Inokuvadza rheumatism, senge rheumatoid arthritis, asi zvakare ankylosing spondylitis, yevana chisingaperi arthritis kana psoriatic arthritis, inobata zviuru zvevanhu muFrance. Kukonzera marwadzo uye hurema hwekushanda pamwe chete nekuparadzwa, iyi rheumatism inogona kuve nemhedzisiro. Pakutanga yaingorapwa chete nemishonga seyakakosha kurapwa, biotherapies izvozvi zvasvika, zvichibvumira zvirinani zvakasarudzika manejimendi eichi chirwere.

Biotherapies inogadzirwa pachishandiswa zvipenyu, zvinozivikanwa nemajini ekugadzira. Naizvozvo vaongorori vakaona cytokine (protein yemasoja ekudzivirira chirwere), TNF-alpha, iyo inoshanda pamaitiro ekuzvimba. Aya ma biotherapies saka anovharira chiito, nenzira mbiri:

• monoclonal antibodies inodzivisa TNF alpha;
• inogadziriswa inogadziriswa inoita sekunyengera uye inobata iyi TNF.

Kusvika pari zvino, pane maantibhakitiriya maviri uye inogadziriswa soluble inowanikwa pamusika.

Mukutarisana nezvirwere zvekuzvimba, mushonga wakaita budiriro huru pamusoro pezana ramakore rapfuura:

• yakatanga kurapwa neasprini pakutanga kwezana ramakore rechi20, hosha dzekuzvimba dzakaderedzwa zvine mwero, kunyangwe zvisingakodzeri mhedzisiro yeaspirini;
• muma1950, cortisone yakaita shanduko yayo kusvika pakurapa kweanopisa. Nemhedzisiro mhedzisiro pane kuzvimba, zvisinei, haimise chirwere, uye ine akawanda asina kugadzikana mhedzisiro.
• ipapo, muma1970, kwaive kuvandudzwa kwekuvhiya kwemapfupa uko kwakaita kuti zvikwanisike kurapa vanhu vane hutachiona hwerheumatism, nekushandisa zvakananga majoini avo anowanzoparadzwa;
• ekutanga ekurapa kwezvinodhaka akasvika muma1980: methotrexate, iwo mumwe mushonga wakatemerwa mune oncology asi muyero yakadzikiswa, yaive inoshanda uye yairegererwa neruzhinji rwevarwere. Zvaifungidzirwa zvisirizvo kuti kurapwa uku kunongofanirwa kushandiswa senzira yekupedzisira; asi mamiriro emajoini akashata panguva yekurasikirwa nenguva, kazhinji makore maviri ekutanga. Nhasi, kurapwa uku kunoiswa nekukurumidza, pazviratidzo zvekutanga zvechirwere, kuitira kuchengetedza majoini. Iyi mishonga ine mukana wekusadhura: kutenderedza 80 euros pamwedzi ye methotrexate, inoshanda kwazvo, uye inoshanda mune chetatu chevarwere vane rheumatoid arthritis;
• Kubva pakupera kwema1990, manejimendi manejimendi ezvirwere izvi akachinja zvakanyanya nekumuka kwe biotherapies yakanangana nehutachiona, uye ichinzi inoshanda zvakanyanya. Parizvino gumi neshanu muhuwandu, ivo vari 100% yakafukidzwa neHutano Inishuwarenzi.

Kunyangwe paine njodzi dzakaratidzwa, mabhenefiti e biotherapies akasimbiswa.

Nepo makumi maviri kusvika makumi matatu muzana evarwere vasina kurerukirwa nemushonga wemushonga unofungidzirwa kuti unonyanya kushanda (methotrexate), zvinoonekwa kuti 20% yevarwere vanopindura zvakanaka kurapwa nebiotherapy. Iyo yakaipa mhedzisiro yezvirwere zvavo zvekuzvimba zvakadzikiswa zvakanyanya:

• kuneta;
• kurwadziwa;
• kuderedzwa kwekufamba.

Varwere vanowanzoona kurapwa uku sekuzvarwa patsva, apo vamwe vaifunga kuti vakatemerwa newiricheya kwehupenyu hwese.

Isu zvakare tinogadza bhenefiti ye biotherapies maererano nenjodzi yezvirwere zvemoyo: iyi njodzi ingadzikiswe neyakareruka chokwadi yekudzora chinhu chinopisa chirwere. Hupenyu hunotarisirwa nevarwere hunogona kuvandudzwa.

Chekupedzisira, ongororo yakaburitswa muLancet muna2008 yakasimudza tariro dzekuregererwa kwakakwana kwechirwere nekushandisa biotherapies. Iyo yekuregererwa mwero pasi pemethotrexate i28% uye inosvika makumi mashanu muzana kana iyo inogadzikana inogamuchirwa inosanganiswa ne methotrexate. Chinangwa chekuregererwa uku kuri kurapwa kunofanira kuteverwa nekudzikiswa zvishoma nezvishoma mumushonga, usati wawana kuregererwa kwakazara.

Nekudaro, TNF-alpha haisi cytokine sedzimwe: zvirokwazvo iine pro-yekuzvimba basa, inobatsirawo kurwisa hutachiona nekenza, nekuparadza cancer maseru. Nekubatisisa iyi morekuru, isu zvakare tinoshayisa simba muviri panjodzi yemamota.

Iyi njodzi dzakadzidzwa muzvidzidzo zvakawanda nemakiriniki ekuedzwa. Kutora zvese izvi zvidzidzo mukufunga, njodzi kenza yakayerwa zvakapetwa kaviri kana katatu uchishandisa monoclonal antibodies; uye njodzi yakawedzerwa ne1,8 nekushandisa iyo inogadziriswa anti-TNF receptor.

Nekudaro, pasi, chokwadi chinoratidzika kunge chakatosiyana: mumarejista evarwere veEuropean neAmerica vanoteverwa nekurapwa nebiotherapies, kuwedzera kwakadai kwegomarara hakuitike. Vanachiremba vanoramba vakasvinura pane ino pfungwa, nepo vachibvuma zvine mwero njodzi asi vanogumburwa nerubatsiro rwebiotherapy.

Nezve hutachiona, njodzi yekutapukirwa kwakakomba inofungidzirwa pa2% yevarwere pagore apo kuzvimba kunotanga (isingasviki mwedzi mitanhatu). Kana iri yechikuru, njodzi i6%. Mhedzisiro iyi inoratidza kuti biotherapy inoita kuti zvikwanise kudzikamisa njodzi idzi mukati mehuwandu hwehuwandu.

Kudzora njodzi iyi inotapukira kunosanganisira nzira dzekuongorora usati wapa anti-TNF kumurwere. Kuongororwa kwakazara kwekiriniki, kubvunzurudzwa uye kuongororwa kwakateedzana kuchadikanwa (kuwanda kweropa, transaminases, hepatitis serology (A, B, uye C), HIV mushure mokubvumirwa nemurwere, kuongorora pamwe nekuvandudza majekiseni, nhoroondo yetibhii.).

Varwere vanofanirwa kubaiwa jekiseni nefuruwenza uye pneumococcus vasati varapwa, uye voita kushanya mwedzi mumwe mushure mekunyora uyezve mwedzi mitatu yega yega, kuti vaone kushanda kwekurapa uye njodzi yehutachiona.