Litlhahiso tsa Tšebeliso ea DMARD le Litlhare tsa Biolotiki
Ka 2012, American College of Rheumatology (ACR) e ntlafalitse litlhahiso bakeng sa ho phekoloa ha ramatiki ea lefuba . Litlhahiso tsa ACR tsa 2012 bakeng sa tšebeliso ea lithethefatsi tse loantšang maloetse (DMARD) le mafu a biologic bakeng sa ramatiki ea lefuba ke tlhaloso ea likhoeletso tsa 2008.
Liphetoho tsa 2012 li lebisitsoe:
- lintlha tsa ho qala kapa ho fetola DMARD le lithethefatsi tsa biologic
- tšebeliso ea li-biologics e kotsing ea bakuli ba kotsing, ho kenyelletsa le ba nang le lefu la lefu la sebete, ho fokotsa pelo ea pelo, le ho bolaea batho
- Tlhahlobo ea lefuba bakeng sa bakuli ba qalang kapa hona joale ba nka lithethefatsi tsa biologic
- ho entoa ho bakuli ba qalang kapa hona joale ba nka DMARD kapa lithethefatsi tsa biolotiki
Litlhahiso tsena li ne li itšetlehile ka lipatlisiso tsa lingoliloeng tsa PubMed le Database ea Cochrane ea Tlhahlobo ea Ts'ebetso, tlhahlobo ea boemo ba tlhokomelo ea bongaka, le maikutlo a litsebi. Lingoliloeng li ile tsa batlisisoa ka li-DMARD tse 8: azathioprine (Imuran), cyclosporine , hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate , minocycline (Minocin), khauta le sulfasalazine (Azulfidine) le lithethefatsi tse 9 tsa biologic: abatacept (Orencia) , adalimumab (Humira), anakinra (Kineret), segerike sekolo (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituxab (Rituxan), leciliumumab (Actemra). Ka lebaka la tšebeliso e mpe ea lithethefatsi le ho hloka boitsebiso bo bocha bo fumanoeng lipatlisisong, azathioprine, cyclosporine, khauta le anakinra ha lia kenyelletsoa ho tsebiso.
Orencia, Rituxan, Kineret, le Actemra ke lithethefatsi tse seng tsa TNF tsa biologic. Enbrel, Remicade, Humira, Simponi, le Cimzia ke TNF blockers.
Bakeng sa bakuli ba nang le ramatiki ea lefu la pele (e hlalositsoeng e le lefu la ramatiki ea likhoeli tse ka tlaase ho 6) le bakuli ba nang le ramatiki ea lefuba ba tšoaroang ke leha e le efe DMARD kapa lithethefatsi tsa biologic, sepheo sa phekolo ke lefu le tlaase kapa le phoso.
Ho qala kapa ho fetola DMARD le Ditshebeletso tsa Biolotiki
- DMARD monotherapy (phekolo e nang le lithethefatsi e le 'ngoe) e khothalelitsoe ho batho ba pele ba nang le lefu la masapo a nang le mafu a fokolang kapa ba nang le bokooa bo bobebe kapa boemong bo bobe ha ho se na liketso tse bobebe tsa lefu lena.
- Phekolo ea meriana ea DMARD e khothalelitsoe ho bakuli ba ramatiki ba matšoao a matšoao a nang le tšoaetso e tloaelehileng kapa e phahameng le likarolo tse mpe tsa boleloa.
- Tšebeliso ea thipa ea TNF ka ntle le methotrexate e ne e khothalelitsoe ho bakuli ba ramatiki ba matšoao a pele a nang le maloetse a phahameng le likarolo tse bobebe tsa boprofeta. Haeba blocker ea TNF ke infliximab (Remicade), leha ho le joalo, e lokela ho sebelisoa le methotrexate.
- Bakeng sa bakuli ba nang le ramatiki ea lefuba, haeba ka mor'a likhoeli tse 3 tsa DMARD monotherapy mokuli a khaotsa ho tloha mesebetsing e fokolang ea maloetse ho ea boemong bo tloaelehileng ba lefu, methotrexate, hydroxychloroquine, kapa leflunomide (Arava) e lokela ho eketsoa.
- Kamor'a likhoeli tse tharo tsa methotrexate kapa methotrexate / DMARD phekolo e kopanetsoeng, eketsa e 'ngoe e seng methotrexate DMARD kapa e fetisetsa ho e' ngoe e seng methotrexate DMARD haeba mokuli ea tiisitsoeng a ntse a e-na le tšebetso e phahameng ea lefu - kapa a eketsa kapa a fetolela blocking ea TNF, abatacept ( Orencia), kapa rituximab (Rituxan).
- Kamor'a likhoeli tse 3 kalafo ea thibelo ea TNF, haeba mokuli a e-na le lefu le itekanetseng le le phahameng le amanang le ho haelloa ke karabelo kapa tahlehelo ea melemo ea phekolo, ho thibela sekhahla se seng sa TNF kapa sa TNF biologic ho khothalletsoa.
- Haeba ho na le tšebetso e fokolang kapa e phahameng ea lefu ka mor'a likhoeli tse 6 tsa kalafo le e seng TNF biologic ka lebaka la ho haelloa ke karabelo kapa tahlehelo ea melemo, mokuli o lokela ho fetisetsoa ho e fapaneng e sa ntseng e le ea TNF biologic kapa e thibelang TNF.
- Haeba mokuli a e-na le tšoaetso e phahameng 'me a hlōleha sekheo sa TNF ka lebaka la ketsahalo e tebileng, ho fetisetsoa ho e seng ea TNF biologic ho buelloa.
- Haeba mokuli a e-na le tšoaetso ea boemo bo itekanetseng le e phahameng 'me a hlōleha ho thibela thibelo ea TNF ka lebaka la ketsahalo e mpe, e se e buelloa ho thibela sefate se seng sa TNF kapa sa TNF biologic.
- Haeba mokuli a e-na le lefu la ho itekanetse kapa le phahameng ka mor'a hore a hlōlehe e seng TNF biologic ka lebaka la ketsahalo e bohloko, ho thibela ho thibela sekheo se seng sa TNF kapa ho thibela TNF.
Tšebeliso ea Biologics ho Rumatoid Arthritis Bakuli ba Nang le Lefu la Sefu, Malignancy, kapa ho Hlōleha ha Pelo ea Lelapa
- Ho khothalletsoa "Etanercept" (Enbrel) bakeng sa batho ba nang le lefu la masapo le lefu la lefu la hepatitis C.
- Lithethefatsi tsa li-biologic ha lia khothalletsoa bakeng sa batho ba nang le lefu la masapo a nang le lefu la sebete le sa foleng B kapa bakuli ba itseng ba nang le lefu la sebete la lefu la B.
- Ho qala kapa ho tsosolosa kalafo ea biologic ho khothalletsoa ho bakuli ba tšoaroang ka nako e telele ho feta lilemo tse hlano tse fetileng kapa bakeng sa bakuli ba phekoloang kankere ea letlalo la nonmelanoma ho feta lilemo tse hlano tse fetileng.
- TNF blockers ha e kgothaletswe bakeng sa batho ba nang le ramatiki ya ramatiki ba nang le boikokobetso ba pelo bo fokolang kapa bo bobebe.
Sefuba (TB) Ho hlahloba
- Ho hlahlojoa bakeng sa tšoaetso ea lefuba e latetseng ho khothalletsoa ho bakuli ba ramatiki ba lefu la masapo ba hlahlobang phekolo ea biologic.
- Ho sa tsotellehe lisosa tsa kotsi bakeng sa tšoaetso ea lefuba e latelang, tlhahlobo ea letlalo la tuberculin kapa tlhahlobo ea interferon-gamma-release e lokela ho etsoa ho bakuli ba itokiselitseng ho qala phekolo ea biologic.
Liente bakeng sa bakuli Ho qala kapa ho fumana DMARD kapa Likokoana-hloko tsa Bioloki
- Liente tse bolailoeng (pneumococcal, mafu a mafu, le lefu la hepatitis B), li-reincbinant (papillomavirus ea motho), le li-vaccine tse nang le litlhare tsa herpes zoster li lokela ho fuoa pele li qala DMARD kapa lithethefatsi tsa biologic.
- Haeba e se e sa etsoa, liente tse bolailoeng kapa tse hlahisitsoeng li lokela ho fuoa bakuli ba seng ba ntse ba nka DMARD kapa lithethefatsi tsa biologic.
- Go thibela ente ea herpes zoster ho ba seng ba ntse ba nka DMARD.
SEHLOOHO - 2015 MELAO ea ACR ea ho Phekola Ramatiki ea Ramatiki
Lataelo li ile tsa boela tsa phatlalatsoa ka 2015 e le tlhahiso ea tataiso ea 2012. Tataiso ea 2015 e akaretsa tšebeliso ea lithethefatsi tse tloaelehileng tsa ho loantša mafu (DMARD), mahlaseli a biologic, Xeljanz (tofacitinib) , le glucocorticoids mathoasong (likhoeli tse ka tlase ho likhoeli tse tšeletseng) le ho thehoa (likhoeli tse 6 kapa ho feta) lefu la ramatiki. E boetse e fanoe ka tataiso ea 2015 ke litlhahiso tsa ho sebelisa mokhoa oa ho phekola , ho khaola le ho khaotsa meriana, le tšebeliso ea lihlahisoa tsa biologic le DMARD ho bakuli ba nang le lefu la lefu la sebete, ho fokolloa ke pelo, ho bolaoa ke mafu le mafu a tebileng.
Tataiso e bua ka tšebeliso ea liente ho bakuli ba qalang kapa ba amohelang DMARD kapa lithethefatsi tsa biologic, ho hlahloba lefuba ho bakuli ba qalang kapa ba amohelang mahlahana a biologic kapa tofacitinib, le ho hlahloba lipatlisiso bakeng sa DMARD tsa setso. Moelelo ona o kenyelletsa likhothaletso tse 74 tseo 23% li nkoang li le matla 'me 77% li na le maemo. U ka e fumana mona: 2015 College of American Rheumatology Guideline bakeng sa Phekolo ea Ramatiki ea Ramatiki.
Mohloli:
Phetoho ea Likhakanyo tsa ACR tsa 2008 bakeng sa Tšebeliso ea DMARD le Biologics ho Phekolo ea Ramatiki ea Ramatiki. Tlhokomelo ea Ramatiki le Lipatlisiso. maq. 625-639. Singh JA le al. May 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract
2015 American College of Rheumatology Guideline bakeng sa Phekolo ea Rheumatoid Arthritis Singh JA et al. Tlhokomelo ea Ramatiki le Lipatlisiso DOI 10.1002 / acr.22783
http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf