{"id":26636,"date":"2023-04-29T15:34:55","date_gmt":"2023-04-29T08:34:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26636"},"modified":"2023-04-29T15:34:55","modified_gmt":"2023-04-29T08:34:55","slug":"viem-khop-dang-thap-co-che-trieu-chung-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/viem-khop-dang-thap-co-che-trieu-chung-chan-doan-va-dieu-tri\/","title":{"rendered":"Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p: C\u01a1 ch\u1ebf, tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (Rheumatoide arthritis) l\u00e0 b\u1ec7nh vi\u00eam h\u1ec7 th\u1ed1ng t\u1ef1 mi\u1ec5n th\u01b0\u1eddng g\u1eb7p \u1ea3nh h\u01b0\u1edfng kho\u1ea3ng 1% d\u00e2n s\u1ed1 th\u1ebf gi\u1edbi. M\u1eb7c d\u00f9, ch\u01b0a r\u00f5 b\u1ec7nh nguy\u00ean nh\u01b0ng y\u1ebfu t\u1ed1 di truy\u1ec1n, n\u1ed9i ti\u1ebft, v\u00e0 m\u00f4i tr\u01b0\u1eddng (nhi\u1ec5m tr\u00f9ng, ch\u1ea5n th\u01b0\u01a1ng..) \u0111\u00e3 d\u1eabn \u0111\u1ebfn ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch ki\u1ec3u d\u00f2ng th\u00e1c g\u00e2y n\u00ean b\u1ec7nh c\u1ea3nh vi\u00eam kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c. S\u1ef1 ph\u00e1t tri\u1ec3n qu\u00e1 m\u1ee9c c\u00e1c t\u1ebf b\u00e0o bao ho\u1ea1t d\u1ecbch v\u00e0 ho\u1ea1t h\u00f3a t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c l\u00e0 ch\u1ec9 \u0111i\u1ec3m s\u1edbm c\u1ee7a ph\u1ea3n \u1ee9ng vi\u00eam kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c v\u00e0 s\u1ebd d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng s\u1ee5n v\u00e0 x\u01b0\u01a1ng sau n\u00e0y.<\/strong><\/p>\n

\"Minh
Minh h\u1ecda vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/figcaption><\/figure>\n

B\u1ec7nh c\u1ea3nh \u0111\u1eb7c tr\u01b0ng c\u1ee7a vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p l\u00e0 vi\u00eam kh\u1edbp \u0111\u1ed1i x\u1ee9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c kh\u1edbp nh\u1ecf nh\u01b0 kh\u1edbp ng\u00f3n b\u00e0n tay, kh\u1edbp ng\u00f3n b\u00e0n ch\u00e2n v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n nh\u01b0 ch\u00e1n \u0103n, m\u1ec7t m\u1ecfi. Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p x\u1ea3y ra trong tu\u1ed5i 40-50 v\u00e0 t\u1ef7 l\u1ec7 m\u1eafc \u1edf n\u1eef g\u1ea5p 2-3 l\u1ea7n so v\u1edbi nam, kho\u1ea3ng c\u00e1ch n\u00e0y thu h\u1eb9p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i.<\/p>\n

1. C\u01a1 ch\u1ebf b\u1ec7nh sinh vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/strong><\/h2>\n

Khi kh\u00e1ng nguy\u00ean x\u00e2m nh\u1eadp v\u00e0o c\u01a1 th\u1ec3 s\u1ebd \u0111\u01b0\u1ee3c c\u00e1c t\u1ebf b\u00e0o tr\u00ecnh di\u1ec7n kh\u00e1ng nguy\u00ean (\u0111\u1ea1i th\u1ef1c b\u00e0o, c\u00e1c t\u1ebf b\u00e0o \u0111u\u00f4i gai, t\u1ebf b\u00e0o di\u1ec7t t\u1ef1 nhi\u00ean) nh\u1eadn bi\u1ebft, sau \u0111\u00f3 \u0111\u01b0\u1ee3c tr\u00ecnh di\u1ec7n cho c\u00e1c t\u1ebf b\u00e0o lympho T v\u00e0 B. C\u00e1c t\u1ebf b\u00e0o lympho T CD4 (T help) \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t v\u00e0 s\u1ea3n xu\u1ea5t ra c\u00e1c lymphokin (Interleukin-4, 10,13), c\u00e1c lymphokin n\u00e0y s\u1ebd k\u00edch th\u00edch c\u00e1c t\u1ebf b\u00e0o lympho B t\u0103ng sinh v\u00e0 bi\u1ec7t ho\u00e1 th\u00e0nh c\u00e1c t\u01b0\u01a1ng b\u00e0o v\u00e0 s\u1ea3n xu\u1ea5t ra c\u00e1c globulin mi\u1ec5n l\u00e0 c\u00e1c t\u1ef1 kh\u00e1ng th\u1ec3.<\/p>\n

T\u1ea1i m\u00e0ng ho\u1ea1t d\u1ecbch kh\u1edbp c\u00f3 t\u00ecnh tr\u1ea1ng l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch kh\u00e1ng nguy\u00ean \u2013 kh\u00e1ng th\u1ec3, do \u0111\u00f3 c\u00f3 t\u00ecnh tr\u1ea1ng th\u1ef1c b\u00e0o xu\u1ea5t hi\u1ec7n v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, \u0111\u1ea1i th\u1ef1c b\u00e0o, t\u1ebf b\u00e0o mastocyte. Sau \u0111\u00f3, ch\u00ednh c\u00e1c t\u1ebf b\u00e0o n\u00e0y l\u1ea1i ti\u1ebft ra c\u00e1c cytokin kh\u00e1c nh\u01b0 TNF-\u03b1, IL-1,2,6, interferon, y\u1ebfu t\u1ed1 ph\u00e1t tri\u1ec3n n\u1ed9i m\u1ea1c m\u1ea1ch m\u00e1u (VEGF) v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 ho\u00e1 \u1ee9ng \u0111\u1ed9ng kh\u00e1c t\u1ea1o v\u00f2ng xo\u1eafn b\u1ec7nh l\u00fd th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh vi\u00eam. S\u1ef1 t\u0103ng sinh m\u1ea1ch d\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a VEGF c\u00f9ng s\u1ef1 x\u00e2m nh\u1eadp m\u1ed9t lo\u1ea1t c\u00e1c t\u1ebf b\u00e0o vi\u00eam kh\u00e1c h\u00ecnh th\u00e0nh n\u00ean m\u00e0ng m\u1ea1ch (m\u1ea3ng pannus). M\u1ea3ng pannus x\u00e2m l\u1ea5n v\u00e0o \u0111\u1ea7u x\u01b0\u01a1ng, s\u1ee5n kh\u1edbp v\u00e0 c\u00e1c enzym ti\u00eau hu\u1ef7 t\u1ed5 ch\u1ee9c do c\u00e1c t\u1ebf b\u00e0o vi\u00eam gi\u1ea3i ph\u00f3ng nh\u01b0 stromelysin, elastase, collagenase… c\u00f9ng s\u1ef1 x\u00e2m nh\u1eadp c\u00e1c nguy\u00ean b\u00e0o x\u01a1 g\u00e2y ph\u00e1 hu\u1ef7 kh\u1edbp, d\u00ednh kh\u1edbp v\u00e0 h\u1eadu qu\u1ea3 l\u00e0 t\u00e0n t\u1eadt. Nh\u01b0 v\u1eady c\u00f3 s\u1ef1 tham gia c\u1ee7a c\u1ea3 mi\u1ec5n d\u1ecbch d\u1ecbch th\u1ec3 (t\u1ea1o th\u00e0nh ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch) v\u00e0 mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o (gi\u1ea3i ph\u00f3ng ra c\u00e1c cytokin th\u1ef1c hi\u1ec7n ph\u1ea3n \u1ee9ng vi\u00eam v\u00e0 ph\u00e1 h\u1ee7y kh\u1edbp), trong \u0111\u00f3 lympho T \u0111\u00f3ng vai tr\u00f2 trung t\u00e2m. D\u1ef1a tr\u00ean s\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh sinh n\u00e0y, c\u00e1c nh\u00e0 khoa h\u1ecdc \u0111\u00e3 nghi\u00ean c\u1ee9u ra c\u00e1c thu\u1ed1c k\u00edch ho\u1ea1t ho\u1eb7c s\u1eeda ch\u1eefa h\u1ec7 mi\u1ec5n d\u1ecbch th\u00f4ng qua \u1ee9c ch\u1ebf t\u1eebng lo\u1ea1i t\u1ebf b\u00e0o, t\u1eebng lo\u1ea1i cytokine \u0111\u1ec3 kh\u1ed1ng ch\u1ebf t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a b\u1ec7nh.<\/p>\n

2. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, sinh h\u1ecdc v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/strong><\/h2>\n

Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n theo Tr\u01b0\u1eddng m\u00f4n Th\u1ea5p Kh\u1edbp h\u1ecdc Hoa K\u1ef3 (American College of Rheumatology), (ACR, 1987)
\nB\u1ea3ng 1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n th\u1ea5p kh\u1edbp c\u1ee7a Tr\u01b0\u1eddng m\u00f4n Th\u1ea5p Kh\u1edbp Hoa K\u1ef3 (ACR, 1987)<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
Ch\u1ea9n \u0111o\u00e1n vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p khi c\u00f3 \u00edt nh\u1ea5t 4 ti\u00eau chu\u1ea9n trong s\u1ed1 7 ti\u00eau chu\u1ea9n<\/strong><\/td>\n<\/tr>\n
1.C\u1ee9ng kh\u1edbp v\u00e0o bu\u1ed5i s\u00e1ng, k\u00e9o d\u00e0i h\u01a1n 1 gi\u1edd<\/td>\n<\/tr>\n
2.Vi\u00eam \u00edt nh\u1ea5t l\u00e0 3 nh\u00f3m kh\u1edbp k\u1ec3 c\u1ea3 hai b\u00ean: kh\u1edbp li\u00ean \u0111\u1ed1t ng\u00f3n g\u1ea7n b\u00e0n tay, kh\u1edbp b\u00e0n ng\u00f3n tay, kh\u1edbp c\u1ed5 tay, kh\u1edbp kh\u1ee7y, kh\u1edbp g\u1ed1i, kh\u1edbp c\u1ed5 ch\u00e2n, kh\u1edbp b\u00e0n ng\u00f3n ch\u00e2n<\/td>\n<\/tr>\n
3.Vi\u00eam kh\u1edbp b\u00e0n tay: vi\u00eam t\u1ed1i thi\u1ec3u m\u1ed9t nh\u00f3m trong s\u1ed1 c\u00e1c kh\u1edbp c\u1ed5 tay, kh\u1edbp ng\u00f3n g\u1ea7n, kh\u1edbp b\u00e0n ng\u00f3n tay.<\/td>\n<\/tr>\n
4. Vi\u00eam kh\u1edbp \u0111\u1ed1i x\u1ee9ng<\/td>\n<\/tr>\n
\u00a0C\u00e1c ti\u00eau ch\u00ed 1-4 ph\u1ea3i k\u00e9o d\u00e0i \u00edt nh\u1ea5t 6 tu\u1ea7n<\/strong><\/td>\n<\/tr>\n
5.\u00a0 H\u1ea1t th\u1ea5p d\u01b0\u1edbi da<\/td>\n<\/tr>\n
6.\u00a0 Y\u1ebfu t\u1ed1 d\u1ea1ng th\u1ea5p trong huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh<\/td>\n<\/tr>\n
7. Phim X quang \u0111i\u1ec3n h\u00ecnh c\u1ee7a VKDT: ch\u1ee5p kh\u1edbp b\u00e0n c\u1ed5 tay, c\u1ed5 tay ho\u1eb7c kh\u1edbp t\u1ed5n th\u01b0\u01a1ng v\u1edbi h\u00ecnh \u1ea3nh b\u00e0o m\u00f2n, h\u00ecnh h\u1ed1c, h\u00ecnh khuy\u1ebft \u0111\u1ea7u x\u01b0\u01a1ng, h\u1eb9p khe kh\u1edbp, m\u1ea5t ch\u1ea5t kho\u00e1ng \u0111\u1ea7u x\u01b0\u01a1ng.<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi c\u00f3 \u2265 4 ti\u00eau chu\u1ea9n. Tri\u1ec7u ch\u1ee9ng vi\u00eam kh\u1edbp (ti\u00eau chu\u1ea9n 1-4) c\u1ea7n c\u00f3 th\u1eddi gian di\u1ec5n ti\u1ebfn \u2265 6 tu\u1ea7n v\u00e0 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi th\u1ea7y thu\u1ed1c.\u00a0<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Ti\u00eau chu\u1ea9n ACR c\u00f3 \u0111\u1ed9 nh\u1ea1y 91-94% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 89% \u1edf b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp ti\u1ebfn tri\u1ec3n. Nh\u01b0ng \u1edf giai \u0111o\u1ea1n s\u1edbm c\u1ee7a b\u1ec7nh th\u00ec \u0111\u1ed9 nh\u1ea1y giao \u0111\u1ed9ng t\u1eeb 40-90% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 50-90%. H\u1ea1t th\u1ea5p d\u01b0\u1edbi da hi\u1ebfm g\u1eb7p. Ngo\u00e0i ra c\u00f2n kh\u1ea3o s\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng ngo\u00e0i kh\u1edbp nh\u01b0 teo c\u01a1, vi\u00eam m\u00f3ng m\u1eaft, tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, vi\u00eam m\u1ea1ch m\u00e1u\u2026th\u01b0\u1eddng g\u1eb7p \u00edt d\u1ec5 b\u1ecb b\u1ecf s\u00f3t.
\nTuy nhi\u00ean c\u00e1c ti\u00eau chu\u1ea9n tr\u00ean th\u1ea5t b\u1ea1i trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n. G\u1ea7n \u0111\u00e2y ACR v\u00e0 EULAR (European League Against Rheumatism) \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t c\u00e1c ti\u00eau chu\u1ea9n c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u1edf giai \u0111o\u1ea1n s\u1edbm, tr\u01b0\u1edbc khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng kh\u1edbp tr\u00ean phim X quang<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Ti\u00eau chu\u1ea9n<\/strong><\/td>\n\u0110i\u1ec3m<\/strong><\/td>\n<\/tr>\n
Qu\u1ea7n th\u1ec3 \u0111\u00edch g\u1ed3m :<\/strong><\/p>\n

1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u00f3 \u00edt nh\u1ea5t 1 kh\u1edbp \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng vi\u00eam bao ho\u1ea1t d\u1ecbch<\/p>\n

2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n gi\u1ea3i th\u00edch v\u1ec1 vi\u00eam bao ho\u1ea1t d\u1ecbch<\/td>\n

<\/td>\n<\/tr>\n
Ph\u00e2n lo\u1ea1i ti\u00eau chu\u1ea9n VKDT:<\/strong><\/p>\n

A.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bi\u1ec3u hi\u1ec7n t\u1ea1i kh\u1edbp<\/strong><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 M\u1ed9t kh\u1edbp l\u1edbn<\/td>\n

 <\/p>\n

0<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2-10 kh\u1edbp l\u1edbn<\/td>\n1<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 1-3 kh\u1edbp nh\u1ecf (k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m bi\u1ec3u hi\u1ec7n t\u1ea1i kh\u1edbp l\u1edbn)<\/td>\n2<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 4-10 kh\u1edbp nh\u1ecf (k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m bi\u1ec3u hi\u1ec7n t\u1ea1i kh\u1edbp l\u1edbn)<\/td>\n3<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 > 10 kh\u1edbp (\u00edt nh\u1ea5t ph\u1ea3i c\u00f3 1 kh\u1edbp nh\u1ecf)<\/td>\n5<\/td>\n<\/tr>\n
B.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bi\u1ec3u hi\u1ec7n huy\u1ebft thanh (\u00edt nh\u1ea5t ph\u1ea3i l\u00e0m 1 x\u00e9t nghi\u1ec7m)<\/strong><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 RF \u00e2m t\u00ednh v\u00e0 anti CCP \u00e2m t\u00ednh<\/td>\n

 <\/p>\n

0<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 RF d\u01b0\u01a1ng t\u00ednh th\u1ea5p ho\u1eb7c anti-CCP d\u01b0\u01a1ng t\u00ednh th\u1ea5p<\/td>\n2<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 RF d\u01b0\u01a1ng t\u00ednh cao ho\u1eb7c anti-CCP d\u01b0\u01a1ng t\u00ednh cao<\/td>\n3<\/td>\n<\/tr>\n
C.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ph\u1ea3n \u1ee9ng vi\u00eam c\u1ea5p (\u00edt nh\u1ea5t ph\u1ea3i l\u00e0m m\u1ed9t x\u00e9t nghi\u1ec7m)<\/strong><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 CRP b\u00ecnh th\u01b0\u1eddng v\u00e0 t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng b\u00ecnh th\u01b0\u1eddng<\/td>\n

 <\/p>\n

0<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 CRP t\u0103ng ho\u1eb7c t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng t\u0103ng<\/td>\n1<\/td>\n<\/tr>\n
D.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Th\u1eddi gian hi\u1ec7n di\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 < 6 tu\u1ea7n<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2265 6 tu\u1ea7n<\/td>\n

0<\/p>\n

1<\/td>\n<\/tr>\n

Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh VKDT khi t\u1ecfng s\u1ed1 \u0111i\u1ec3m l\u00e0 6\/10<\/p>\n

(ti\u00eau ch\u00ed d\u01b0\u01a1ng t\u00ednh th\u1ea5p khi \u2264 3 l\u1ea7n tr\u1ecb b\u00ecnh th\u01b0\u1eddng v\u00e0 d\u01b0\u01a1ng t\u00ednh cao khi > 3 l\u1ea7n tr\u1ecb b\u00ecnh th\u01b0\u1eddng<\/td>\n

<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/strong><\/h3>\n

Thang \u0111i\u1ec3m DAS 28:<\/strong>
\n\u00b7 DAS 28 < 2.6: Lui b\u1ec7nh
\n\u00b7 2.6 \u2264 DAS 28 < 3.2: B\u1ec7nh ho\u1ea1t \u0111\u1ed9ng nh\u1eb9
\n\u00b7 3.2 \u2264 DAS 28 \u2264 5.1: B\u1ec7nh ho\u1ea1t \u0111\u1ed9ng trung b\u00ecnh
\n\u00b7 DAS 28 >5.1: B\u1ec7nh ho\u1ea1t \u0111\u1ed9ng n\u1eb7ng<\/p>\n

DAS 28 g\u1ed3m:<\/strong>
\n\u00b7 S\u1ed1 kh\u1edbp s\u01b0ng
\n\u00b7 S\u1ed1 kh\u1edbp \u0111au
\n\u00b7 T\u1ed1c \u0111\u1ed9 l\u1eafng m\u00e1u (VSS)
\n\u00b7 V\u00e0 \/Ho\u1eb7c CRP
\n\u00b7 \u0110i\u1ec3m \u0111\u00e1ng l\u01b0u \u00fd l\u00e0 DAS28 kh\u00f4ng t\u00ednh c\u00e1c kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m, c\u1ed9t s\u1ed1ng, h\u00e1ng, c\u1ed5, b\u00e0n ch\u00e2n, \u1ee9c \u0111\u00f2n, c\u00f9ng vai \u0111\u00f2n \u2026 n\u00ean n\u1ebfu b\u1ecb th\u00eam c\u00e1c kh\u1edbp tr\u00ean th\u00ec ph\u1ea3i d\u00f9ng c\u00e1c thang \u0111i\u1ec3m th\u00edch h\u1ee3p \u0111\u1ec3 \u0111\u00e1nh gi\u00e1<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/strong><\/h2>\n

Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb: \u0110i\u1ec1u tr\u1ecb to\u00e0n di\u1ec7n, t\u00edch c\u1ef1c, d\u00e0i h\u1ea1n v\u00e0 theo d\u00f5i th\u01b0\u1eddng xuy\u00ean. C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n hay c\u00f2n g\u1ecdi nh\u00f3m thu\u1ed1c DMARDs (Disease modifying antirheumatic drugs) kinh \u0111i\u1ec3n nh\u01b0 methotrexate, sulfasalazine, hydroxychloroquine\u2026) c\u00f3 vai tr\u00f2 trong \u1ed5n \u0111\u1ecbnh b\u1ec7nh v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian t\u00e1i ph\u00e1t<\/p>\n

3.1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p: <\/strong><\/h3>\n

Nh\u1eb1m c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng vi\u00eam, gi\u1ea3m \u0111au, duy tr\u00ec kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng (tuy nhi\u00ean thu\u1ed1c kh\u00f4ng thay \u0111\u1ed5i \u0111\u01b0\u1ee3c di\u1ec5n ti\u1ebfn vi\u00eam c\u1ee7a b\u1ec7nh)<\/p>\n

a. Thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid:<\/strong><\/p>\n

– Nh\u00f3m thu\u1ed1c kh\u00e1ng vi\u00eam \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc COX 2 (v\u00ec th\u01b0\u1eddng s\u1eed d\u1ee5ng d\u00e0i ng\u00e0y), s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 kh\u1ed1ng ch\u1ebf \u0111\u01b0\u1ee3c \u0111\u1ee3t c\u1ea5p. Nh\u00f3m kh\u00e1ng vi\u00eam kh\u00f4ng steroid anti-COX-2 \u00edt bi\u1ebfn ch\u1ee9ng v\u1edbi d\u1ea1 d\u00e0y. C\u1ea7n theo d\u00f5i ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd tim m\u1ea1ch, r\u1ed1i lo\u1ea1n lipid m\u00e1u, h\u00fat thu\u1ed1c c\u1ee7a b\u1ea3n th\u00e2n) tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb.
\n– Nh\u00f3m thu\u1ed1c kh\u00e1ng vi\u00eam \u1ee9c ch\u1ebf kh\u00f4ng ch\u1ecdn l\u1ecdc: Diclofenac (Voltaren), Piroxicam \u2026<\/p>\n

b. Corticosteroid: <\/strong><\/p>\n

Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p nh\u1ea1y c\u1ea3m v\u1edbi corticoid, th\u01b0\u1eddng s\u1eed d\u1ee5ng ng\u1eafn h\u1ea1n trong khi ch\u1edd \u0111\u1ee3i c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n c\u00f3 hi\u1ec7u l\u1ef1c. S\u1eed d\u1ee5ng prednisone 10mg\/ng\u00e0y trong \u0111\u1ee3t c\u1ea5p v\u00e0 <10mg\/ng\u00e0y trong duy tr\u00ec. Corticoid li\u1ec1u th\u1ea5p l\u00e0m ch\u1eadm l\u1ea1i ti\u1ebfn tri\u1ec3n b\u1ec7nh. Ch\u00fa \u00fd c\u00e1c bi\u1ebfn ch\u1ee9ng do s\u1eed d\u1ee5ng corticoid d\u00e0i ng\u00e0y nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y, b\u1ec7nh l\u00fd tim m\u1ea1ch, lo\u00e3ng x\u01b0\u01a1ng, b\u1ed5 sung vitamin v\u00e0 canxi<\/a>, mu\u1ed1i phospho, hormon thay th\u1ebf.<\/p>\n

Trong \u0111\u1ee3t c\u1ea5p vi\u00eam \u0111a kh\u1edbp n\u1eb7ng, c\u00f3 th\u1ec3 ti\u00eam truy\u1ec1n methylprednisolon: 250mg-1000mg\/ng\u00e0y, trong 3 ng\u00e0y li\u00ean ti\u1ebfp t\u1ea1i b\u1ec7nh vi\u1ec7n; sau \u0111\u00f3 chuy\u1ec3n v\u1ec1 li\u1ec1u th\u00f4ng th\u01b0\u1eddng. Ti\u00eam truy\u1ec1n \u00edt bi\u1ebfn ch\u1ee9ng h\u01a1n s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng d\u00e0i ng\u00e0y li\u1ec1u cao, tuy nhi\u00ean ph\u1ea3i ki\u1ec3m tra phim ph\u1ed5i, c\u00e1c xoang, x\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb<\/p>\n

3.2. \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7: <\/strong><\/h3>\n

Kem corticoid t\u1ea1i kh\u1edbp t\u1ed5n th\u01b0\u01a1ng, ph\u1eabu thu\u1eadt,\u00a0 v\u1eadt l\u00fd li\u1ec7u ph\u00e1p<\/p>\n

3.3. \u0110i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n b\u1eb1ng c\u00e1c thu\u1ed1c ch\u1ed1ng th\u1ea5p c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh: <\/strong><\/h3>\n

\u0110\u1ec3 l\u00e0m ch\u1eadm ho\u1eb7c l\u00e0m ng\u01b0ng ti\u1ebfn tri\u1ec3n v\u00e0 c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh, c\u1ea7n \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i v\u00e0 theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng, c\u1eadn l\u00e2m s\u00e0ng trong su\u1ed1t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/p>\n

\u0110i\u1ec1u tr\u1ecb n\u00e0y l\u00e0m ch\u1eadm c\u00e1c ti\u1ebfn tri\u1ec3n b\u1ec7nh v\u1ec1 c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, sinh h\u1ecdc, v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh.<\/p>\n

a. Th\u1ec3 m\u1edbi m\u1eafc v\u00e0 th\u1ec3 th\u00f4ng th\u01b0\u1eddng:<\/strong> s\u1eed d\u1ee5ng DMARDs c\u1ed5 \u0111i\u1ec3n nh\u01b0 methotrexate (MTX), Sulfasalazine (SSZ) ho\u1eb7c k\u1ebft h\u1ee3p MTX v\u00e0 SSZ v\u00e0\/ho\u1eb7c Hydroxychloroquine n\u1ebfu \u0111\u01a1n thu\u1ea7n kh\u00f4ng hi\u1ec7u qu\u1ea3
\nMethotrexate: hi\u1ec7u qu\u1ea3 nhanh, trong kho\u1ea3ng 6 tu\u1ea7n sau khi \u0111i\u1ec1u tr\u1ecb, t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng kho\u1ea3ng 60%. Sulfasalazin: t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng 60% sau 3 th\u00e1ng. Leflunomide (Arava): t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng 50-55%.<\/p>\n

b. Th\u1ec3 n\u1eb7ng, kh\u00e1ng tr\u1ecb v\u1edbi DMARDs c\u1ed5 \u0111i\u1ec3n (sau \u2265 6 th\u00e1ng) c\u1ea7n k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c sinh h\u1ecdc kh\u00e1c<\/strong><\/p>\n

MTX v\u00e0 kh\u00e1ng IL-6 (Tocilizumab)
\nMTX v\u00e0 kh\u00e1ng TNF-\u03b1 (Etanercept, Infliximab)
\nMTX v\u00e0 kh\u00e1ng t\u1ebf b\u00e0o lympho B (Rituximab)
\nMTX v\u00e0 kh\u00e1ng IL-1 b\u1eb1ng IL-1-RA (Anakinra, Kineret).<\/p>\n

3.4. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p kh\u00e1c<\/strong><\/h3>\n

a. Bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3<\/strong>
\n\u00b7 T\u1eadp luy\u1ec7n, h\u01b0\u1edbng d\u1eabn v\u1eadn \u0111\u1ed9ng ch\u1ed1ng co r\u00fat g\u00e2n, d\u00ednh kh\u1edbp, teo c\u01a1. Trong \u0111\u1ee3t vi\u00eam c\u1ea5p \u0111\u1ec3 kh\u1edbp \u1edf t\u01b0 th\u1ebf ngh\u1ec9 c\u01a1 n\u0103ng, tr\u00e1nh k\u00ea ho\u1eb7c \u0111\u1ed9n \u1edf kh\u1edbp. Khuy\u1ebfn kh\u00edch t\u1eadp ngay khi c\u00e1c tri\u1ec7u ch\u1ee9ng thuy\u00ean gi\u1ea3m, t\u0103ng d\u1ea7n, t\u1eadp nhi\u1ec1u l\u1ea7n trong ng\u00e0y, c\u1ea3 th\u1ee5 \u0111\u1ed9ng l\u1eabn ch\u1ee7 \u0111\u1ed9ng theo \u0111\u00fang ch\u1ee9c n\u0103ng sinh l\u00fd c\u1ee7a kh\u1edbp
\n\u00b7 Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, t\u1eafm su\u1ed1i kho\u00e1ng, ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh.<\/p>\n

b. Ph\u00f2ng ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb ho\u1eb7c b\u1ec7nh k\u00e8m theo<\/strong>
\n\u00b7 Vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y, n\u00ean ph\u00f2ng ng\u1eeba b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton
\n\u00b7 Khi s\u1eed d\u1ee5ng corticoid b\u1ea5t c\u1ee9 li\u1ec1u n\u00e0o tr\u00ean 1 th\u00e1ng c\u1ea7n b\u1ed5 sung calcium, vitamin D. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng n\u1eb7ng n\u00ean d\u00f9ng bisphosphonate
\n\u00b7 \u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u: acid folic, s\u1eaft, vitamin B12<\/p>\n

NGU\u1ed2N THAM KH\u1ea2O<\/strong>
\n1. B\u1ec7nh vi\u1ec7n Ch\u1ee3 r\u1eaby (2013), \u201cLupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng\u201d, Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb 2013 Ph\u1ea7n N\u1ed9i khoa, Nh\u00e0 xu\u1ea5t b\u1ea3n Y h\u1ecdc TP H\u1ed3 Ch\u00ed Minh.
\n2. B\u1ec7nh h\u1ecdc N\u1ed9i khoa 2019, NXB \u0110\u1ea1i h\u1ecdc Hu\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (Rheumatoide arthritis) l\u00e0 b\u1ec7nh vi\u00eam h\u1ec7 th\u1ed1ng t\u1ef1 mi\u1ec5n th\u01b0\u1eddng g\u1eb7p \u1ea3nh h\u01b0\u1edfng kho\u1ea3ng 1% d\u00e2n s\u1ed1 th\u1ebf gi\u1edbi. M\u1eb7c d\u00f9, ch\u01b0a r\u00f5 b\u1ec7nh nguy\u00ean nh\u01b0ng y\u1ebfu t\u1ed1 di truy\u1ec1n, n\u1ed9i ti\u1ebft, v\u00e0 m\u00f4i tr\u01b0\u1eddng (nhi\u1ec5m tr\u00f9ng, ch\u1ea5n th\u01b0\u01a1ng..) \u0111\u00e3 d\u1eabn \u0111\u1ebfn ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch ki\u1ec3u d\u00f2ng th\u00e1c g\u00e2y n\u00ean […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nVi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p: C\u01a1 ch\u1ebf, tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/title>\n<meta name=\"description\" content=\"Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (Rheumatoide arthritis) l\u00e0 b\u1ec7nh vi\u00eam h\u1ec7 th\u1ed1ng t\u1ef1 mi\u1ec5n th\u01b0\u1eddng g\u1eb7p \u1ea3nh h\u01b0\u1edfng kho\u1ea3ng 1% d\u00e2n s\u1ed1 th\u1ebf gi\u1edbi.\" \/>\n<meta name=\"robots\" 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