Ka Hōʻoia Lapaʻau o nā Maʻi Autoimmune
ʻO nā maʻi Autoimmune kahi hui o nā maʻi kahi e hoʻouka ai ka ʻōnaehana pale - ka mea i manaʻo ʻia e pale i ke kino mai ka maʻi - i nā ʻiʻo ponoʻī o ke kino. ʻO kēia ka hopena i ka mumū mau loa e hiki ke hoʻopilikia i ka aneane o nā ʻōkana: ka ʻili, nā hono, ke koko, nā glands, nā māmā, nā puʻupaʻa, a me ka ʻōnaehana nerve. ʻO nā hiʻohiʻona kaulana o nā maʻi autoimmune e komo pū ana me ka systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ka maʻi thyroid autoimmune (Graves' lāua ʻo Hashimoto's), type 1 diabetes mellitus, multiple sclerosis, psoriasis, maʻi celiac, a me nā maʻi ʻōpū mumū e like me Crohn's a me ulcerative colitis. No ka mea, pinepine ʻole nā hōʻailona a hiki ke hoʻohālike i nā maʻi a i ʻole nā maʻi ʻē aʻe, ʻo ka ʻike lapaʻau o nā maʻi autoimmune e pono ai ke ala akahele a ʻōnaehana, a me ke koho ʻana i nā hoʻokolohua kākoʻo kūpono.
No ke aha he mea paʻakikī pinepine ka hoʻoholo ʻana i ka maʻi autoimmune?
ʻO ka pilikia nui ka ʻokoʻa o nā hōʻailona a me ke ʻano loli o ka maʻi (nā flares a me nā remissions). Hiki i kekahi maʻi ke hōʻike me ka luhi mau a me ka ʻeha iki o nā hono, aʻo kekahi e ʻike i nā ʻulaʻula ʻili, ke kuni, ka pohō kaumaha, a i ʻole ka hana ʻino o ke kino e like me ka nephritis. Eia kekahi, loaʻa i kekahi mau maʻi autoimmune nā hōʻailona like ʻole; no ka laʻana, hiki i ka maʻi Sjögren ke hōʻike me SLE a i ʻole scleroderma. Loaʻa i kekahi mau maʻi nā autoantibodies maikaʻi me ka ʻole o nā hōʻailona maopopo, no laila pono e wehewehe mau ʻia nā ʻike o ka hale hana ma ke ʻano lapaʻau.
Nā hana mua: anamnesis i kuhikuhi ʻia
Hoʻomaka pinepine kahi hōʻailona lapaʻau me kahi mōʻaukala piha. Pono ke kauka e ʻimi i ka hoʻopiʻi nui, ka lōʻihi, ke ʻano o ka hoʻi hou ʻana, nā mea hoʻoulu, a me ka hopena i nā hana o kēlā me kēia lā. ʻO ka luhi nui ʻaʻole i hoʻomaikaʻi me ka hoʻomaha, ke kuni haʻahaʻa e hoʻi hou ana, a me ka pohō kaumaha i wehewehe ʻole ʻia he mau hōʻailona ʻōnaehana e pono ke hoʻomaopopo ʻia.
Kōkua nā hōʻailona kikoʻī o ke kino i ke alakaʻi ʻana i ka kānalua. ʻO ka ʻeha hui like ʻole ma nā lima me ka ʻoʻoleʻa o ke kakahiaka e mau ana ma mua o 30-60 mau minuke e hōʻike paha i ka RA. ʻO kahi ʻulaʻula ʻano pepeke ma ka maka e ʻoi aʻe ka ʻino ma hope o ka lā, nā ʻeha waha e hoʻi hou ana, ka nalowale o ka lauoho, a me ka ʻeha hui e kānalua paha no ka SLE. ʻO nā maka maloʻo mau a me ka waha e hōʻike paha i ka maʻi Sjögren. ʻO ka maʻi kahe koko mau a i ʻole ka ʻeha ʻōpū mau e kuhikuhi paha i ka maʻi ʻōpū mumū. ʻO nā hoʻopiʻi o ka mae ʻana, ka nāwaliwali o nā wāwae, a i ʻole nā pilikia ʻike episodic e hāpai i ka nīnau o kahi maʻi autoimmune neurologic e like me ka sclerosis multiple.
He mea nui nō hoʻi ka mōʻaukala ʻohana, ʻoiai he kuleana ko ka predisposition genetic i nā maʻi autoimmune he nui. Eia kekahi, ʻo ka mōʻaukala o kekahi mau maʻi, ka ʻike ʻana i ka lāʻau lapaʻau, ka puhi paka, ke kaumaha, ke kaumaha postpartum, a me nā kūlana hormonal e pili ana paha me ka hoʻomaka ʻana a i ʻole ka ʻino ʻana o nā maʻi autoimmune i kekahi mau maʻi.
Hoʻokolokolo kino: e ʻimi ana i nā hōʻailona o ka mumū a me ke komo ʻana o ke kino
ʻO ka pahuhopu o ka hoʻokolohua kino ke ʻike i nā hōʻike o ka mumū, loiloi i ka pili ʻana o nā ʻōkana, a kāpae i nā hōʻailona ʻokoʻa. E loiloi ke kauka i nā hōʻailona koʻikoʻi (ke kuni, ke koko), e nānā i nā ʻōhū (e.g., ka ʻōhū photosensitivity, purpura), nā ʻeha waha, nā lymph node i hoʻonui ʻia, a me nā hōʻailona o ka anemia e like me ka pallor.
I loko o ka ʻōnaehana musculoskeletal, ʻo ka nānā ʻana i ka palupalu, ka pehu ʻana o nā hono, ka palena o ka neʻe ʻana, ke ʻano ʻino, a i ʻole nā nodules rheumatoid e kōkua i ka hoʻokaʻawale ʻana i ka mumū o nā hono mai ka ʻeha mechanical. I loko o ke kelepa thyroid, ʻo ka hoʻonui ʻia ʻana, ka haʻalulu, a i ʻole ka bradycardia e hōʻike ana i ka maʻi thyroid autoimmune. Pono nā hoʻokolohua pulmonary, cardiac, a me ka ʻōpū no ka mea hiki i nā maʻi autoimmune ke hoʻoulu i ka pleural effusion, pericarditis, hepatosplenomegaly, a i ʻole ka ʻeha ʻōpū mumū. Loiloi kahi hoʻokolohua neurological i ka ikaika, nā reflexes, ka manaʻo, a me ka hoʻonohonoho ʻana, ʻoiai inā loaʻa nā hōʻailona neurological.
Nā hoʻokolohua hoʻokolohua maʻamau: loiloi i ka mumū a me kona hopena
Ke kānalua ʻia kahi maʻi autoimmune, ʻo nā hoʻokolohua hoʻokolohua mua e komo pū me kahi hoʻāʻo koko, ka erythrocyte sedimentation rate (ESR) a i ʻole C-reactive protein (CRP), nā hoʻokolohua hana puʻupaʻa a me ke ake, urinalysis, a me kahi ʻikepili metabolic. Hiki ke loaʻa ka anemia, leukopenia, a i ʻole thrombocytopenia i ka SLE a i ʻole nā maʻi hematologic autoimmune ʻē aʻe. ʻO kahi ESR/CRP kiʻekiʻe e hōʻike paha i ka mumū, ʻoiai kekahi mau kūlana autoimmune e loaʻa paha kahi CRP kiʻekiʻe iki ʻoiai ka hana ikaika.
He mea nui ka urinalysis no ka ʻike ʻana i ka proteinuria a i ʻole hematuria e hōʻike ana i ka pili ʻana o nā puʻupaʻa, e like me ka lupus nephritis. Pono paha kahi hoʻāʻo ratio protein/creatinine mimi a i ʻole kahi hōʻiliʻili mimi 24-hola e hoʻoholo ai i ke kiʻekiʻe o ka proteinuria.
Nā Autoantibodies a me ka hoʻāʻo immunological: kī akā ʻaʻole hoʻokahi wale nō
He mea nui ka hoʻāʻo ʻana o ka autoantibody i ka ʻike ʻana, akā pono e hoʻomaopopo ʻia kona mau palena. Hoʻohana pinepine ʻia nā antibodies antinuclear (ANA) ma ke ʻano he mau hoʻāʻo nānā no ka SLE i manaʻo ʻia, ka maʻi Sjögren, ka maʻi ʻiʻo pili i hui ʻia, a me ka scleroderma. ʻAʻole hōʻike koke kahi ANA maikaʻi i kahi maʻi autoimmune, no ka mea hiki ke loaʻa i kekahi poʻe olakino, ʻoi aku hoʻi ma nā titers haʻahaʻa. I ka ʻaoʻao ʻē aʻe, ʻo ka ANA maikaʻi ʻole e hoʻemi i ka hiki o kekahi mau hōʻailona, e like me SLE, ʻoiai ʻaʻole ia e kāpae i ka hiki.
Kōkua nā autoantibodies kikoʻī hou aku i ka hōʻoia ʻana i ka maʻi, e like me ka anti-dsDNA a me ka anti-Sm ma SLE; anti-CCP a me ka rheumatoid factor ma RA; anti-Ro/SSA a me anti-La/SSB ma Sjögren's; anti-centromere a i ʻole anti-Scl-70 ma scleroderma; a me ANCA ma kekahi vasculitis. He mea pono nō hoʻi ka hoʻāʻo ʻana i ka hoʻopihapiha (C3, C4), ʻoi aku hoʻi ma SLE, no ka mea hiki ke emi iho i ka wā o ka maʻi ikaika.
Eia nō naʻe, pono e noʻonoʻo mau ka wehewehe ʻana i nā hōʻailona, nā ʻike o ka hoʻokolokolo kino, a me nā ʻike kākoʻo ʻē aʻe. Hiki i nā autoantibodies ke lilo i "clue," akā ʻaʻole pono e hoʻokumu ʻia kahi hōʻailona ma kahi hopena hoʻokahi.
Nā hoʻokolohua kiʻi a me nā kaʻina hana kūikawā
Kōkua ke kiʻi ʻana i ka loiloi ʻana i ka pōʻino o nā kino a hoʻokaʻawale i ka mumū mai nā kūlana ʻē aʻe. Hiki i nā kukuna X, ka ultrasound hui, a i ʻole MRI ke loiloi i ka synovitis, ka ʻino o ka iwi, a me ke komo ʻana o nā ʻiʻo palupalu i ka arthritis mumū. No ka komo ʻana o ka pulmonary, hiki i kahi scan CT umauma ke loiloi i ka maʻi interstitial lung, hiki ke hana ma scleroderma, RA, a i ʻole myositis. Pono paha ka Echocardiography inā kānalua ʻia ka pericarditis a i ʻole ka pulmonary hypertension.
Pono kekahi mau hihia i kahi biopsy e hōʻoia i ka hōʻailona a i ʻole e loiloi i ka nui o ka pōʻino, e like me ka biopsy kidney i ka lupus nephritis i manaʻo ʻia, kahi biopsy ʻili i ka vasculitis a i ʻole cutaneous lupus, a me kahi biopsy ʻōpū i ka maʻi celiac a i ʻole ka maʻi ʻōpū mumū. He mea nui kēia mau kaʻina hana no ka mea hiki i nā hopena ke hoʻoholo i nā koho lapaʻau a me ka prognosis.
Nā pae hoʻohālikelike a me ka hōʻailona ʻokoʻa
No kekahi mau maʻi, aia nā pae hoʻokaʻawale honua (e.g., ACR/EULAR) e hoʻomaʻamaʻa i ka hoʻohālikelike ʻana, ʻoi aku hoʻi i ka noiʻi a me ka hana lapaʻau. ʻOiai ʻaʻole hoʻokahi "mea hana diagnostic," hiki i kēia mau pae ke alakaʻi i nā kauka i ka loiloi ʻana i ka hui pū ʻana o nā hōʻailona, ka hoʻokolokolo kino, nā autoantibodies, a me nā ʻike kākoʻo.
Pono e noʻonoʻo mau ʻia nā maʻi ʻokoʻa. ʻO nā maʻi maʻi mau (tuberculosis, hepatitis, HIV), nā maʻi hematologic, nā hopena lāʻau, nā maʻi endocrine, a me ka fibromyalgia hiki ke hoʻohālike i nā hōʻailona autoimmune. Ma muli o ka hoʻohana pinepine ʻana o ka lāʻau autoimmune i nā immunosuppressants, he mea nui ka kāpae ʻana i nā maʻi hana a me nā kūlana ʻē aʻe e hiki ke hoʻonui me ka hoʻopau ʻana i ka pale ʻana.
E hoʻoholo i ka hana a ka maʻi a me ke komo ʻana o ke kino
Ma waho aʻe o ka hoʻoholo ʻana i ke ʻano o ka maʻi, loiloi pinepine nā kauka i ke kiʻekiʻe o ka hana a me nā ʻōkana e pili ana. Hoʻopili kēia i ka wikiwiki a me ka ikaika o ka lāʻau lapaʻau. No ka laʻana, ʻokoʻa ka mālama ʻana i ka arthritis liʻiliʻi ma SLE ma mua o ka lupus nephritis a i ʻole ke komo ʻana o ka ʻōnaehana nerve waena. Hiki i ka loiloi hana ke hoʻohana i nā helu kikoʻī (e.g., no SLE a i ʻole RA), me nā palena hoʻokolohua e like me ka complement, anti-dsDNA, CRP, a me nā ʻike lapaʻau.
Ke kuleana o ka laulima ʻana a me ka hahai ʻana
ʻO ka ʻike ʻana i nā maʻi autoimmune e koi pinepine i ka laulima ʻana o nā ʻoihana like ʻole: ka lāʻau lapaʻau kūloko—rheumatology, dermatology, neurology, nephrology, gastroenterology, a me hematology. ʻAʻole ia he mea maʻamau ka maopopo ʻana o ka ʻike ma hope o ka nānā mau ʻana, ʻoiai ʻo kekahi mau maʻi e hōʻike mua ana i nā hōʻailona liʻiliʻi wale nō. No laila, ʻo ka hahai ʻana i hoʻonohonoho ʻia, ka palapala hōʻailona, a me ka loiloi hou ʻana o nā hoʻokolohua hale hana he ʻāpana ia o ke kaʻina hana diagnostic.
Pani
ʻO ka ʻike lapaʻau o ka maʻi autoimmune he hana multistep e hoʻohui i kahi mōʻaukala i kālele ʻia, kahi hoʻokolokolo kino kikoʻī, ka loiloi hale hana maʻamau, ka hoʻāʻo autoantibody koho, a me ke kiʻi ʻana a me ka biopsy inā pono. Aia nā pilikia nui i ke ʻano kikoʻī ʻole o nā hōʻailona, nā ʻano maʻi e loli mau ana, a me ka hiki ke hoʻopili ʻia ma waena o nā syndromes. ʻO nā kī i ka holomua, ʻo ia ka wehewehe ʻana i kēlā me kēia hopena hoʻāʻo i loko o ka pōʻaiapili lapaʻau o ka mea maʻi, ka hoʻopau ʻana i nā ʻike ʻokoʻa hiki ke hōʻino, a me ka hana ʻana i ka hahai lōʻihi. Me ka ʻike pololei, hiki ke hoʻopilikino ʻia ka lāʻau lapaʻau e kāohi i ka mumū, pale i ka hōʻino ʻana o nā kino, a hoʻomaikaʻi i ke ʻano o ke ola o ka mea maʻi.
