Matenda a nyamakazi, monga nyamakazi ya nyamakazi, komanso ankylosing spondylitis, nyamakazi ya ana kapena nyamakazi ya psoriatic, imakhudza anthu masauzande ambiri ku France. Kuchititsa ululu ndi kulemala kwa ntchito ndi kuwonongeka kwa mgwirizano, rheumatism iyi ikhoza kukhala ndi zotsatirapo zoopsa. Omwe amangotengedwa ndi mankhwala okhawo ngati chithandizo choyambirira, ma biotherapies tsopano afika, kulola kuwongolera kwamunthu payekhapayekha kwa matendawa.

Biotherapies amapangidwa pogwiritsa ntchito zamoyo, zomwe zimadziwika ndi genetic engineering. Choncho ochita kafukufuku anapeza cytokine (mapuloteni a chitetezo cha mthupi), TNF-alpha, yomwe imagwira ntchito zotupa. Ma biotherapies awa amalepheretsa zochita zake, mwa njira ziwiri:

• ma antibodies a monoclonal amalepheretsa TNF alpha;
• cholandirira chosungunuka chimagwira ntchito ngati chinyengo ndikutchera TNF iyi.

Mpaka pano, pali ma antibodies awiri ndi cholandilira chosungunuka chomwe chilipo pamsika.

Poyang'anizana ndi matenda otupa, mankhwala apita patsogolo kwambiri m'zaka zapitazi:

• poyamba ankachitira aspirin kumayambiriro kwa zaka za m'ma 20, matenda otupa anali ochepa pang'ono, ngakhale zotsatira zosafunika za aspirin;
• m'zaka za m'ma 1950, cortisone inapanga kusintha kwake pochiza njira yotupa. Ndi zotsatira zachangu pa kutupa, komabe, sizimayimitsa matendawa, ndipo zimakhala ndi zotsatira zambiri zosasangalatsa;
• ndiye, m'ma 1970, chinali chitukuko cha opaleshoni ya mafupa yomwe inachititsa kuti azitha kuchiza anthu omwe ali ndi rheumatism yotupa, pogwiritsa ntchito mwachindunji ziwalo zawo zowonongeka;
• mankhwala oyambirira oyambirira a mankhwala anafika m'zaka za m'ma 1980: methotrexate, mankhwala omwewo omwe amaperekedwa mu oncology koma pa mlingo wochepa, anali othandiza komanso olekerera odwala ambiri. Zinkaganiziridwa molakwika kuti mankhwalawa ayenera kugwiritsidwa ntchito ngati njira yomaliza; koma mkhalidwe wa mafupawo unasokonekera mkati mwa kutaya nthaŵi kumeneku, nthaŵi zambiri zaka ziwiri zoyambirira. Masiku ano, mankhwalawa amagwiritsidwa ntchito mwamsanga, pa zizindikiro zoyamba za matendawa, kuti asunge mafupa. Mankhwalawa ali ndi ubwino wokhala otsika mtengo: kuzungulira 80 euro pamwezi kwa methotrexate, yogwira mtima kwambiri, komanso yothandiza pa gawo limodzi mwa magawo atatu a odwala matenda a nyamakazi;
• Kuchokera kumapeto kwa zaka za m'ma 1990, kasamalidwe ka mankhwala a matendawa asintha kwambiri ndi kutuluka kwa ma biotherapies omwe akutsata njira zotupa, ndipo amadziwika kuti ndi othandiza kwambiri. Pakali pano khumi ndi asanu mwa chiwerengero, iwo ali 100% omwe ali ndi inshuwalansi ya umoyo.

Ngakhale zoopsa zomwe zawonetsedwa, mapindu a biotherapies amatsimikizika.

Ngakhale kuti 20 mpaka 30% ya odwala samatsitsimutsidwa ndi mankhwala omwe amawoneka kuti ndi othandiza kwambiri (methotrexate), akudziwika kuti 70% ya odwala amavomereza chithandizo chamankhwala ndi biotherapy. Zotsatira zoyipa za matenda awo otupa zidachepetsedwa kwambiri:

• kutopa;
• ululu;
• kuchepetsa kuyenda.

Odwala nthawi zambiri amapeza chithandizochi ngati kubadwanso, pamene ena ankaganiza kuti amayenera kuyenda panjinga za olumala moyo wawo wonse.

Timakhazikitsanso phindu la biotherapies ponena za chiopsezo cha matenda a mtima: chiopsezochi chikanachepetsedwa ndi mfundo yosavuta yochepetsera gawo lotupa la matendawa. Motero nthawi ya moyo wa odwala idzakhala yabwino.

Pomaliza, kafukufuku yemwe adasindikizidwa mu Lancet mu 2008 adadzutsa chiyembekezo choti matendawa athe kuthetsedwa pogwiritsa ntchito njira zamankhwala. Mlingo wokhululukidwa pansi pa methotrexate ndi 28% ndipo umafika 50% ngati cholandirira chosungunuka chikuphatikizidwa ndi methotrexate. Cholinga cha chikhululukiro ichi pansi pa chithandizo chiyenera kutsatiridwa ndi kuchepa kwapang'onopang'ono kwa mankhwala, musanayambe kukhululukidwa kwathunthu.

Komabe, TNF-alpha si cytokine monga enawo: ndithudi kukhala ndi gawo lothandizira kutupa, kumathandizanso kulimbana ndi matenda ndi khansa, powononga maselo a khansa. Pokola molekyuyi, timafooketsanso thupi kuti lisakhale ndi zotupa.

Zowopsa izi zaphunziridwa m'maphunziro ambiri ndi mayeso azachipatala. Kutengera maphunziro onsewa, chiopsezo khansa adayesedwa ngati kuwirikiza kawiri kapena katatu pogwiritsa ntchito ma antibodies a monoclonal; ndi chiwopsezo chochulukitsidwa ndi 1,8 pogwiritsa ntchito cholandilira anti-TNF chosungunuka.

Komabe, pansi, chowonadi chikuwoneka chosiyana kwambiri: m'mabuku a odwala a ku Ulaya ndi ku America omwe amatsatiridwa ndikuthandizidwa ndi biotherapies, kuwonjezeka kotere kwa khansa sikuchitika. Madokotala amakhalabe tcheru pamfundoyi, pomwe amavomereza chiwopsezo chochepa koma amachotsedwa ndi phindu la biotherapy.

Ponena za matenda, chiwopsezo cha matenda oopsa chikuyembekezeka 2% ya odwala pachaka pomwe kutupa kumayamba (osakwana miyezi 6). Ngati ndi wamkulu, chiopsezo ndi 5%. Zotsatirazi zikuwonetsa kuti biotherapy imapangitsa kuti zitheke kuchepetsa zoopsazi mkati mwa ziwerengero zomveka.

Kuwongolera chiopsezo chopatsiranachi kumaphatikizapo njira zowunikira musanapereke mankhwala oletsa TNF kwa wodwala. Kuyeza bwinobwino zachipatala, kuyankhulana ndi mndandanda wa mayesero adzakhala kofunika (kuwerengera magazi, transaminases, hepatitis serology (A, B, ndi C), HIV pambuyo pa chilolezo cha odwala, kuyang'anira ndi kukonzanso katemera, mbiri ya chifuwa chachikulu.

Choncho, odwala ayenera katemera fuluwenza ndi pneumococcus pamaso mankhwala, ndi maulendo mwezi umodzi pambuyo mankhwala ndiyeno miyezi itatu iliyonse, kuti aone mphamvu ya mankhwala ndi chiopsezo cha matenda.