Isifo samathambo esivuvukalayo, esifana ne-rheumatoid arthritis, kodwa ne-ankylosing spondylitis, isifo samathambo esingelapheki sezingane noma isifo samathambo se-psoriatic, sithinta izinkulungwane zabantu eFrance. Ukubangela ubuhlungu nokukhubazeka okusebenzayo ngokubhujiswa okuhlangene, le rheumatism ingaba nemiphumela emibi kakhulu. Ngaphambilini yayiphathwa kuphela ngezidakamizwa njengokwelashwa okuyisisekelo, ama-biotherapies manje asefikile, okuvumela ukuphathwa komuntu siqu kwalesi sifo.

I-Biotherapies ithuthukiswa kusetshenziswa izinto eziphilayo, ezikhonjwe ngobunjiniyela bezakhi zofuzo. Ngakho-ke abacwaningi bahlonze i-cytokine (iphrotheni yesimiso sokuzivikela komzimba), i-TNF-alpha, esebenza ngezinqubo zokuvuvukala. Lawa ma-biotherapies avimba isenzo sawo, ngezindlela ezimbili:

• amasosha omzimba e-monoclonal avimbela i-TNF alpha;
• i-soluble receptor isebenza njenge-decoy futhi icupha le TNF.

Kuze kube manje, kunamasosha omzimba amabili kanye nesamukeli esincibilikayo esitholakala emakethe.

Lapho kubhekene nezifo ezivuvukalayo, imithi yenze intuthuko enkulu phakathi nekhulu leminyaka elidlule:

• ekuqaleni belashwa nge-aspirin ekuqaleni kwekhulu lama-20, izifo ezivuvukalayo zancishiswa ngokulinganisela, naphezu kwemiphumela engathandeki ye-aspirin;
• ngawo-1950, i-cortisone yenza ukufika kwayo okuguquguqukayo ekwelapheni inqubo yokuvuvukala. Ngemiphumela esheshayo yokuvuvukala, noma kunjalo, akuvimbi lesi sifo, futhi kunemiphumela emibi eminingi engakhululekile;
• khona-ke, ngawo-1970, kwaba ukuthuthukiswa kokuhlinzwa kwamathambo okwenza kwaba nokwenzeka ukwelapha abantu abane-rheumatism evuthayo, ngokusebenza ngokuqondile amalunga abo avame ukubhujiswa;
• imithi yokuqala yokwelapha eyisisekelo yafika ngeminyaka yawo-1980: i-methotrexate, umuthi ofanayo owawunqunywe ku-oncology kodwa ngesilinganiso esincishisiwe, yayisebenza kahle futhi yabekezelelwa iningi leziguli. Kwakucatshangwa ngokungalungile ukuthi lokhu kwelashwa kufanele kusetshenziswe kuphela njengendlela yokugcina; kodwa isimo samalunga sawohloka phakathi nalokhu kulahlekelwa isikhathi, ngokuvamile eminyakeni emibili yokuqala. Namuhla, lokhu kwelashwa kusetshenziswa ngokushesha, ngezibonakaliso zokuqala zesifo, ukuze kugcinwe amalunga. Le mithi inenzuzo yokungabizi: cishe ama-euro angu-80 ngenyanga nge-methotrexate, ephumelela kakhulu kubo, futhi ephumelelayo engxenyeni yesithathu yeziguli ezine-arthritis ye-rheumatoid;
• Kusukela ekupheleni kweminyaka yawo-1990, ukuphathwa kwezidakamizwa kwalezi zifo kuye kwashintsha kakhulu ngokuvela kwezindlela zokwelapha eziqondiswe kuzinqubo zokuvuvukala, futhi kuthiwa zisebenza kangcono kakhulu. Njengamanje ziyishumi nanhlanu ngenani, zikhavwe ngo-100% kuMshwalense Wezempilo.

Naphezu kwezingozi eziveziwe, izinzuzo ze-biotherapies zisungulwe kahle.

Nakuba u-20 kuya ku-30% weziguli ungakhululekanga ngokwelashwa kwezidakamizwa okubhekwa njengokuphumelela kakhulu (i-methotrexate), kuphawulwe ukuthi u-70% weziguli usabela kahle ekwelashweni nge-biotherapy. Imiphumela emibi yezifo zabo ezivuthayo yancipha kakhulu:

• ukhathele;
• ubuhlungu;
• ukuhamba okuncishisiwe.

Iziguli zivame ukubhekana nalokhu kwelashwa njengokuzalwa kabusha, lapho abanye babecabanga ukuthi bayohlala ezihlalweni zabakhubazekile ukuphila kwabo konke.

Siphinde sisungule inzuzo ye-biotherapies mayelana nengozi yezifo zenhliziyo: le ngozi izoncishiswa ngeqiniso elilula lokunciphisa ingxenye yokuvuvukala yesifo. Ngaleyo ndlela iminyaka yokuphila yeziguli izothuthukiswa.

Ekugcineni, ucwaningo olwanyatheliswa kuyi-Lancet ngo-2008 lwaphakamisa amathemba okuthi lesi sifo sixole ngokuphelele ngokusebenzisa ama-biotherapies. Izinga lokuxolelwa ngaphansi kwe-methotrexate lingama-28% futhi lifinyelela ku-50% uma i-soluble receptor ihlanganiswa ne-methotrexate. Inhloso yalokhu kuxolelwa ngaphansi kokwelashwa kufanele kulandelwe ukuncipha kancane kancane kwemithi, ngaphambi kokuthola ukukhululwa okuphelele.

Kodwa-ke, i-TNF-alpha ayiyona i-cytokine njengamanye: ngempela ukuba nendima ye-pro-inflammatory, iphinde isize ukulwa nezifo nomdlavuza, ngokubhubhisa amangqamuzana omdlavuza. Ngokubamba le molekyuli, senza futhi umzimba ube buthaka ngokumelene nengozi yezimila.

Lezi zingozi zihlolisiswe ocwaningweni oluningi ngezivivinyo zomtholampilo. Uma kubhekwa zonke lezi zifundo, ingozi anomdlavuza kukalwa njengokuphindwe kabili noma kathathu kusetshenziswa amasosha omzimba e-monoclonal; kanye nengozi ephindwe ngo-1,8 ngokusebenzisa isamukeli esincibilikayo se-anti-TNF.

Kodwa-ke, phansi, iqiniso libonakala lihluke kakhulu: kumarejista eziguli zaseYurophu naseMelika ezilandelwa futhi zelashwa nge-biotherapies, ukwanda okunjalo komdlavuza akwenzeki. Odokotela bahlala beqaphile kuleli phuzu, kuyilapho bevuma ubungozi obusesilinganisweni kodwa baxazululwa yinzuzo ye-biotherapy.

Ngokuphathelene nezifo, ingozi yokutheleleka okukhulu ilinganiselwa ku-2% weziguli ngonyaka lapho ukuvuvukala kuqala (ngaphansi kwezinyanga ezingu-6). Uma isikhulile, ingozi ingu-5%. Le miphumela ibonisa ukuthi i-biotherapy yenza kube nokwenzeka ukukhawulela lezi zingozi ngaphakathi kwezibalo ezifanele.

Ukulawula le ngozi ethathelwanayo kuhilela amasu okuhlola ngaphambi kokunikeza isiguli i-anti-TNF. Ukuhlolwa okuphelele komtholampilo, inhlolokhono kanye nochungechunge lokuhlolwa kuyodingeka (ukubalwa kwegazi, ama-transaminase, i-hepatitis serology (A, B, no-C), i-HIV ngemva kwemvume yesiguli, ukuqapha nokubuyekezwa kwemigomo, umlando wesifo sofuba. ).

Ngakho-ke iziguli kufanele zigonyelwe umkhuhlane kanye ne-pneumococcus ngaphambi kokwelashwa, futhi zivakashele inyanga eyodwa ngemva kwencwadi kadokotela bese emva kwezinyanga ezintathu, ukuze zihlole ukusebenza kokwelashwa kanye nobungozi bokutheleleka.