{"id":17893,"date":"2023-04-11T05:52:35","date_gmt":"2023-04-10T22:52:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17893"},"modified":"2023-04-13T18:16:34","modified_gmt":"2023-04-13T11:16:34","slug":"viem-khop-dang-thap-tu-chan-doan-den-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/viem-khop-dang-thap-tu-chan-doan-den-dieu-tri\/","title":{"rendered":"Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p: t\u1eeb ch\u1ea9n \u0111o\u00e1n \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd kh\u1edbp m\u00e3n t\u00ednh, th\u01b0\u1eddng g\u00e2y ra \u0111au, s\u01b0ng v\u00e0 bi\u1ebfn d\u1ea1ng kh\u1edbp. Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh l\u00fd n\u00e0y v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng, tuy nhi\u00ean c\u00e1c y\u1ebfu t\u1ed1mi\u1ec5n d\u1ecbch v\u00e0 m\u00f4i tr\u01b0\u1eddng \u0111\u01b0\u1ee3c cho l\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a b\u1ec7nh. Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c khi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 d\u00f9ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p gi\u1eefa thu\u1ed1c, t\u1eadp luy\u1ec7n v\u00e0 ch\u0103m s\u00f3c kh\u1edbp.<\/strong><\/p>\n<figure id=\"attachment_17977\" aria-describedby=\"caption-attachment-17977\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-17977 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190905_160432_775536_viem_khop_dang_thap.max-1800x1800-1-300x186.jpg\" alt=\"\" width=\"300\" height=\"186\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190905_160432_775536_viem_khop_dang_thap.max-1800x1800-1-300x186.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190905_160432_775536_viem_khop_dang_thap.max-1800x1800-1.jpg 660w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-17977\" class=\"wp-caption-text\">Bi\u1ebfn d\u1ea1ng kh\u1edbp l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh<\/figcaption><\/figure>\n<h2>1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/h2>\n<h3>1.1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n theo H\u1ed9i Th\u1ea5p kh\u1edbp h\u1ecdc Hoa K\u1ef3 (ACR 1987):<\/h3>\n<p>\u0110\u1ed9 nh\u1ea1y 91-94% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 89% tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p \u0111\u00e3 ti\u1ebfn tri\u1ec3n<\/p>\n<ul>\n<li>C\u1ee9ng kh\u1edbp bu\u1ed5i s\u00e1ng: k\u00e9o d\u00e0i tr\u00ean 1 gi\u1edd.<\/li>\n<li>Vi\u00eam t\u1ed1i thi\u1ec3u 3 trong s\u1ed1 14 nh\u00f3m kh\u1edbp sau: ng\u00f3n tay g\u1ea7n, b\u00e0n ng\u00f3n tay, c\u1ed5 tay, khu\u1ef7u, g\u1ed1i, c\u1ed5 ch\u00e2n, b\u00e0n ng\u00f3n ch\u00e2n (2 b\u00ean).<\/li>\n<li>Trong \u0111\u00f3 \u00edt nh\u1ea5t m\u1ed9t kh\u1edbp thu\u1ed9c v\u1ecb tr\u00ed sau: ng\u00f3n g\u1ea7n, b\u00e0n ng\u00f3n tay, c\u1ed5 tay.<\/li>\n<li>Vi\u00eam kh\u1edbp \u0111\u1ed1i x\u1ee9ng.<\/li>\n<li>H\u1ea1t d\u01b0\u1edbi da (n\u1ed1t th\u1ea5p).<\/li>\n<li>Y\u1ebfu t\u1ed1 th\u1ea5p RF (+).<\/li>\n<li>D\u1ea5u hi\u1ec7u X-quang kh\u1edbp \u0111i\u1ec3n h\u00ecnh<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi: c\u00f3 \u2265 4 ti\u00eau chu\u1ea9n v\u00e0 ti\u00eau chu\u1ea9n 1 &#8211; 4 k\u00e9o d\u00e0i \u00edt nh\u1ea5t 6 tu\u1ea7n.<\/li>\n<\/ul>\n<h3>1.2. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n theo Li\u00ean \u0111o\u00e0n ch\u1ed1ng Th\u1ea5p kh\u1edbp ch\u00e2u \u00c2u (EULAR 2010)<\/h3>\n<p>Ti\u00eau chu\u1ea9n n\u00e0y c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam kh\u1edbp \u1edf giai \u0111o\u1ea1n s\u1edbm, tr\u01b0\u1edbc 6 tu\u1ea7n. Tuy nhi\u00ean c\u1ea7n theo d\u00f5i s\u00e1t t\u00ecnh tr\u1ea1ng ti\u1ebfn tri\u1ec3n b\u1ec7nh sau khi \u0111\u00e3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o ti\u00eau chu\u1ea9n n\u00e0y.<\/p>\n<p>A. Kh\u1edbp t\u1ed5n th\u01b0\u01a1ng \u00a0\u00a0\u00a0 \u0110i\u1ec3m<br \/>\n+ 1 kh\u1edbp l\u1edbn: \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 0<br \/>\n+ 2 &#8211; 10 kh\u1edbp l\u1edbn: \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 1<br \/>\n+ 1 &#8211; 3 kh\u1edbp nh\u1ecf: \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a02<br \/>\n+ 4 &#8211; 10 kh\u1edbp nh\u1ecf: \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 3<br \/>\n+ &gt; 10 kh\u1edbp nh\u1ecf: \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 5<\/p>\n<p>B. X\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch (\u00edt nh\u1ea5t ph\u1ea3i th\u1ef1c hi\u1ec7n m\u1ed9t x\u00e9t nghi\u1ec7m)<br \/>\n&#8211; C\u1ea3 RF v\u00e0 Anti CCP \u00e2m t\u00ednh \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a00<br \/>\n&#8211; RF ho\u1eb7c Anti CCP d\u01b0\u01a1ng t\u00ednh th\u1ea5p \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a02<br \/>\n&#8211; RF ho\u1eb7c Anti CCP d\u01b0\u01a1ng t\u00ednh cao \u00a0 \u00a0 \u00a0 \u00a0 3<\/p>\n<p>C. Ph\u1ea3n \u1ee9ng vi\u00eam c\u1ea5p t\u00ednh<br \/>\n&#8211; C\u1ea3 CPR v\u00e0 t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng b\u00ecnh th\u01b0\u1eddng \u00a0\u00a00<br \/>\n&#8211; CRP ho\u1eb7c t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng t\u0103ng \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a01<\/p>\n<p>D. Th\u1eddi gian b\u1ecb b\u1ec7nh<br \/>\n+ &lt; \u00a0\u00a06 tu\u1ea7n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 0<br \/>\n+ &gt;= 6 tu\u1ea7n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 1<\/p>\n<p>Ch\u1ea9n \u0111o\u00e1n vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p khi \u0111\u1ea1t \u2265 6\/10 \u0111i\u1ec3m<\/p>\n<p>L\u01b0u \u00fd<br \/>\n&#8211; Kh\u1edbp l\u1edbn bao g\u1ed3m: Kh\u1edbp h\u00e1ng, kh\u1edbp g\u1ed1i, c\u1ed5 ch\u00e2n, kh\u1edbp khu\u1ef7u, kh\u1edbp vai<br \/>\n&#8211; Kh\u1edbp nh\u1ecf: \u00a0Kh\u1edbp c\u1ed5 tay, b\u00e0n ng\u00f3n, kh\u1edbp ng\u00f3n g\u1ea7n<br \/>\n&#8211; \u00c2m t\u00ednh: RF \u2264 14 UI\/ml; Anti CCP \u226417 UI\/ml<br \/>\n&#8211; D\u01b0\u01a1ng t\u00ednh th\u1ea5p: Gi\u00e1 tr\u1ecb x\u00e9t nghi\u1ec7m \u22643 l\u1ea7n m\u1ee9c b\u00ecnh th\u01b0\u1eddng<br \/>\n&#8211; D\u01b0\u01a1ng t\u00ednh cao: Gi\u00e1 tr\u1ecb x\u00e9t nghi\u1ec7m \u2265 3 l\u1ea7n m\u1ee9c b\u00ecnh th\u01b0\u1eddng<\/p>\n<h2>2. \u0110\u00e1nh gi\u00e1 ho\u1ea1t t\u00ednh c\u1ee7a b\u1ec7nh<\/h2>\n<p>DAS28= [0.56\u221a(s\u1ed1 kh\u1edbp \u0111au) + 0.28\u221a(s\u1ed1 kh\u1edbp s\u01b0ng) + 0.7 ln(VS gi\u1edd \u0111\u1ea7u ho\u1eb7c CRP)] + 0.014(GH)<br \/>\nDAS 28 &lt; 2,6:\u00a0B\u1ec7nh kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng.<br \/>\n2,6 \u2264 DAS 28 &lt; 3,2:\u00a0Ho\u1ea1t \u0111\u1ed9ng b\u1ec7nh m\u1ee9c \u0111\u1ed9 nh\u1eb9.<br \/>\n3,2 \u2264 DAS 28 \u2264 5,1: Ho\u1ea1t \u0111\u1ed9ng b\u1ec7nh m\u1ee9c \u0111\u1ed9 trung b\u00ecnh.<br \/>\nDAS 28 &gt;5,1:\u00a0B\u1ec7nh ho\u1ea1t \u0111\u1ed9ng m\u1ea1nh.<\/p>\n<p>T\u1ea1i Vi\u1ec7t Nam thang \u0111i\u1ec3m DAS28 (disease activity score) th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u1ea5t\/ Hi\u1ec7u ch\u1ec9nh cho 28 kh\u1edbp th\u01b0\u1eddng g\u1eb7p trong VKDT n\u00ean t\u00ean DAS28 (trong \u0111\u00f3 GH (General health): \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean thang \u0111i\u1ec3m VAS t\u1eeb 0 \u2013 100mm)<\/p>\n<p>* M\u1ed9t s\u1ed1 thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 ho\u1ea1t t\u00ednh b\u1ec7nh kh\u00e1c<br \/>\nCh\u1ec9 s\u1ed1 SDAI (Simplified Disease Activity Index)<br \/>\nSDAI = S\u1ed1 kh\u1edbp \u0111au (t\u1ed5ng s\u1ed1 28 kh\u1edbp) + S\u1ed1 kh\u1edbp s\u01b0ng + VAS b\u1ec7nh nh\u00e2n + VAS b\u00e1c s\u0129 \u0111\u00e1nh gi\u00e1 (0-10) + CRP (mg\/dl)<br \/>\nSDAI &lt; 3,3: B\u1ec7nh kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng<br \/>\n3,3 &lt; SDAI &lt; 11: Ho\u1ea1t \u0111\u1ed9ng nh\u1eb9<br \/>\n11 &lt; SDAI &lt; 26: Ho\u1ea1t \u0111\u1ed9ng trung b\u00ecnh<br \/>\nSDAI &gt; 26: Ho\u1ea1t \u0111\u1ed9ng m\u1ea1nh<br \/>\nCh\u1ec9 s\u1ed1 CDAI (Clinical Disease Activity Index)<br \/>\nCDAI = S\u1ed1 kh\u1edbp \u0111au + S\u1ed1 kh\u1edbp s\u01b0ng + VAS b\u1ec7nh nh\u00e2n + VAS b\u00e1c s\u0129.<br \/>\nCDAI &lt; 2,8: B\u1ec7nh kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng<br \/>\n2,8 &lt; CDAI &lt; 10: B\u1ec7nh ho\u1ea1t \u0111\u1ed9ng nh\u1eb9<br \/>\n10 &lt; CDAI &lt; 22: B\u1ec7nh ho\u1ea1t \u0111\u1ed9ng trung b\u00ecnh<br \/>\nCDAI &gt; 22: B\u1ec7nh ho\u1ea1t \u0111\u1ed9ng m\u1ea1nh<\/p>\n<h2>3. \u0110\u00e1nh gi\u00e1 lui b\u1ec7nh<\/h2>\n<p>Theo ACR\/EULAR 2011, ti\u00eau chu\u1ea9n lui b\u1ec7nh cho VKDT (d\u1ef1a tr\u00ean Boolean) nh\u01b0 sau, t\u1ea1i b\u1ea5t k\u1ef3 th\u1eddi \u0111i\u1ec3m n\u00e0o, BN \u0111\u00e1p \u1ee9ng t\u1ea5t c\u1ea3 ti\u00eau chu\u1ea9n sau:<\/p>\n<ul>\n<li>S\u1ed1 kh\u1edbp \u0111au \u2264 1<\/li>\n<li>S\u1ed1 kh\u1edbp s\u01b0ng \u2264 1<\/li>\n<li>CRP \u2264 1 mg\/dl<\/li>\n<li>\u0110\u00e1nh gi\u00e1 chung c\u1ee7a b\u1ec7nh nh\u00e2n (thang \u0111i\u1ec3m 0 \u2013 10) \u2264 1<\/li>\n<li>Ho\u1eb7c d\u1ef1a v\u00e0o ch\u1ec9 s\u1ed1 ho\u1ea1t t\u00ednh b\u1ec7nh nh\u01b0 DAS28 \u2264 2,6 ho\u1eb7c SDA1 \u2264 3,3<\/li>\n<\/ul>\n<h2>4. \u0110i\u1ec1u tr\u1ecb<\/h2>\n<p>C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/p>\n<ul>\n<li>Thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (NSAIDs): \u01afu ti\u00ean c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid lo\u1ea1i \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc COX 2 do b\u1ec7nh nh\u00e2n ph\u1ea3i d\u00f9ng d\u00e0i ng\u00e0y, l\u01b0u \u00fd c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 c\u00e1ch ph\u00f2ng tr\u00e1nh t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n.<\/li>\n<li>Corticosteroid: gi\u1ea3m \u0111au, s\u01b0ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng kh\u1edbp. Tuy nhi\u00ean c\u1ea7n l\u01b0u \u00fd v\u1ec1 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 l\u00ean ti\u00eau h\u00f3a, tim m\u1ea1ch,&#8230; khi s\u1eed d\u1ee5ng.<\/li>\n<li>Thu\u1ed1c ch\u1ed1ng th\u1ea5p t\u00e1c d\u1ee5ng ch\u1eadm (DMARDs): l\u00e0m gi\u1ea3m vi\u00eam v\u00e0 ng\u0103n s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh<br \/>\n&#8211; Methotrexat l\u00e0 ch\u1ea5t kh\u00e1ng acid folic, t\u00e1c d\u1ee5ng ph\u1ee5 g\u00e2y t\u0103ng men gan, nhi\u1ec5m \u0111\u1ed9c ph\u1ed5i do methotrexat l\u00e0 bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u00f3 th\u1ec3 x\u1ea3y ra b\u1ea5t c\u1ee9 l\u00fac n\u00e0o trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<br \/>\n&#8211; Hydrochloroquine: t\u00e1c d\u1ee5ng ph\u1ee5 nh\u00ecn m\u1edd, nh\u1ea1y c\u1ea3m \u00e1nh s\u00e1ng, b\u1ec7nh l\u00fd v\u00f5ng m\u1ea1c, thay \u0111\u1ed5i gi\u00e1c m\u1ea1c.<br \/>\n&#8211; Sulfasalazine: t\u00e1c d\u1ee5ng ph\u1ee5 l\u00e0m gi\u1ea3m to\u00e0n th\u1ec3 huy\u1ebft c\u1ea7u, m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t, gi\u1ea3m ti\u1ec3u c\u1ea7u, thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u to.<\/li>\n<li>Thu\u1ed1c sinh h\u1ecdc (bDMARDs): \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch g\u00e2y vi\u00eam v\u00e0 gi\u00fap ki\u1ec3m so\u00e1t b\u1ec7nh l\u00fd. C\u00e1c bDMARDs c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng, d\u1ecb \u1ee9ng v\u00e0 ph\u1ea3n \u1ee9ng v\u1edbi thu\u1ed1c.<br \/>\n&#8211; TNF-alpha inhibitors: l\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf TNF-alpha, m\u1ed9t ch\u1ea5t g\u00e2y vi\u00eam quan tr\u1ecdng trong c\u01a1 th\u1ec3. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y bao g\u1ed3m Adalimumab, Etanercept, Infliximab, Golimumab v\u00e0 Certolizumab.<br \/>\n&#8211; Interleukin inhibitors: \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c ch\u1ea5t g\u00e2y vi\u00eam kh\u00e1c nh\u01b0 interleukin-1 v\u00e0 interleukin-6. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y bao g\u1ed3m Tocilizumab, Anakinra, Canakinumab v\u00e0 Sarilumab.<br \/>\n&#8211; B-cell inhibitors: gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o B mi\u1ec5n d\u1ecbch, m\u1ed9t lo\u1ea1i t\u1ebf b\u00e0o g\u00e2y vi\u00eam. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y bao g\u1ed3m Rituximab v\u00e0 Belimumab.<br \/>\n&#8211; T-cell inhibitors: \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o T mi\u1ec5n d\u1ecbch, m\u1ed9t lo\u1ea1i t\u1ebf b\u00e0o g\u00e2y vi\u00eam. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y bao g\u1ed3m Abatacep<\/li>\n<\/ul>\n<h2>5. K\u1ebft lu\u1eadn<\/h2>\n<p>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd kh\u1edbp ph\u1ed5 bi\u1ebfn, g\u00e2y ra \u0111au, s\u01b0ng v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng kh\u1edbp. Ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 gi\u1ea3m tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 cho vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p bao g\u1ed3m DMARDs, bDMARDs, glucocorticoid v\u00e0 NSAIDs. Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd b\u1edfi b\u00e1c s\u0129 v\u00e0 b\u1ec7nh nh\u00e2n c\u1ea7n th\u01b0\u1eddng xuy\u00ean ki\u1ec3m tra s\u1ee9c kh\u1ecfe \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c.<\/p>\n<p>\u0110\u1ec3 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, Qu\u00fd kh\u00e1ch vui l\u00f2ng b\u1ea5m s\u1ed1\u00a0<a class=\"contact-button link-in-body\" href=\"http:\/\/0283 6221 166\"><b class=\"link-in-body\">HOTLINE<\/b><\/a>\u00a0ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp\u00a0<a class=\"appointment-button link-in-body\" href=\"https:\/\/vinmec.com\/vi\/dangkykham\/\"><b class=\"link-in-body\">T\u1ea0I \u0110\u00c2Y<\/b><\/a>. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean\u00a0<a class=\"link-in-body\" href=\"https:\/\/vinmec.com\/myvinmec\/\" target=\"_blank\" rel=\"noopener\">\u1ee9ng d\u1ee5ng MyVinmec<\/a>\u00a0\u0111\u1ec3 qu\u1ea3n l\u00fd, theo d\u00f5i l\u1ecbch v\u00e0 \u0111\u1eb7t h\u1eb9n m\u1ecdi l\u00fac m\u1ecdi n\u01a1i ngay tr\u00ean \u1ee9ng d\u1ee5ng.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd kh\u1edbp m\u00e3n t\u00ednh, th\u01b0\u1eddng g\u00e2y ra \u0111au, s\u01b0ng v\u00e0 bi\u1ebfn d\u1ea1ng kh\u1edbp. Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh l\u00fd n\u00e0y v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng, tuy nhi\u00ean c\u00e1c y\u1ebfu t\u1ed1mi\u1ec5n d\u1ecbch v\u00e0 m\u00f4i tr\u01b0\u1eddng \u0111\u01b0\u1ee3c cho l\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a b\u1ec7nh. Vi\u00eam kh\u1edbp [&hellip;]<\/p>\n","protected":false},"author":14,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p: t\u1eeb ch\u1ea9n \u0111o\u00e1n \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p l\u00e0 b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n, g\u00e2y ra \u0111au, s\u01b0ng kh\u1edbp. 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Ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 k\u1ecbp th\u1eddi gi\u00fap ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/viem-khop-dang-thap-tu-chan-doan-den-dieu-tri\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-10T22:52:35+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-13T11:16:34+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190905_160432_775536_viem_khop_dang_thap.max-1800x1800-1-300x186.jpg\" \/>\n<meta name=\"author\" content=\"Phuong Ly Hai\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Phuong Ly Hai\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/viem-khop-dang-thap-tu-chan-doan-den-dieu-tri\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/viem-khop-dang-thap-tu-chan-doan-den-dieu-tri\/\",\"name\":\"Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p: t\u1eeb ch\u1ea9n \u0111o\u00e1n \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb - Vinmec\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-10T22:52:35+00:00\",\"dateModified\":\"2023-04-13T11:16:34+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/680cd7f8c3dcc41bb0f1442f657fc8ad\"},\"description\":\"Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p l\u00e0 b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n, g\u00e2y ra \u0111au, s\u01b0ng kh\u1edbp. 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