TNF a hoʻemi i ka hōʻino hui pū i loko o PsA me kēia mau TNF alpha-blockers:

• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)

Hiki i nā biologics ke kuhikuhi i nā protein interleukin (cytokines) ke hōʻemi i ka mumū a hoʻomaikaʻi i nā ʻōuli ʻē aʻe. Ua ʻae ʻia kēia mau mea no ka mālama ʻana iā PsA. Pākuʻi ʻia lākou:

• ustekinumab (Stelara), kahi monoclonal antibody e kuhikuhi ana i ka interleukin-12 a me ka interleukin-23
• secukinamab (Cosentyx), nā pahuhopu interleukin-17A

ʻO kekahi koho lapaʻau ʻo ia ka lāʻau apremilast (Otezla), ka mea i māka i nā mole i loko o nā hunaola i hoʻopili ʻia me ka mumū. Hoʻomaha ia i ka enzyme phosphodiesterase 4, a i ʻole PDE4. Hoʻoemi ka Apremilast i ka mumū a me ka huʻi pū.

Loaʻa nā hopena āpau i nā lāʻau āpau e mālama iā PsA, no laila he mea nui e loiloi i nā pono a me nā hopena me kāu kauka.

ʻO ka lawe lawe ʻana

Hiki i ka MTX ke lilo i lapaʻau kūpono no PsA no ka mea e hoʻoliʻiliʻi ia i ka mumū a kōkua i nā ʻōuli i ka nui. Hiki iā ia ke loaʻa nā hopena koʻikoʻi, no laila pono ʻoe e nānā mau.

Inā ʻoi aku ma mua o hoʻokahi o kāu mau hono i hoʻopili ʻia, hoʻohui pū ʻia ka MTX me kahi DMARD biologic he mea pono paha i ka hoʻopaʻa ʻana i ka luku pū. Kūkākūkā me nā kauka lapaʻau a pau me nā kauka, a nānā pinepine i ka hoʻolālā lapaʻau. Maliʻa paha e hiki mai ana ka noiʻi hoʻomau ʻana i nā lāʻau ʻo PsA i ka wā e hiki mai ana.

Hiki paha iā ʻoe ke ʻike he mea maikaʻi ke kamaʻilio pū me kahi "hoʻokele hoʻomanawanui" ma ka National Psoriasis Foundation, a i ʻole hui pū me kekahi o kāna mau hui kūkā kamaʻilio psoriasis.