Ke nāwaliwali nei hoʻi ʻoe? Malia paha he maʻi kēia i kapa ʻia ʻo myopathy!

Ke manaʻo nei ʻoe i kekahi manawa ua nāwaliwali a luhi kou mau lālā? Ke paʻakikī nei iā ʻoe ke hana i nā mea maʻalahi e like me ke ala ʻana mai kahi noho, hāpai i kahi mea kaumaha, a i ʻole ke kāhili ʻana i kou lauoho? Inā manaʻo ʻoe e nāwaliwali ana kou mau ʻiʻo me ke kumu ʻole, mai hoʻokuke wale iā ia me he mea maʻamau. Malia paha ke kumu o kēia mau hōʻailona he ʻano i kapa ʻia ʻo 'myopathy', a mākou e kamaʻilio nei i kēia lā. Mai hopohopo, e kamaʻilio mākou e pili ana i kēia ma ke ʻano maʻalahi e hiki ai iā ʻoe ke hoʻomaopopo.

He aha ka myopathy? I ka ʻōlelo maʻalahi...

ʻO ka myopathy, i ka ʻōlelo maʻalahi, he hui ia o nā maʻi e hoʻopilikia ai i nā ʻiʻo e pili ana i ko kākou mau iwi. Hoʻopōʻino kēia mau maʻi i ko kākou mau olonā ʻiʻo a hoʻonāwaliwali iā lākou. E like me ka nāwaliwali o ka ʻenekini o ke kaʻa, lilo ia i mea paʻakikī ke hoʻokele, ke nāwaliwali nā ʻiʻo, lilo ia i mea paʻakikī i ko kākou kino ke hana i nā hana o kēlā me kēia lā.

Aia kekahi ʻano like ʻole o ka myopathy?

ʻAe, hiki ke hoʻokaʻawale ʻia nā myopathies ma nā ʻano like ʻole. Ua māhele nui ʻia lākou i ʻelua mau māhele: nā myopathies hoʻoilina a me nā myopathies i loaʻa . E nānā kākou i kēlā me kēia ʻano.

He aha nā Myopathies i hoʻoilina ʻia?

ʻO kēia nā ʻano myopathy i hoʻokumu ʻia e ka hoʻoilina ʻana i kahi hoʻololi gene ʻano ʻē i loaʻa i loko o ko mākou kino i ka wā hānau, pinepine mai ko mākou makuahine a makuakāne paha.

• Nā myopathies hānau ʻole:

Hoʻomaka pinepine nā hōʻailona i ka wā hānau a i ʻole i ka wā kamaliʻi. Eia nō naʻe, hiki iā lākou ke ʻike ʻia i kekahi manawa i ka wā ʻōpio a i ʻole ma hope. ʻO kahi hiʻohiʻona kūikawā o kēia ʻano, ʻaʻole i kaupalena ʻia ka nāwaliwali i nā ʻiʻo kokoke i ke kikowaena o ke kino, akā hiki ke hoʻopilikia i nā ʻiʻo o ke kino holoʻokoʻa, a pinepine ka maʻi ʻaʻole holomua.

• Nā myopathies mitochondrial:

Loaʻa i ko kākou mau pūnaewele nā ​​hale hana liʻiliʻi i kapa ʻia ʻo mitochondria e hana ana i ka ikehu. Hoʻokumu ʻia kēia ʻano myopathy e kahi kīnā i loko o kēia mau mitochondria. Ma waho aʻe o ka nāwaliwali o nā ʻiʻo, hiki i kēia mau kūlana ke hoʻopilikia i nā ʻōnaehana ʻē aʻe, e like me ka puʻuwai, ka lolo, a me ka ʻōnaehana gastrointestinal. Hiki iā lākou ke ulu ma muli o nā hoʻololi genetic, inā he mōʻaukala ʻohana a ʻaʻole paha.

• Nā myopathies metabolic:

Hoʻokumu ʻia kēia myopathy e nā hemahema i loko o nā genes e hana ana i nā enzymes e kōkua i nā ʻiʻo e hana a neʻe pono. Hiki iā ia ke hana i ka luhi i ka wā hoʻoikaika kino, ʻeha ma nā poʻohiwi a me nā ʻūhā i ka wā e hoʻoikaika kino ana, a i ʻole kahi kūlana i kapa ʻia ʻo rhabdomyolysis, kahi e haki ai nā olonā ʻiʻo me ka ʻeha ʻole. I kekahi manawa hiki i nā hōʻailona ke hele mai a hele aku, me ka nāwaliwali o nā ʻiʻo a laila hoʻi i ka maʻamau.

• Nā maʻi ʻiʻo:

I kēia mau hihia, nāwaliwali mālie nā ʻiʻo a me ka mae ʻana ma muli o kahi ʻano ʻē a i ʻole ka nele o nā protein kākoʻo kūkulu e pono ai nā ʻiʻo. I kēlā me kēia hihia, ua hoʻopilikia ʻia nā lima a me/a i ʻole nā ​​wāwae i nā kekelē like ʻole. I kekahi manawa hiki ke hoʻopilikia ʻia nā ʻiʻo o nā maka a i ʻole ke alo.

He aha nā myopathies i loaʻa?

ʻO kēia nā ʻano myopathies e ulu aʻe ma hope o ke ola. Hiki ke hana ʻia e nā kumu like ʻole, me nā maʻi ʻē aʻe, nā maʻi ʻeha, ka ʻike ʻana i kekahi mau lāʻau lapaʻau, a me nā electrolyte imbalances i loko o ke kino.

• ʻO ka myopathy autoimmune/inflammatory:

ʻO ka mea e hana ʻia ma kēia, ʻo ia ka hoʻouka ʻana o ka ʻōnaehana pale ponoʻī o ko kākou kino i ko kākou mau ʻiʻo ponoʻī. ʻO ka hopena, ua hōʻino ʻia ka hana o nā ʻiʻo. Ua like ia me ko kākou mau pale ponoʻī e hoʻouka ana iā lākou iho.

• ʻO ka myopathy ʻawahia:

Hana ʻia kēia kūlana ke hoʻopilikia kahi mea ʻawahia a lāʻau lapaʻau paha i ke ʻano a i ʻole ka hana o nā ʻiʻo.

• Nā mea ʻawahia: ʻAila ʻona, toluene (kahi mea lele i loaʻa i nā mea e like me ka pena a kekahi poʻe e hanu ai e kiʻekiʻe).
• Nā lāʻau lapaʻau: Nā lāʻau lapaʻau immunotherapy inhibitor Checkpoint (e.g., pembrolizumab, nivolumab), corticosteroids (e.g., prednisone), nā lāʻau hoʻohaʻahaʻa cholesterol (statins), amiodarone, colchicine, chloroquine, antivirals a me nā protease inhibitors no ka maʻi HIV, omeprazole.

• Nā myopathy endocrine:

Hana ʻia kēia kūlana i ka wā e hoʻopilikia ai ka hana o nā hormones i loko o ko mākou kino i nā ʻiʻo.

• ʻO ke kinoea thyroid: ʻOiai ʻoi aku ka maʻamau o nā pae hormone thyroid haʻahaʻa (hypothyroidism), hiki ke loaʻa nā pilikia ma muli o ke kiʻekiʻe o nā pae hormone thyroid (hyperthyroidism).
• ʻO ke kelepa parathyroid: Hoʻonui ka Hyperparathyroidism i nā pae calcium i loko o ke koko.
• ʻO ke kelepa adrenal: ʻO ka maʻi ʻo Addison a me ka maʻi ʻo Cushing.

• Nā myopathies maʻi:

Hiki i nā maʻi like ʻole ke hoʻopilikia i ka hana o nā ʻiʻo.

• Nā maʻi viral: 'HIV', 'influenza', 'Epstein-Barr'.
• Nā maʻi bacteria: 'pyomyositis bacteria'.
• ʻO ka maʻi Lyme.
• Nā maʻi parasitic: 'trichinosis', 'toxoplasmosis', 'cysticercosis'.
• Nā maʻi fungal: Candida, Coccidiomycosis.

• Nā kaulike ʻole o ka electrolyte:

ʻO ka hoʻonui ʻia a i ʻole ka emi ʻana o nā pae o kekahi mau electrolytes koʻikoʻi i loko o ko mākou kino hiki ke hoʻopilikia i ka hana ʻana o nā ʻiʻo.

• Potassium: ua emi iho (`hypokalemia`), ua piʻi aʻe (`hyperkalemia`).
• Magnesium: Hoʻonui ʻia ('Hypermagnesemia').

• ʻO ka myopathy maʻi koʻikoʻi ma ka keʻena mālama koʻikoʻi:

He kūlana kēia e hoʻopilikia ai i nā lālā a me nā ʻiʻo hanu i ka poʻe maʻi nui a loaʻa ka lāʻau lapaʻau ma kahi keʻena mālama koʻikoʻi (ICU) . Hiki ke hana ʻia e ka noho paʻa ʻole no ka manawa lōʻihi a i ʻole ma ka hoʻohana ʻana i nā mea hoʻomaha ʻiʻo, corticosteroids, a me nā lāʻau hiamoe i hoʻohana ʻia i ka wā o ka lāʻau lapaʻau.

ʻO wai ka mea i ʻoi aku ka paʻakikī o ka loaʻa ʻana o ka myopathy? Pehea ka maʻamau o kēia maʻi?

Hiki i ka myopathy ke ulu i loko o kekahi, akā aia kekahi poʻe i kahi pilikia kiʻekiʻe iki aʻe.

Nā kumu e hoʻonui ai i ka pilikia:

• Inā loaʻa ka myopathy i kekahi o ka ʻohana, a laila nui ka manawa kūpono e hoʻoilina i kēia maʻi ma ke ʻano genetic.
• ʻOiai he kāne. Hoʻoili ʻia kekahi mau ʻano myopathy ma o ka chromosome X, no laila hiki iā lākou ke hoʻopilikia nui i nā kāne ma mua o nā wahine. Eia nō naʻe, ʻo nā ʻano myopathy congenital i hoʻoili ʻia ma o nā chromosome ʻē aʻe e hoʻopilikia like i nā kānaka āpau.
• Loaʻa i kahi maʻi autoimmune, metabolic, a i ʻole endocrine.
• ʻO ka ʻike ʻia ʻana i kekahi mau lāʻau lapaʻau a i ʻole nā ​​​​mea ʻawahia (e nānā i ka ʻāpana ma ka myopathy ʻawahia a mākou i kūkākūkā ai ma mua).

ʻOkoʻa ka laha o ka myopathy ma muli o ke ʻano. Eia kekahi laʻana, ʻo ka myopathy e ulu ana ma hope o ke ola:

• ʻOi aku ka maʻamau o nā myopathies inflammatory a me endocrine ma mua o nā ʻano ʻē aʻe, a ʻoi aku ka maʻamau o nā wahine ma mua o nā kāne.
• Ma waena o 9 a me 32 o kēlā me kēia 100,000 mau kānaka e ʻeha nei i nā myopathies inflammatory.
• Ma waena o 25% a me 79% o nā pākeke me ka hypothyroidism e hoʻomohala i nā hōʻailona e pili ana i nā ʻiʻo, akā ʻo ka nui o ka myopathy akaka e like paha me 10%.

ʻO nā myopathies congenital maʻamau ka muscular dystrophies, ʻoi aku ka nui o nā kāne.

• ʻO nā maʻi muscular dystrophies ʻo Duchenne a me Becker nā ʻano maʻamau, e hoʻopilikia ana ma kahi o 7 no 100,000 mau kānaka ma ka honua holoʻokoʻa.
• Hoʻopilikia nā maʻi mitochondrial i hoʻokahi i loko o 5,000 mau kānaka, a ʻo ka hapa nui o kēia mau mea e hoʻopilikia i nā ʻiʻo iwi.
• He mea kākaʻikahi loa nā ʻano ʻē aʻe o nā myopathies congenital.

No laila, he aha nā hōʻailona o ka myopathy?

He nui nā ʻano myopathy i loaʻa i kekahi mau hōʻailona maʻamau. Eia kēia mau mea:

• Ka nāwaliwali o nā ʻiʻo.ʻOi loa aku nā ʻiʻo o nā poʻohiwi, nā lima o luna, a me nā ʻūhā (ʻo ia nā mea i hoʻopilikia nui ʻia a koʻikoʻi loa).
• ʻO ka ʻūpā ʻana o nā ʻiʻo, ka ʻoʻoleʻa, a me nā spasms.
• Manaʻo koke i ka luhi i ka wā e hoʻoikaika kino ai a i ʻole e hana i kahi hana liʻiliʻi.
• Manaʻo make a nele i ka ikaika.

He aha ke ʻano maoli o ka myopathy?

I loko o nā myopathies he nui, nāwaliwali like nā ʻiʻo ma nā ʻaoʻao ʻelua o ke kino (symmetric). ʻO nā ʻiʻo kokoke i waenakonu o ke kino (nā ʻiʻo proximal), e like me nā poʻohiwi, nā lima o luna, nā pūhaka, a me nā ʻūhā, ua hoʻopilikia nui ʻia. ʻO ka hopena, hiki iā ʻoe ke ʻike i nā hōʻailona e like me:

• Ka paʻakikī e hana i nā hana o kēlā me kēia lā, e like me ka ʻauʻau ʻana, ke kāhiko ʻana, a me ke kāwili ʻana i kou lauoho.
• Ka paʻakikī ke ala aʻe mai kahi noho, piʻi i ke alapiʻi, a i ʻole ka hana ʻana i nā hana e pono ai ke piʻi ʻana ma luna o kou poʻo (e laʻa, ke hoʻololi ʻana i ke kukui uila ma ke kaupaku).
• Manaʻo e like me ka ʻūlū ʻana a me ka wili ʻana o nā ʻiʻo.
• Luhi koke nā ʻiʻo i ka wā e hana ai i kahi hana.
• Ka paʻakikī o ka hanu ʻana i ka wā hoʻoikaika kino.

ʻAʻole ia e hoʻopilikia pinepine i nā ʻiʻo o nā poho lima a me nā kapuwaʻi.

ʻOkoʻa nā hōʻailona ʻē aʻe ma muli o ke ʻano o ka myopathy.

• Hiki i ka nāwaliwali o nā ʻiʻo ke mau (ʻaʻole holomua) a i ʻole e holomua mālie. I kekahi mau maʻi, hiki i ka nāwaliwali o nā ʻiʻo ke hele mai a hele aku, a i nā manawa ʻē aʻe he ikaika maʻamau paha.
• Ka lohi o ka ulu ʻana o nā mākau neʻe (e like me ka hele wāwae, ka lele ʻana, ka piʻi ʻana i ke alapiʻi, ka paʻa ʻana i ka puna a i ʻole ka penikala) i nā keiki ʻōpio.
• ʻAʻole hiki ke hoʻomau me nā keiki ʻē aʻe i ka wā e pāʻani ana i nā haʻuki a i ʻole ke pāʻani ʻana ma waho (e.g., ke pāʻani hopu).
• Nā pilikia me nā ʻiʻo e kōkua ai i ka moni ʻana a me ka ʻōlelo ʻana. Hiki i kēia ke kumu e paʻa ai ka meaʻai a me ka ʻōlelo ʻana i ka leo ʻole.

He aha kaʻu e hana ai inā manaʻo wau he myopathy koʻu?

Inā loaʻa iā ʻoe kēia mau hōʻailona, ​​​​pono ʻoe e kamaʻilio mua me kāu kauka mālama mua. Ma muli o kāu mau hōʻailona, ​​​​hiki iā ia ke kuhikuhi iā ʻoe i kahi loea, e like me ke kauka neurologist a i ʻole ka rheumatologist.

Pehea e ʻike ʻia ai ka myopathy?

E nīnau aku kāu kauka iā ʻoe e pili ana i kou mōʻaukala olakino, inā paha ua loaʻa i kekahi o kou ʻohana nā maʻi like, nā lāʻau lapaʻau āu e lawe ai, a me kāu mau hōʻailona. A laila e hana lākou i kahi hoʻokolokolo kino. E nānā lākou i kou ʻili, nā reflexes, ka ikaika o nā ʻiʻo, ke kaulike, a me ka ʻike.

Nā ʻano hoʻokolohua a ke kauka e kauoha ai:

• Nā hoʻāʻo koko:
• I kekahi mau myopathies, hiki ke piʻi aʻe nā pae enzyme ʻiʻo e like me ka creatine kinase (CK) a i ʻole aldolase ma muli o ka haki ʻana o nā olonā ʻiʻo.
• Nā pae electrolyte e like me ka sodium, magnesium, potassium, calcium, a me ka phosphorus.
• Nā hoʻāʻo no nā maʻi autoimmune: No ka laʻana, `Antinuclear Antibodies (ANA), `Rheumatoid Factor', `Sedimentation Rate' a me `C-reactive protein'.
• Nā hoʻāʻo ʻana o nā kelepa endocrine: no ka laʻana, nā pae hormone thyroid.
• ʻO ka Electromyography (EMG) a me nā haʻawina hoʻoili nerve: Ke ana kēia mau hoʻokolohua i ke ʻano a me ka nui o ka hōʻino ʻana o nā ʻiʻo ma ke ana ʻana i ke ʻano o ka hele ʻana o ka uila ma o nā ʻiʻo a me ke kau ʻana i nā nila liʻiliʻi i loko o nā ʻiʻo.
• ʻO kahi hoʻāʻo magnetic resonance imaging (MRI) o nā ʻiʻo .
• Nā hoʻāʻo hoʻoilina.
• Biopsy ʻiʻo: Pili kēia i ka wehe ʻana i kahi ʻāpana liʻiliʻi o ka ʻiʻo ʻiʻo no ka hoʻokolokolo ʻana.

Pehea e mālama ʻia ai ka myopathy?

Ke ʻike ʻia ke ʻano kikoʻī o ka myopathy āu i loaʻa ai, e hoʻomohala kāu kauka i kahi hoʻolālā lapaʻau i kūpono i kāu mau hōʻailona.

ʻO ka hapa nui o nā lāʻau lapaʻau e pili ana i ka hoʻōla kino, ka hoʻōla hana, a me kekahi ʻano hoʻoikaika kino . ʻO nā lāʻau lapaʻau ʻē aʻe he kikoʻī i ke ʻano o ka myopathy. Ma keʻano laulā, hiki ke mālama maikaʻi ʻia ka hapa nui o nā myopathies i loaʻa, e hōʻemi ana i ka nāwaliwali a me nā hōʻailona. Loaʻa i kekahi mau myopathies hānau nā lāʻau lapaʻau kikoʻī e hiki ke hoʻolohi i ka holomua o ka maʻi. I kēia manawa, ʻaʻohe lāʻau lapaʻau kikoʻī no ka hapa nui o nā myopathies hānau, akā hiki i ka hoʻōla kino a me kekahi ʻano hoʻoikaika kino ke kōkua.

ʻO nā myopathies e pili ana i ka mumū a me ka autoimmune

ʻO ka pahuhopu o ka mālama ʻana no kēia mau mea, ʻo ia ka hōʻemi ʻana i ka mumū a me ka pane autoimmune o ke kino. ʻO nā lāʻau lapaʻau maʻamau no kēia mau myopathies:

• Nā lāʻau lapaʻau immunomodulatory/immunosuppressant: No ka laʻana, methotrexate, cyclosporine, tacrolimus, azathioprine, mycophenolate, rituximab, a me ka intravenous (IVIg) a i ʻole subcutaneous (SubQIg) immunoglobulin.
• ʻO nā `Corticosteroids`: No ka laʻana ʻo `prednisone` a i ʻole `methylprednisolone`.

Nā myopathies hoʻoilina a me nā genetics

ʻAʻohe lāʻau lapaʻau kūikawā a hoʻōla piha paha i nā myopathies congenital a me genetic.ʻO ke alakaʻi nui ʻana ma o ka kaohi ʻana i nā hōʻailona a me nā ʻano lapaʻau like ʻole. Ke hana ʻia nei kekahi mau hoʻokolohua lapaʻau ma nā wahi noiʻi like ʻole e pili ana i ka mālama ʻana a me ka lāʻau lapaʻau gene.

Hiki ke mālama ʻia nā kūlana i kapa ʻia ʻo Duchenne muscular dystrophy a me ka maʻi Pompe me nā lāʻau lapaʻau kikoʻī.

Nā myopathies i loaʻa ʻē aʻe

Hoʻōla nā kauka i nā myopathies i hoʻokumu ʻia e nā kumu endocrine, toxic, a me nā maʻi ma ka mālama ʻana i ka maʻi kumu i hoʻokumu ai i ka myopathy. Hoʻōla ʻia nā myopathies toxic ma ka hoʻōki ʻana i ka mea hana hewa (e.g., ka waiʻona, toluene) a i ʻole ka lāʻau lapaʻau (e.g., statins). ʻO nā hōʻailona ʻiʻo i hoʻokumu ʻia e nā bacteria, nā virus, a i ʻole nā ​​​​mea maʻi ʻē aʻe e hoʻomaikaʻi pinepine ʻia ke mālama pololei ʻia ka maʻi me nā antibiotics.

Pehea wau e mālama ai i koʻu olakino?

Inā he congenital, loaʻa, a i ʻole he maʻi lōʻihi (mau) ka myopathy, aia nā mea hiki iā ʻoe ke hana e mālama i kou olakino a hoʻokele i ke kūlana. ʻO kēia mau mea:

• E ʻai i ka ʻai maikaʻi a kaulike. E hoʻokomo i nā huaʻai a me nā mea kanu like ʻole i kāu papaʻai.
• E noho ikaika me ka hoʻoikaika kino cardiovascular mālie. Ma muli o kou ʻano myopathy, hiki ke aʻo ʻia ʻoe ʻaʻole e hana i kekahi mau ʻano hāpai kaumaha. No laila e kamaʻilio me kāu kauka ma mua o ka hoʻomaka ʻana i kekahi papahana hoʻoikaika kino.
• E mālama i ke kaumaha olakino.
• Inā loaʻa iā ʻoe kahi ʻili ʻulaʻula i hoʻokumu ʻia e ka dermatomyositis, e pale i kou ʻili mai ka lā. Hiki i kēia ke hoʻonui i ka ʻili. E ʻaʻahu i nā lole pale a me ka pāpale i nā manawa hiki. Mai poina e kau i ka sunscreen me ka liʻiliʻi o SPF 30 ma mua o ka hele ʻana i waho.
• Inā paʻakikī iā ʻoe ke ale, e ʻai i nā meaʻai palupalu a hapa paʻa paha. Hiki iā ʻoe ke hoʻomoʻa i kāu meaʻai. Inā he kanaka moe ʻoe, e ʻai me ka noho ʻana i luna ma kahi moe.
• E lawe i nā lāʻau lapaʻau a pau i kuhikuhi ʻia i ka manawa kūpono.
• Inā ʻōlelo ʻia nā lāʻau lapaʻau e like me ka physical therapy, ka occupational therapy, a i ʻole ka speech therapy, e komo i loko o lākou.

E hoʻomanaʻo, no ka mea, he nui nā ʻano o ka myopathy, pono kāu kauka e hoʻomohala i kahi hoʻolālā lapaʻau e pili pono ana i kou ʻano myopathy a me kāu mau hōʻailona. No laila, he mea nui e hahai pololei i kāna mau kuhikuhi. Eia kekahi, e makaʻala i kou kino. E hoʻomaopopo i nā loli i kou kūlana a i ʻole ke koʻikoʻi o kāu mau hōʻailona. E ʻike i kāu kauka ma kahi papa hana maʻamau (a i ʻole ma mua inā ʻike ʻoe i kekahi mau loli). Ma kēia ala, hiki iā ʻoe ke hana i nā hoʻololi i kāu hoʻolālā lapaʻau i ka wā e ʻike ʻia ai nā hōʻailona.

ʻO ka mea hope loa, nā mea nui e hoʻomanaʻo

ʻAʻole ia he mea e makaʻu ai ka myopathy, akā, ʻaʻole ia he kūlana e hoʻowahāwahā ʻia.

• Inā loaʻa iā ʻoe ka nāwaliwali mau o nā ʻiʻo, ka ʻeha, a i ʻole ka luhi, e ʻike pono i ke kauka.
• Nui nā ʻano myopathy, no laila he mea nui loa ka loaʻa ʻana o kahi hōʻoia pololei.
• Aia nā lāʻau lapaʻau a me nā ʻano hoʻokele no nā ʻano myopathy he nui.
• Ma ka hahai ʻana i nā ʻōlelo a kāu kauka, ka lawe ʻana i ka lāʻau lapaʻau i kuhikuhi ʻia, a me ke ola ʻana i kahi nohona olakino, hiki iā ʻoe ke ola i kahi ola maikaʻi me kēia maʻi.

Manaʻolana wau he kōkua kēia ʻike iā ʻoe. Inā he mau nīnau hou aku kāu, mai makaʻu e kamaʻilio me ke kauka i kēlā me kēia manawa.

ʻO ka myopathy, nāwaliwali o nā ʻiʻo, ʻeha ʻiʻo, nā maʻi hoʻoilina, nā maʻi autoimmune, nā hōʻailona ʻiʻo, ka mālama ʻana i ka myopathy