Ke ala aʻe nei ʻoe i kekahi manawa i ke kakahiaka me ka manaʻo ʻoʻoleʻa a paʻakikī? He paʻakikī anei ke kūlou no kekahi manawa? Hiki paha kēia ma muli o Ankylosing Spondylitis , kahi maʻi e hoʻopilikia ai i nā hono o ka iwi kuamoʻo. Inā ua hoʻāʻo ʻoe i nā lāʻau hōʻoluʻolu ʻeha ma luna o ke kauka ( NSAID ) a ʻaʻole i emi ka ʻeha a me ka pehu, e ʻōlelo paha kāu kauka i kahi DMARD. No laila e hele kākou i ke kumu o kēia.
He aha nā DMARD a pehea lākou e hana ai?
I ka Ankylosing Spondylitis, lilo ka ʻōnaehana pale o ko mākou kino, ʻo ia hoʻi ka ʻōnaehana pale kino , i mea hana nui a hoʻomaka e hoʻouka i ko mākou mau hono iwi kuamoʻo ponoʻī. Hoʻoulu kēia i ka mumū , ka ʻeha, a me ka ʻoʻoleʻa e paʻakikī ai ka hoʻoneʻe pono ʻana i ka iwi kuamoʻo.
ʻO DMARD kahi pōkole no 'Disease-Modifying Antirheumatic Drug' . I ka ʻōlelo maʻalahi, ʻo ia hoʻi 'ka lāʻau lapaʻau arthritis e hoʻololi i ka maʻi'. Hana kēia mau lāʻau lapaʻau ma ka hōʻoluʻolu ʻana i ka ʻōnaehana pale hana nui. ʻAʻole e like me nā lāʻau ʻeha maʻamau (NSAID), ʻaʻole wale kēia e hōʻemi i ka ʻeha, akā kōkua pū kekahi i ka hoʻomalu ʻana i ka holomua o ka maʻi a pale i ka hōʻino hou ʻana i nā hono. ʻO ia ke kumu i kapa ʻia ai lākou he mau lāʻau "disease-modifying".
He aha nā ʻano DMARD i hāʻawi ʻia no ka Ankylosing Spondylitis?
Hiki ke hoʻokaʻawale ʻia nā DMARD i hāʻawi ʻia no kēia maʻi i kekahi mau ʻano nui. Ua kapa ʻia lākou he biologics a me nā DMARD kuʻuna. E nānā kākou i kēlā me kēia ʻano.
| ʻAno lāʻau lapaʻau | He wehewehe pōkole |
|---|---|
| Nā mea olaola (e.g. nā mea hoʻopaʻa TNF, nā mea hoʻopaʻa IL-17) | Hana lākou ma ke kuhikuhi ʻana i nā protein kikoʻī e hoʻoulu ai i ka mumū i loko o ka ʻōnaehana pale. Hāʻawi ʻia kēia mau mea ma o ka inikini a i ʻole ka hoʻokomo ʻana i loko o ke kino. |
| Nā mea pale JAK | He ʻano DMARD hou nō hoʻi kēia. ʻAʻole kēia he biologics. Hana lākou ma ke kuhikuhi ʻana i kahi hui o nā enzymes e hoʻoulu ai i ka mumū. Hiki ke lawe ʻia lākou ma ke ʻano he mau pila. |
| Nā DMARD Kuʻuna (e.g. Methotrexate, Sulfasalazine) | Hoʻohana nui ʻia kēia mau mea no ka maʻi ʻaʻai o nā hono peripheral, e like me nā lima, nā wāwae, nā pūhaka, a me nā kuli. ʻAʻole lākou i kūpono no ka maʻi ʻaʻai o ka iwi kuamoʻo. |
Biologics: Nā lāʻau lapaʻau e hana ana ma ka pahuhopu like
Ua like nā mea olaola me nā snipers. Hoʻopaʻa lākou a hoʻouka wale i nā protein e hoʻokumu pololei ana i ka pilikia.
- Nā mea hoʻopaʻa TNF: ʻO kēia ka papa mua o nā lāʻau biologic i ʻāpono ʻia no ka ankylosing spondylitis. Hana lākou ma ke kāohi ʻana i kahi protein i kapa ʻia ʻo Tumor Necrosis Factor (TNF), ka mea e hoʻoulu ai i ka mumū. Hiki iā lākou ke kōkua me ka arthritis o ka iwi kuamoʻo a me nā hono ʻē aʻe, a me nā kūlana e hiki ke hana me ka maʻi, e like me ka uveitis , ka mumū o ka maka, a me ka Inflammatory Bowel Disease (IBD) ( ka maʻi Crohn a me ka ulcerative colitis). E kuhikuhi pinepine kāu kauka i kēia mau mea inā ua hoʻāʻo ʻoe ma ka liʻiliʻi he ʻelua ʻano o nā mea hoʻomaha ʻeha (NSAID) a ʻaʻohe hopena.
- ʻAdalimumab (Humira)
- ʻO Certolizumab (Cimzia)
- ʻEtanercept (Enbrel)
- ʻO Infliximab (Remicade)
- ʻO Golimumab (Simponi)
E noʻonoʻo, ʻaʻole i hana kekahi mea hoʻopaʻa TNF iā ʻoe. Mai hopohopo. Hiki i ke kauka ke hoʻololi iā ʻoe i kahi lāʻau ʻē aʻe ma ka papa like. A laila aia kahi manawa kūpono e loaʻa ai nā hopena.
- Nā mea pale IL-17: Hana kēia ma ke kāohi ʻana i kahi protein mumū ʻē aʻe i kapa ʻia ʻo Interleukin-17 (IL-17). He koho maikaʻi lākou no ka poʻe i pane ʻole i nā mea pale TNF a i ʻole ʻaʻole hiki ke lawe i nā mea pale TNF ma muli o nā kūlana e like me ka maʻi puʻuwai a i ʻole ka sclerosis maha (MS).
- ʻIxekizumab (Taltz)
- ʻO Secukinumab (Cosentyx)
Nā mea hoʻopaʻa JAK: Nā lāʻau lapaʻau hou e hiki ke lawe ʻia ma ke ʻano he mau pila
He ʻokoʻa kēia mai nā biologics. He hopena maikaʻi lākou no ka mea makemake ʻole i nā inikini, no ka mea, hele mai lākou ma ke ʻano pila. Hana lākou ma ke kuhikuhi ʻana i kahi ʻōnaehana enzyme i kapa ʻia ʻo Janus Kinase (JAK), ka mea e hoʻoulu ai i ka mumū.
- ʻO Tofacitinib (Xeljanz)
- ʻUpadacitinib (Rinvoq)
Nā DMARD Kuʻuna: Nā lāʻau lapaʻau i hoʻohana pinepine ʻia no nā hono peripheral
Hāʻawi ʻia kēia mau mea no ka ʻeha a me ka pehu ʻana i nā hono e like me nā lima, nā wāwae, nā pūhaka, a me nā kuli, ma mua o ka ʻeha ma ka iwi kuamoʻo.
- Methotrexate: Loaʻa kēia ma ke ʻano he pila a i ʻole ka inikini. Kōkua ia i ka pale ʻana i ka hōʻino ʻana i nā hono.
- Sulfasalazine (Azulfidine): He lāʻau lapaʻau kēia no nā hono peripheral a me IBD. Lawe ʻia ia ma ke ʻano he pila.
Pehea e koho ai ke kauka i ka DMARD kūpono nou?
Noʻonoʻo kāu kauka i kekahi mau kumu i ke koho ʻana i kahi lāʻau lapaʻau.
- Pehea ka koʻikoʻi o kou mau hōʻailona.
- Nā lāʻau lapaʻau āu i hoʻohana ai ma mua a me nā hopena āu i loaʻa mai iā lākou.
- Nā hopena ʻaoʻao o ka lāʻau lapaʻau i nīnau ʻia a pehea lākou e hoʻopilikia ai i kou olakino.
He aha nā hopena ʻaoʻao o kēia lāʻau lapaʻau?
E like me nā lāʻau lapaʻau āpau, hiki i nā DMARD ke loaʻa nā hopena ʻaoʻao. He mea liʻiliʻi kekahi, aʻo kekahi hiki ke koʻikoʻi. No laila e kamaʻilio me kāu kauka e pili ana i kēia mau mea ma mua o ka hoʻomaka ʻana i ka lāʻau lapaʻau.
- Nā mea pale biologics a me JAK: Hoʻolohi kēia i ka ʻōnaehana pale, e hoʻemi ana i ka hiki ke hakakā i nā maʻi. No laila, he mea nui e hōʻoia i ka loaʻa ʻana o kāu mau lāʻau pale āpau ma mua o ka hoʻomaka ʻana i kēia mau lāʻau.
- Hoʻāʻo ʻana no ka maʻi puʻupuʻu (TB): He mea nui e hoʻāʻo ʻia no ka maʻi puʻupuʻu (TB) ma mua o ka hoʻomaka ʻana i nā mea hoʻopaʻa TNF, no ka mea, hiki i kēia mau lāʻau lapaʻau ke hoʻāla hou i nā germs TB hiamoe i loko o kou kino.
- Nā hopena ʻaoʻao ʻē aʻe: Hiki ke ʻulaʻula ma kahi i inikini ʻia, ka ʻeha poʻo, a me ka ʻulaʻula o ka ʻili. Hiki i nā mea hoʻopaʻa IL-17 ke hoʻonui i ka IBD i kekahi manawa.
Nā hopena ʻaoʻao o nā DMARD kuʻuna
- Methotrexate: ʻO ka ʻeha o ka ʻōpū, nā ʻeha waha, a me ka helu haʻahaʻa o nā cell koko hiki ke hoʻoulu i nā maʻi, ke kuni, a me ka palapū. No ka hōʻemi ʻana i kēia mau mea, e hāʻawi kāu kauka iā ʻoe i nā papa waikawa folic. I ka wā e lawe ana i kēia lāʻau lapaʻau , pono ʻoe e loaʻa i nā hoʻāʻo koko i kēlā me kēia 1-3 mahina e nānā i kāu hana puʻupaʻa a me ke ake. ʻAʻole ʻōlelo ʻia kēia lāʻau lapaʻau i ka wā hāpai.
- Sulfasalazine: Hiki ke loaʻa ka nausea, ka luaʻi, ka ʻike i ka lā, nā ʻulaʻula ʻili, a me nā poʻo ʻeha. Hiki i kēia lāʻau lapaʻau ke hoʻololi i kou mimi, ka hou, a me nā waimaka i kala melemele-ʻalani. ʻAʻole ia he mea weliweli, akā hiki iā ia ke hoʻohaumia i nā lole.
ʻO ka mea nui loa, ʻaʻole e hopohopo inā loaʻa iā ʻoe kekahi mau hopena ʻaoʻao a e hoʻomaopopo koke i kāu kauka.
He aha ka mea e manaʻo ai i ka hoʻomaka ʻana o ka lāʻau lapaʻau?
ʻAʻole like ka hana a kēia mau lāʻau lapaʻau no nā kānaka a pau. E kiʻi i nā hopenaHiki ke hala kekahi mau pule a i ʻole hoʻokahi a ʻelua paha mahina. No laila he mea nui e hoʻomanawanui. Mai hoʻōki koke i ka lawe ʻana i ka lāʻau lapaʻau no ka mea ke manaʻo nei ʻoe ʻaʻole ia e hoʻomaikaʻi.
Eia kekahi, ʻoiai inā ua emi loa kāu mau hōʻailona, he mea nui loa ia e hoʻomau i ka lawe ʻana i kāu lāʻau lapaʻau no ka lōʻihi e like me ka ʻōlelo a kāu kauka iā ʻoe. Inā ʻoe e hoʻōki, hiki i ka maʻi ke hoʻāla hou.
Leka Lawe-Home
- ʻAʻole like nā DMARD me nā lāʻau ʻeha maʻamau. Ma waho aʻe o ka hōʻemi ʻana i ka ʻeha, kāohi pū lākou i ka holomua o ka maʻi a pale i ka hōʻino ʻana o nā hono.
- Aia nā ʻano lāʻau like ʻole, e like me nā biologics, nā mea hoʻopaʻa JAK, a me nā DMARD kuʻuna. Na kāu kauka e koho i ka lāʻau i kūpono loa i kou kūlana.
- Ma muli o ke kāohi ʻana o kēia mau lāʻau i ka ʻōnaehana pale, aia kahi pilikia o ka maʻi. He mea nui e hoʻāʻo ʻia no ka maʻi puʻupuʻu (TB) ma mua o ka hoʻomaka ʻana i nā mea hoʻopaʻa TNF.
- He manawa ka lōʻihi e ʻike ai i nā hopena, no laila e hoʻomanawanui i kāu lāʻau lapaʻau. ʻOiai inā e emi ana kāu mau hōʻailona, mai hoʻōki i ka lawe ʻana i ka lāʻau me ka ʻole o ke aʻo ʻana a kāu kauka.
- Inā loaʻa iā ʻoe kekahi hopena ʻaoʻao a i ʻole he pilikia, e kamaʻilio koke me kāu kauka.
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