Indwara y’imitsi y’igihe gito (Indwara y’imitsi y’utugingo ngengabuzima nini), Ububabare bwo mu rwasaya igihe umuntu ariko aratagura, no Gutakaza amaso mu buryo butunguranye¶

Umutwe mushasha ku rusengero rumwe canke zompi, ububabare bw’urukoba rw’umutwe iyo uriko urakama umushatsi wawe, canke urushe rwo mu rwasaya rubabaje igihe uriko uratagura ivyokurya ku muntu akuze afise imyaka 50 canke irenga, ni ikintu gikomeye c’ubuvuzi kizwi nka Temporal Arteritis canke Giant Cell Arteritis (GCA). Iyo iyo ndwara y’imitsi minini y’ubudahangarwa bw’umubiri ivyimba kandi igafunga amashami y’imitsi y’amaso n’imitsi migufi y’inyuma y’amaso igaburira umutsi w’amaso, itera ubuhumyi butunguranye, butagira ububabare, budashobora gusubira inyuma mw’ijisho rimwe (Arteritic Anterior Ischemic Optic NeuropathyA-IONpathy [). N’ikindi gihambaye kuruta, iyo ijisho rya mbere rihejeje kubona, 30 gushika kuri 50 kw’ijana vy’abarwayi batavuwe baracika impumyi ubudasiba mw’ijisho ryabo rya kabiri (risigaye) mu masaha 24 gushika ku misi 7. Nimba wewe canke umuntu afise imyaka 50 canke irenga afise ububabare bw’umutwe bushasha, urwaya rwo mu rwasaya igihe ariko arata, kubona kabiri, kubona nabi mu gihe gito, canke gutakaza amaso mu buryo butunguranye, hamagara ku nimero y’ivyihutirwa yo mu karere iwanyu ubwo nyene biciye ku . inomero z'ivyihutirwa. Gusubiramwo ivyihutirwa bijanye n’imitsi n’imitsi y’amaso mu 2019. indwara y'amaso n'umutsi wo hagati wo mu maso, gutakaza amaso mu buryo butunguranye, gutandukana kw’amaso, n’indwara y’amaso ifunga imfuruka, na kwemera indwara y'umutima n'ugusubiza vyihutirwa.

Ivyo ubikore ubu¶

1. Hamagara inomero y’ivyihutirwa yo mu karere kawe canke ugende ubwo nyene ku bitaro bijejwe ivy’ivyihutirwa (911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza) iyo umuntu akuze afise imyaka 50 canke irenga afise Ihinduka ryose ry’amaso (ugupfuka, umugozi w’umukara, canke5. double vision) CANKE ububabare bushasha bw’umutwe bufatanye n’ububabare bw’urwasaya igihe umuntu arya canke ububabare bwo mu mutwe. Ntukigere urindira umuganga w’amaso, umuganga w’amenyo canke umuganga w’ubuvuzi bwa mbere mu ndwi iza.
2. Gerageza ijisho ryose ubwaryo ubu nyene mu gupfuka ijisho rimwe rimwe n’ikiganza cawe. Akenshi abarwayi ntibamenya ko ijisho rimwe ryatakaje igice canke vyose gushika bapfutse ijisho ryabo ryiza. Andika isaha n’umunota nyavyo ukuntu umuntu abona ibintu bitari vyo, igitutu canke ukuntu umuntu abona ibintu bibiri vyatanguyeko.
3. Ubwo nyene ubone "Ibimenyetso bitanu vy'umutuku vy'umutwe n'ivy'umubiri vy'indwara y'imitsi y'amaraso":
4. Jaw or tongue claudication: Urwasaya rwawe, itama, canke ururimi rwawe vyoba bitangura kubabara, gutera ivyatsi, canke kwumva urushe umaze gutagura ivyokurya bitagura (nk’inyama canke umukate) mu masegonda 60 gushika kuri 90, bikaguhatira guhagarara no kuruhuka?
5. Ububabare bw’urukoba rw’umutwe: Mbega gukaraba umushatsi wawe, kwambara amataratara canke inkofero, canke kuruhutsa umutwe wawe ku musego, vyoba bigutera ububabare canke bikomeretse hirya no hino mu rusengero canke mu gitsibo?
6. Abnormal superficial temporal artery: Mbega umutsi uri imbere y’ugutwi kwawe gusa no ku ruhande rw’urusengero rwawe usa n’uwugaragara cane canke ufise ibinogo, wumva uryoshe canke umeze nk’umugozi iyo uwukozeko buhoro, canke nta n’umutsi usanzwe utera?
7. Ibimenyetso vy’imburi vy’amaso vy’igihe gito: Woba warigeze gushikirwa n’ibihe bigufi vy’iminota 2 gushika ku 15 vy’ugucika kw’ibara ry’umuhondo canke ry’ugucika kw’ijisho rimwe (amaurosis fugax) canke ibihe bigufi vy’ukubona ibintu bibiri (diplopia)** mu misi mikeyi iheze?
8. Polymyalgia Rheumatica (PMR) n’umururumba w’umubiri: Woba warigeze gukomantara cane mu gitondo no kubabara ku bitugu vyose, ku ijosi no ku bibero bimara iminota irenga 45, umuriro w’agaciro gatoyi udasobanutse, ivyuya mw’ijoro, canke gutakaza ibiro utabishaka?
9. Bwira umuforoma n'umuganga wo mu cumba c'ubuvuzi vyihutirwa ubwo nyene ushitse: "Turakeka ko dufise indwara y'imitsi y'amaraso (Giant Cell Arteritis) kandi turakeneye gusuzumwa ubwo nyene kugira ngo tubone imiti myinshi y'imitsi y'amaraso kugira ngo ukingire amaso." Gukoresha izina nyaryo ry'ubuvuzi bibuza ububabare bw'umutwe bwawe nk'ubwa tegrasion canke migraine birabuza ko ububabare bwawe bwo mu rwasaya butamenyekana nabi ko ari ingorane y’amenyo canke y’umutsi w’umutima.
10. Gushimika ku vy’uko ubuvuzi bwa corticosteroid BUTACEREZWA mu gihe urindiriye gupima umutsi w’igihe gito canke gupima umutsi w’umubiri. Mu mabwirizwa y’Ishure ryisumbuye ry’Amerika ry’Ivy’Imitsi (ACR), ry’Uburayi (EULAR), n’iry’Ubwongereza (BSR), imiti y’imitsi y’umubiri iterwa mu mutsi canke mu kanwa itegerezwa gutangwa **ubwo nyene; iyo biopsie iguma ari iyo gupima imisi 10 gushika kuri 14 inyuma y’aho umuntu atanguriye gufata imiti, mu gihe kurindira amasaha 24 kugira ngo umuntu afate iyo biopsie ata steroïde bishobora guhuma ijisho ryasigaye ubuziraherezo.
11. Ntufate imiti y’umuvuduko w’amaraso canke imiti igabanya umuvuduko w’amaraso imbere y’uko ushika mu bitaro. Kugabanya umuvuduko w’amaraso bigabanya umuvuduko w’amaraso mu mitsi migufi y’inyuma y’amaso isanzwe ipfutse igaburira umutwe w’umutsi w’amaso kandi bishobora gutuma umutsi w’amaso uhagarara.

Igiti c'ingingo: Gutoranya no kwihutisha imiti y'imiti mu bikekwa ko ari indwara y'imitsi y'amaraso¶

flowchart TD
    Start["Imyaka y'abantu bakuze >= Imyaka 50 n'umutwe mushasha, ububabare bwo mu mutwe, ububabare bwo mu rwasaya, PMR, canke uguhinduka kw'amaso"] --> VisionCheck{"Mbega Hari Ibimenyetso Biboneka Biriho? (Ukwirabura guhoraho, igitutu co mu kirere, igihu c’ibara ry’agahama, ugucika intege kw’iminota 5 / amaurosis fugax, CANKE kubona kabiri)"}

    VisionCheck -->|"EGO: Gutakaza amaso, Gucika intege mu gihe gito, canke Gutakaza amaso"| VisualEmergency["IVYIHUTIRIZWA VY'IMITSI Y'AMASO (KIZA IJISHO RYA KABIRI): 1. Hamagara 911 / 112 / 999 -> Igisata c'Ivyihutirwa vy'Ibitaro UBU. 2. Gutanga umuti witwa Stat High-Dose IV (500 gushika ku 1.000 mg IV/umunsi x imisi 3) UBWO nyene imbere yo gufata umubiri. 3. Gushushanya Stat ESR, CRP, & CBC (Ivyuma vy’amaraso) ku gihe co gushirwa mu mubiri."]

    VisionCheck -->|"NTA bimenyetso bigaragara"| JawIschemiaCheck{"Mbega hariho ubumuga bwo mu rwasaya, ururimi canke ubumuga bwo mu mutwe?"}

    JawIschemiaCheck -->|"EGO: Ububabare bwo mu rwasaya/ururimi iyo umuntu arya (Ikibazo kinini co guhuma vuba)"| HighRiskCranial["GCA y’IGIHUGU IRI MU GIHUGU: 1. Isuzuma ry’Igisata c’Ivyihutirwa UYU MUSI. 2. Utangure gufata imiti myinshi yo mu kanwa (60 mg/umunsi, canke 1 mg/kg/umunsi) canke imiti y’umubiri yitwa Methylprednisolone ubwo nyene. 3. Ultrason y’umutsi w’igihe gito + Biopsy vyihuse mu misi 7."]

    JawIschemiaCheck -->|"NO Gukubita urusaya"| ClassicCranialCheck{"Umutwe mushasha wo mu rusengero/mu mutwe, ububabare bwo mu mutwe, umutsi w’igihe gito ukomeye/utagira umutima, canke PMR urutugu/itako rikomeye + ESR/CRP irengeye?"}

    ClassicCranialCheck -->|"EGO: GCA y'umutwe canke y'umutsi munini ikora idakomeye"| StandardGCA["GCA YO MU GIHUGU IKORA ATA ISCHÉMIE: 1. Tangira Prednisone yo mu kanwa (40 gushika kuri 60 mg/umusi) UBWO nyene uno musi (ntiwigere urindira ko bafata umubiri). 2. Gutegura Urutonde rw’Ivyuma vy’Imitsi y’Igihe n’Ivy’Imitsi ("Halo Sign") na/canke Biopsy y’umutsi w’igihe gito mu misi 7 gushika kuri 14. 3. Rimbura ubuvuzi bwo gukingira imiti yitwa Tocilizumab."]

    VisualEmergency --> BiopsyFollow["Kwemeza ko umuntu arwaye Inyuma y’aho Steroïdes zitanguriye: Gukora Ultrasound y’Ibara ry’Igihe/Axillary + Biopsy y’Igihe (nibura uburebure bwa cm 1,5 gushika kuri 2,0 inyuma yo gushirwako) mu misi 10 gushika kuri 14."]

Ivyerekeye umubiri w’umuntu: Ingene indwara y’imitsi y’umubiri ishobora guhuma ijisho¶

Ni kuki Giant Cell Arteritis ifata imitsi y’amaraso iri hagati n’iyikomeye inyuma y’imyaka 50¶

Indwara y’imitsi y’amaraso (GCA), mu mateka yitwa Indwara y’imitsi y’igihe gito canke Indwara ya Horton, ni yo ndwara y’imitsi y’amaraso ikunda gufata abantu bakuze mu bihugu vy’uburengero, ikaba igaragara hafi gusa ku bantu b’imyaka 50 n’irenga (wi bitera abagore incuro 2 canke 3 kuruta abagabo).

Udakunze indwara y’imitsi mito, igitero c’ubudahangarwa bw’umubiri muri GCA gitera imitsi y’ubunini buringaniye n’imitsi minini ifise uruzitiro rw’imbere rwo gukomera, cane cane amashami yo hanze y’umutwe y’imitsi y’inyuma n’iyo mu mutima, imitsi y’umugongo alla, the umutsi w'igifu: 1. Ugukora kw’utugingo ngengabuzima tw’imitsi mu Adventitia: Impinduka ziterwa n’imyaka mu ruhome rw’umutsi n’ibintu bitazwi bitera ibidukikije bikora utugingo ngengabuzima tw’imitsi tuba mu gice co hanze (adventitia) c’umutsi biciye ku bihimba bimeze nk’ivya Toll. 2. Ugutora utugingo ngengabuzima twa CD4+ (Inzira za Th1 na Th17): Utugingo ngengabuzima tw’ibiti dukora dutora utugingo ngengabuzima T dufasha CD4+ biciye mu vasa vasorum (utugingo ngengabuzima dutoduto tw’amaraso tugaburira uruhome rw’umutsi). Utu tugingo ngengabuzima T dutandukanye mu maboko abiri atandukanye y'umururumba: - Ikiganza ca Th17 / Interleukin-6 (IL-6): Gituma igitigu gikora neza amaproteine y’inzira y’ububabare (proteine C, fibrinogène, amyloïde A sérique), umuriro mwinshi, ivyutsi vy’ijoro, igitigiri kinini c’amaplatelete, n’indwara y’ibihaha; uku kuboko kurashobora gufatwa neza cane n’imiti igabanya ububabare n’imiti igabanya ubukana bw’indwara ya IL-6 (tocilizumab)**. - Ikiganza ca Th1 / Interferon-gamma (IFN-\(\gamma\)): Gituma ama macrophage akorana mu ingingo nini zifise utugingo ngengabuzima twinshi zitagura igice c’imbere c’umubiri maze zikarekura umusemburo w’ugukura ukomoka ku maraso (PDGF) n’umusemburo w’ugukura kw’imitsi (V). 3. Ivyimba vy’imbere mu mubiri (Occlusion Luminal): Mu kwishura ku PDGF na VEGF, myofibroblastes zigenda zija imbere zigagwira ningoga imbere mu gipfukisho c’imbere (intima) c’umutsi. Uruhome rw’umutsi ruravyimba ruja imbere gushika umuyoboro w’amaraso wo hagati ucitse nk’umwobo w’ipin canke ugapfukwa burundu n’umutsi w’amaraso (luminal occlusion), ugatuma ingingo ziri munsi y’umugezi zipfa inzara z’umwuka w’ikirere.

Ni imitsi iyihe y’amaso yihariye ipfutse muri GCA?¶

Iyo GCA iteye imitsi y’umubiri, yerekana ko hariho ugukunda cane Imitsi y’inyuma y’amaso (SPCAs), ikurikirwa n’imitsi y’amaso yo hagati (CRA)** n’imitsi y’amaso yo hagati: - 80 gushika kuri 85 kw’ijana vy’ugutakaza amaso kwa GCA: Indwara y’amaso y’imbere (A-AION). Imitsi migufi y’inyuma y’amaso ikora uruziga rwa Zinn-Haller rutanga Umutwe w’imitsi y’amaso y’imbere n’iy’inyuma** n’umutsi w’amaso w’inyuma**. Iyo GCA ipfutse imitsi migufi y’inyuma y’amaso, umutwe w’umutsi w’amaso uragira infarction nini kandi yuzuye. Ku kigeragezo ca fundoscope, igihimba c'amaso kigaragara ** nk'ikivyimvye kandi "kimwerutse nk'ibara ry'agahama" (pallid disc edema)** aho gusa n'ibara ry'agahama gusa, kuko amaraso zero asigara mu gitanda c'amaraso. - 10 gushika kuri 15 kw’ijana vy’ugutakaza amaso ya GCA: Ugufunga kw’imitsi y’inyuma y’amaso (A-CRAO). Akenshi bishika icarimwe n’ugufunga kw’amaso y’inyuma, bikaba bituma amaso y’inyuma agira infarct yera nk’amata afise ikintu gitukura nk’igiti c’umukara hamwe n’ukudasohoka kw’amaraso. - 5 kw’ijana vy’ugutakaza amaso mu GCA: Indwara y’amaso y’inyuma (A-PION) canke Indwara y’amaso y’inyuma. Muri A-PION, infarction iba inyuma y’igihimba c’ijisho mu mutsi w’amaso w’inyuma, rero igihimba c’amaso kigaragara nk’ikisanzwe ku musi wa mbere Ala Inenge y’amaso (RAPD / umunyeshure wa Marcus Gunn), ihinduka ibara ry’umuhondo n’ibara ry’umuhondo haciye indwi 4 gushika ku 6.

Kubera iki kubona ibintu bibiri mu gihe gito (diplopie) n’ukubona ibintu bibiri ari imburi z’amasaha 24¶

Kugeza kuri 30 gushika kuri 40 kw’ijana vy’abarwayi bacika impumyi ubudasiba kubera Giant Cell Arteritis bararonse ibimenyetso vy’imburi imisi 1 gushika kuri 7 IMBERE y’uko bacika impumyi ubudasiba vyabuze canke vyaciwe: 1. Ugutakaza amaso y’igihe gito (Amaurosis Fugax in GCA): Bitandukanye n’ivyo bita embolic amaurosis fugax biva ku gice c’umubiri citwa carotid plaque (aho igihimba c’umubiri citwa cholesterol gifunga umutsi mu minota 5), ugucika intege kw’igihe gito canke ugucika kw’ibara ry’umuhondo mu GCA bishika kubera ko umuvuduko w’amaraso ugenda ugabanuka mu gice c’umubiri c’inyuma c’umubiri. n’ibara ry’umubiri ry’umubiri. Guhaguruka gusa uvuye ku ntebe, gupfukama canke gushikirwa n’ugucika intege kw’umuvuduko w’amaraso mw’ijoro nk’uko bisanzwe, bituma umutsi w’amaso ugenda ugabanuka munsi y’urugero rw’amaraso mu minota 5 gushika ku 20. 2. Imbonerakure y’amaso y’igihe gito canke y’igihe gito (Imbonerakure zibiri, iboneka mu bice 10 gushika kuri 15 kw’ijana vya GCA): Imitsi y’inyuma y’amaso igendagenda amaso (n’imitsi y’umutwe III, IV, na VI iyigenzura) igaburirwa n’amashami y’imitsi y’umutsi w’amaso. Iyo GCA ipfutse iyo mitsi y’imitsi, imitsi imwe canke myinshi y’ijisho iracika ischemie, bigatuma umuntu abona ukubona kabiri mu buryo butunguranye canke mu buryo buhagaze, ivyo bikaba bikunda guhindukahinduka ku murango. Ku murwayi wese afise imyaka 50 canke irenga, ukubona kabiri gushasha ni Giant Cell Arteritis gushika bigaragajwe ko ataco bimaze kandi kenshi bibanza ubuhumyi bwose bw’imitsi y’amaso amasaha 24 gushika kuri 72 gusa.

Kwemera ubuvuzi bwihishije bw'indwara y'imitsi y'igihe gito¶

Kubera ko Giant Cell Arteritis itera umururumba mu mashami menshi y’umutsi w’inyuma, w’imbere, w’umugongo, n’uw’umutsi w’umutima, abarwayi bakunda kuza mbere ku baganga b’amenyo, ku mavuriro y’ugutwi-izuru n’umuhogo, ku baganga b’imitsi, canke ku baganga b’amaso rusangi aho kuja ku baganga b’amaso. Kumenya ivyo bigereranyo vya kera birakiza amaso n’ubuzima:

1. Ivyiyumviro vy’amenyo n’ivy’amenyo: Gutera ivyatsi mu rwasaya, ugutera ivyatsi kw’ururimi, n’ububabare bw’amenyo¶

Jaw claudication iboneka mu bice nka 45 gushika kuri 50 kw’ijana vy’abarwayi bafise GCA kandi ifise igipimo c’ubushobozi bwinshi (ubushobozi bwo gupima) c’ikimenyetso cose c’ubuvuzi co kumenya imbere y’igihe ko umuntu afise umutsi w’igihe gito: - Impamvu y’umubiri: Ugucika intege kw’umururumba w’umutsi w’amano**, umutsi wo mu maso, n’imitsi y’igihe kirekire** (amashami y’umutsi w’inyuma wo mu mutwe) utanga amaraso ku mitsi masseter, temporalis, na pterygoid y’amaso. - Uko wotandukanya GCA Jaw Claudication n'indwara ya TMJ canke igisebe c'amenyo:

2. Imburi y’abaganga b’urukoba: Ububabare bw’urukoba n’ugupfa kw’urukoba¶

• Ububabare bw'urukoba rw'umutwe: Kubera ko imitsi y'imbere y'igihe, y'inyuma y'amatwi, n'iy'inyuma itanga ivyuma vy'umutwe n'ivy'urukoba, ischemie y'urukoba rw'umutwe ituma gusa umuntu akoresha igisokozo mu mushatsi, akaruhutsa umutwe ku musego, canke we.
• Scalp Necrosis: Mu GCA ikaze itavuwe, gufunga burundu imitsi yo hejuru y’igihe gito n’iy’inyuma bituma ibice vy’urukoba biri ku ntugu canke ku mutwe w’umutwe bihinduka umutuku, ibivyimba, n’ibisebe bikagira eschar yirabura. Kubera ko indwara y’umutwe yerekana ko umuntu afise ubumuga bwo mu mutwe burengeje urugero, abarwaye indwara y’umutwe baragira igipimo kirenze 60 kw’ijana c’ubuhumyi budashobora gusubira inyuma.

3. Indwara y'imitsi y'amaraso "y'ubupfumu" (20% vy'abarwayi b'impumyi ntibagira ububabare bw'umutwe)¶

Umutego ukomeye mu buvuzi bw’ibihe vyihutirwa ni ukwiyumvira ko umurwayi atagira umutwe adashobora kugira indwara y’imitsi y’igihe gito. Urutonde rw'ubuvuzi rwerekana ko hafi 20 kw'ijana vy'abarwayi bafise indwara y'imitsi y'amaraso y'ibihimba vy'irondoka (Giant Cell Arteritis) igaragazwa n'ibipimo vy'amaraso, bafise "Occult GCA": bagaragaza n'ukubura amaso mu buryo butunguranye ata kubabara mw'ijisho rimwe kandi **nta mutwe utagira ububabare, nta n'ububabare bwo mu mutwe busanzwe, n'ububabare busanzwe bw'urukoba rw'umutwe, n'ububabare busanzwe bw'umubiri ( nk’ugukomantara kw’ibitugu mu gitondo, urushe, kugabanya ibiro, canke ESR/CRP irengeye igihe umuntu asuzumwa amaraso). Rero, umurwayi wese afise imyaka 50 canke irenga afise indwara y’amaso y’imbere (AION) canke indwara y’umutsi w’imbere (CRAO) ategerezwa kuba afise stat ESR, CRP, n’Ibara ry’Amaraso ryose (platelet) labs zafashwe mu gisata c’Ivyihutirwa.

4. Guterana kw’indwara y’ibihaha (PMR) (50% vy’abarwayi ba GCA)¶

Indwara y’ibihaha (PMR) n’indwara y’ibihaha binini ni indwara zifitaniye isano cane n’uburyo bumwe bw’ubudahangarwa bw’umubiri: - 40 gushika kuri 50 kw’ijana vy’abarwayi bavuwe ko bafise indwara ya Giant Cell Arteritis barafise ibimenyetso vya PMR bifatanya. - 15 gushika kuri 20 kw’ijana vy’abarwayi mu ntango bavuwe ko bafise PMR yitandukanije (bafata umuti witwa prednisone mu rugero rutoyi, \(10\text{ gushika kuri }15\text{ mg/day}\), kubera ububabare, intugu, izosi, n’imikanda y’amafyigo bikomeye mu gitondo) mu nyuma baragira indwara y’ibihimba vy’umubiri vyitwa Giant Cell Arteritis vyuzuye. - Imbuzi ikomeye ku barwayi ba PMR: Igitigiri gito ca prednisone (\(10\text{ gushika kuri }20\text{ mg}\) ku musi) kivura ugukomantara kw’ibitugu mu gihe c’indwara ya PMR ariko NTIGIKOMEYE bihagije kugira ngo umuntu ntabe ari impumyi kubera Giant Cell Arteritis. Umurwayi wese afise PMR afise ububabare bushasha bw’umutwe, ububabare bwo mu mutwe, ububabare bw’urwaya iyo arya, canke abona neza, ategerezwa kuja mu bitaro vy’Ivyihutirwa ubwo nyene kugira ngo ashire hejuru ku buvuzi bw’imiti myinshi ya GCA (\(60\text{ mg}\) mu kanwa canke \(1,000\text{ mg}\) IV).

5. GCA y’ubwato bunini, ubusuma bwo munsi y’urutugu, n’indwara y’ubwonko¶

Mu bice 30 gushika ku bice 80 kw’ijana vy’abarwayi ba GCA bafashwe amashusho hakoreshejwe ubuhinga bwa PET-CT canke CT angiography, indwara y’imitsi y’ibihimba vy’irondoka (granulomatous vasculitis) irashika kure y’ibihimba vy’irondoka ikaja mu mitsi y’amaraso aorta, subclavial, axillary, n’imitsi y’umugongo: - Ugutera amaboko n’umuvuduko w’amaraso utaringaniye: Gucika intege kw’imitsi yo munsi y’amaboko n’iy’inyuma y’amaboko bitera urushe rw’amaboko rubabaye iyo umuntu aterura ibintu hejuru y’umutwe, amaboko akanye, ata n’imitsi y’amaboko ihari, n’itandukaniro ry’umuvuduko w’amaraso ry’umubiri ryitwa \(>10\text{ na mm**g\)}te - Indwara y’umugongo n’ubwonko: Bitandukanye n’indwara y’imitsi (itera imitsi yo mu mutwe), GCA itera cane imitsi yo hanze y’umutwe uko iduga ica mw’izosi imbere y’uko itobora dura mater. Kugeza kuri 4 gushika ku 7 kw’ijana vy’abarwayi ba GCA baragwara indwara y’umutima, cane cane mu karere k’umugongo (itera umutwe utunguranye, gutakaza uburinganire/ataxia, kuvuga nabi, dysphagie, canke ubuhumyi bwo ku mpande zompi). - Umutsi w'umutsi w'igifu n'ugucagura: Abarwayi ba GCA barafise incuro 17 z'indwara y'umutsi w'umutsi w'igifu n' gucagura umutsi w'amaraso ugereranyije n’abo mu runganwe rwabo, bisaba gufata amashusho y’umutsi w’amaraso mu ntango no mu bihe bitandukanye.

Gupima amaraso vyihutirwa no gufata amashusho yo gupima indwara mu bitaro¶

1. Ivyo bipimo bitatu vy’amaraso bitegekanijwe: ESR, CRP, na Platelets¶

Imbere canke igihe bashira umurongo wo mu mutsi wo gufata umuti witwa methylprednisolone, abaganga b’ibihe vyihutirwa barapima amaraso gatatu vyihuta: 1. C-Reactive Protein (CRP): Ikimenyetso c’inzira y’ububabare gikomeye cane (kiduze \(>5\igisomwa{ gushika ku }10\igisomwa{ mg/L}\) mu 95 gushika ku 98 kw’ijana vy’indwara ya GCA itavuwe). Mu buryo butandukanye na ESR, CRP ntigoramye kubera ukubura amaraso canke ubuhinga bw’utugingo ngengabuzima dutukura kandi iraduga ikagwa ningoga iyo habaye igikorwa c’umururumba. 2. Igitigiri c’Ivyiyumviro vy’Imitsi y’Imitsi (ESR / Igitigiri c’Imitsi y’Imitsi y’Umubiri): Igitigiri c’Ivyiyumviro vy’Ivyiyumviro (kenshi \(>50\text{ gushika kuri }100+\text{ mm/hour}\)) muri GCA. - Uko woharura umupaka wo hejuru usanzwe w'imyaka: Ku bagabo, \(\text{Max Normal ESR} = \text{Imyaka} \div 2\). Ku bagore, \(\umwandiko{ESR isanzwe} = (\umwandiko{Imyaka} + 10) \div 2\). (Nk’akarorero, ku mugore w’imyaka 70, ESR ishika kuri \(40\text{ mm/hr}\) ishobora kuba isanzwe; muri GCA ni \(60\text{ gushika kuri }120\text{ mm/hr}\)). 3. Ibara ry’amaraso ryose (CBC) Uravye canecane ku bihimba vy’umubiri (Thrombocytose réactive): Biterwa n’urugero rwo hejuru rwa Interleukin-6, Igitigiri c’ibihimba vy’umubiri (igitigiri c’ibihimba vy’umubiri \(>400.000/\mu\text a{L}\)) biraboneka mu bice birenga 50 kw’ijana vy’abantu bafise GCA kandi biopsie nziza y’umutsi w’igihe gito kuruta ESR yonyene, ifatanijwe n’umutsi w’amaraso usanzwe w’umururumba uhoraho**.

2. Ivyuma vy'imitsi vyihuta ("Ikimenyetso c'umuco") n'ivy'imitsi y'igihe gito¶

Igihe imiti myinshi yitwa corticosteroïdes imaze gutangura mu Gisata c’Ivyihutirwa kugira ngo umurwayi akingire amaso, abaganga b’amagufa, amaso n’abaganga b’imitsi bararemeza ko iyo ndwara bakoresheje uburyo bubiri bw’inyongera:

• Ibara ry'umubiri ry'imitsi y'igihe n'iy'inyuma (Umurongo wa mbere mu ngingo ngenderwako za EULAR):
• Igikoresho co gupima imitsi gikoresha incuro nyinshi gisuzuma imitsi y’igihe gito (amashami asanzwe y’umubiri, imbere n’ay’imbere) n’imitsi y’imbere y’umubiri.
• Ikimenyetso c'"Halo": Igisebe c'umururumba kiri mu ruhome rw'umutsi kigaragara nk'uruzitiro rw'umwiza, uruzitiro rudashobora gukomera ("halo") rukikuje ibara ry'amaraso ry'i Doppler.
• Idirisha ry’Igihe co Gukora Ultrasound: Bitandukanye n’amahinduka y’ibihimba vy’umubiri (bimara indwi 2), ikimenyetso c’Ultrasound Halo gitangura kugabanuka cane iyo steroids IV zikoreshwa cane zitanguye kandi zishobora kuzimangana inyuma y’imisi 3 gushika ku 7 y’ubuvuzi bwa steroids. Ku bw’ivyo, ivy’ugupima imitsi vyihuta bikwiye gukorwa mu masaha 24 gushika kuri 72 umuntu atanguye gufata imiti y’ibitera indwara.
• Ibipimo vy'umutsi w'igihe gito (TAB, Ivy'imitsi y'umubiri):
• Ikoreshwa nk’uburyo bwo kubaga buto buto bwo kubaga umuntu atari mu bitaro akoresheje umuti wo gutera umuti witwa lidocaine, ugakura igice c’umutsi w’igihe gito ku ruhande rw’ibimenyetso.
• Kubera iki uburebure bw'igipimo c'umubiri (\(\ge 1.5\text{ gushika }2.0\text{ cm}\)) Bihambaye ("Gisimbuka ibikomere"): Giant Cell Arteritis itera umururumba mu mutsi mu bice bitandukanye ("simbuka ibikomere"), bisobanura ko milimetero 5 z'umutsi zishobora gusa n'izisanzwe umururumba w’ibihimba vy’umubiri. Kugira ngo abaganga babaga igice c’umutsi kidashikamye c’amasentimetero 2,0 gushika kuri 2,5 (kipima nibura amasentimetero 1,5 gushika kuri 2,0 inyuma yo gushiramwo formaline) maze bagasuzuma ibice vyinshi vy’umubiri bikurikirana.
• Idirisha ry’Igihe co Gupima: Ivyimburwa vy’ibihimba vy’umubiri, utugingo ngengabuzima dukomeye, n’uguca ibice kw’ibihimba vy’umubiri bikomeye biguma bigaragara neza munsi y’igikoresho citwa microscope nibura imisi 10 gushika kuri 14 (kandi kenshi bishika ku ndwi 4) umuntu amaze gutangura gufata imiti myinshi yitwa corticosteroids. Ntukigere ucerezwa gutangura imiti y'ibitera umubiri kugira ngo urindire umwanya wo gupima umubiri.

Ivyiyumviro bishingiye ku bitaro vy'imiti yitwa corticosteroid n'imiti y'ibinyabuzima¶

Amabwirizwa mpuzamakungu ariho ubu aturutse ku Ishure ryisumbuye ry’Amerika ry’Ivy’Imitsi (ACR), Ishirahamwe ry’Uburaya ry’Ivy’Imitsi (EULAR), na Ishirahamwe ry’Ubwongereza ry’Ivy’Imitsi (BSR) rigabanya ubuvuzi bw’intango bwihutirwa hakurikijwe nimba hariho ubumuga bwo mu maso canke bwo mu mutwe:

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911 ku bijanye n’ugutakaza amaso cane canke ugende ubwo nyene ku bitaro biri hafi vy’Igisata c’Ivyihutirwa gifise ubuvuzi bw’indwara y’umutima n’amaso. Kurikiza Ishure ry’Amerika ry’Ivy’Imitsi (ACR) / Ishirahamwe ry’Ivy’Imitsi na Ishure ry’Amerika ry’Ivy’Amaso (AAO) amabwirizwa asaba ko umuntu afata umuti witwa methylprednisolone imbere y’uko afata umutsi w’igihe gito.
• Ubwongereza: Hamagara 999 (canke 112) canke ugende ku kigo c’ubuvuzi bw’ivyihutirwa / Ivuriro ry’amaso ryihutirwa rya NHS / Ivuriro rya GCA ryihuta ubwo nyene. Mu nzira za NICE na Ishirahamwe ry’Ubwongereza ry’Ivy’Imitsi (BSR) Inzira za GCA zihuta, abarwayi bafise ibimenyetso vy’amaso baca bafata umuti witwa methylprednisolone IV muri A&E n’isubiramwo ryihutirwa ry’ubuvuzi bw’imitsi/amaso mu masaha 24.
• Ubumwe bw'Uburaya: Hamagara 112. EULAR (Ishirahamwe ry’Uburayi ry’Ivy’Imitsi) amabwirizwa asaba ko umuntu ahita afata imiti myinshi yitwa glucocorticoid, akayifata vuba cane mu masaha 72 mu bigo vy’imitsi vyihariye.
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande. Kurikiza Ishirahamwe ry’Abaganga b’Imitsi ryo muri Australiya na Nouvelle-Zélande (ANZAN) na RANZCO (Ishure ry’Abaganga b’Amaso ry’Ubwami bwa Australiya na Nouvelle-Zélande) amategeko y’ivyihutirwa A-AION.
• Ubuhindi na Aziya-Pasifike: Hamagara 112 mu Buhindi, 119 mu Buyapani na Koreya y’Epfo, canke 995 muri Singapore. Naho GCA ifise urugero rutoyi rw’intango mu bantu bo muri Aziya kuruta mu bantu bo mu Buraya bwo mu Buraruko, iracariho ubudasiba mu bantu bakuze barengeje imyaka 50 kandi kenshi irabura canke igacerezwa; gusaba mu buryo butomoye stat ESR, CRP, n’isuzuma ry’imiti y’ibitera indwara y’ibihaha ku muntu wese akuze afise ububabare bushasha bw’umutwe, ububabare bw’urwaya, n’ukubura amaso.

Raba inomero z'ivyihutirwa ku nimero zose zo kohereza ku rwego mpuzamakungu.

Ibibazo bikunda kubazwa¶

Umuntu afise imyaka iri musi ya 50 yoshobora kugwara indwara y’imitsi y’igihe gito (Artérite des cellules géantes)?¶

Indwara y’ukuri y’imitsi y’amaraso (Giant Cell Arteritis) yemejwe n’ibipimo vy’amaraso (biopsie) igaragara hafi gusa ku bantu bakuze bafise imyaka 50 n’irenga, aho abarwayi barenga 80 kw’ijana baba bafise imyaka irenga 65 kubera ko guhindura imitsi y’amaraso n’ugukura kw’umubiri bivanye n’imyaka kugira ngo iyo ndwara itere. Mu murwayi ari munsi y’imyaka 40 canke 50 afise umururumba nk’uwo w’imitsi minini n’ugutakaza umutima w’ukuboko, abaganga barasuzuma ko afise **Takayasu Arteritis**, gucagura umutsi w’umutwe, canke izindi ndwara z’imitsi y’umubiri mu kibanza cavyo.

Nimba namaze gutakaza amaso mw’ijisho rimwe kubera Giant Cell Arteritis uno musi, mbega imiti yo gutera imitsi yoba izotuma iryo jisho risubira kubona neza?¶

Igihe umutwe w’umutsi w’amaso umaze gufatwa n’indwara y’umutsi w’amaso, urupfu rw’imitsi y’amaso rurabaho ningoga, ni co gituma abarwayi nka 4 gushika kuri 15 kw’ijana gusa bashobora kubona neza igice c’ijisho ryamaze gufatwa mbere n’aho boba baciye bafata umuti witwa methylprednisolone mu mutsi. Ariko rero, gutangura gufata imiti myinshi mu maraso y’umubiri ubu nyene ni ikintu gihindura ubuzima vyihutirwa cane kubera ko ata miti igabanya ubukana bw’indwara, abarwayi bashika kuri 50 kw’ijana bazotakaza amaso mw’ijisho ryabo rya kabiri (ryiza) mu misi 1 gushika ku misi 7, bigatuma bacika impumyi rwose mu maso yompi.

Kuki ntashobora kurindira imisi 2 ngo ntangire gufata umuti wa prednisone gushika umuganga amaze gukora biopsie y’umutsi wanje w’igihe gito?¶

Kurindira mbere n'amasaha 24 gushika kuri 48 ata steroïdes kugira ngo biopsie igume "itavuwe" birateye akaga kandi ntibikenewe. Ivyigwa vy’ubuhinga bw’imitsi vyerekana ko ikimenyetso c’umururumba, utugingo ngengabuzima dukomeye dufise utugingo ngengabuzima twinshi, n’ugusenyuka kw’imitsi y’imbere mu mubiri biguma bigaragara neza imbere mu ruhome rw’imitsi y’igihe gito nibura imisi 10 gushika ku misi 14 inyuma y’aho umuntu atanguriye gufata imiti myinshi, mu gihe isaha yose ata miti y’imitsi y’amaso ishobora gutera ingorane.

Ni kuki umuganga wanje w’amenyo ata kibazo na kimwe yabonye mu menyo yanje mu gihe urwaya rwanje rubabaza igihe cose ntaye ivyo kurya?¶

Mu ndwara ya Giant Cell Arteritis, ububabare bw’urwaya iyo uriko uratagura (**claudication ya urwaya**) ntaco bihuriyeko n’amenyo yawe canke urugingo rw’urwaya; biterwa n’umururumba w’umubiri ugabanya imitsi y’amano n’iyo mu maso itanga amaraso afise umwuka w’ikirere (oxygène) ku mitsi yawe yo gutafuna. Nka kurya nyene umurwayi afise imitsi y’amaguru yazibiye agira ibicurane vy’inyana amaze kugenda amabarabara abiri, imitsi yawe yo gutagura iraheza ikabura umwuka w’ikirere iyo umaze gutagura ivyo kurya mu masegonda 60, ikababaza gushika uretse gutagura, kandi ikagabisha ko hariho ingorane zishobora gutera imitsi y’ijisho ryawe.

Ni gute ibipimo vy’amaraso vyanje vy’umubiri (CRP) n’ivy’umubiri (ESR) bishobora kuba bisanzwe nimba amaso yanje ariko aragenda arazimangana igihe ndiko ndafata umuti wa Tocilizumab (Actemra)?¶

Tocilizumab ikora mu guhagarika ata guca ku ruhande umusemburo witwa Interleukin-6 (IL-6), ari wo kimenyetso nyaco c’imiti igitigu gikeneye kugira ngo gikore C-Reactive Protein (CRP) na fibrinogène (ivyo bituma ESR ikora). Ku bw’ivyo, umurwayi afata Tocilizumab hafi y’igihe cose azogira CRP na ESR bisanzwe rwose ku bipimo vy’amaraso naho umururumba w’imitsi Th1 woba ukiriko urakora mu mitsi yabo; abaganga bategerezwa kwizigira ibimenyetso vy’ubuvuzi nk’ugufatwa n’umutwe, ububabare bwo mu rwasaya, canke ihinduka ry’amaso aho kwizigira ibimenyetso vy’amaraso kugira ngo bamenye ko umuntu asubiye gufata Tocilizumab.

None umuganga w'amaso aravye mw'ijisho ryanje iyo disc optique "chalky white" bisobanura iki?¶

Mu buryo busanzwe, butagira imitsi, bw’indwara y’umutsi w’amaso (Non-Arteritic Anterior Ischemic Optic Neuropathy, canke NAION), umutwe w’umutsi w’amaso uvyimvye usa n’uw’umutuku canke w’umutuku (hyperemic) ufise utubara dutoduto tw’amaraso dufise ishusho y’urubeya. Iyo umuganga w'amaso abonye **umutsi w'amaso uvyimvye, "umweru nk'uw'umukara" mu misi ya mbere nyene umuntu atabona neza, vyerekana ko umutsi w'amaso w'inyuma wacitse kandi ni ikimenyetso c'umutsi w'amaso w'inyuma w'umubiri w'umuntu.

Inyobora zifitaniye isano¶

• Indwara y’amaso (Ugufunga umutsi w’amaso wo hagati) n’indwara y’umutsi w’amaso y’igihe gito
• Gutakaza amaso bukwi na bukwi, gutandukana kw'amaso, n'indwara y'amaso y'ibara ry'agahama
• Kwemera indwara y'umutima (FAST) n'ugusubiza vyihutirwa
• Indwara y'amafyigo n'urushinge rwihutirwa rw'indwara ya Addison

Amasoko n'ubuyobozi buzwi¶

• Ishure ryisumbuye ry’Amerika ry’Ivy’Imitsi (ACR) n’Ishirahamwe ry’Ivy’Imitsi (Leta Zunze Ubumwe za Amerika): 2021 Ishirahamwe ry’Ivy’Imitsi ry’Amerika / Ishirahamwe ry’Ivy’Imitsi y’Imitsi ry’Igihugu ry’Igihugu ry’Ivy’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Igihugu (Maz n’abandi, Arthritis & Rheumatcoral high clinicor mandating glucocorids; gukeka imbere y’uko umuntu afata biopsie n’ubuvuzi bw’inyongera bwa tocilizumab).
• Ishirahamwe ry’Uburaya ry’Abaganga b’Imitsi (EULAR): Impanuro za EULAR ku bijanye no gucungera indwara y’imitsi minini n’ugukoresha amashusho mu ndwara y’imitsi minini mu bikorwa vy’ubuvuzi (Hellmich n’abandi / Dejaco n’abandi, *Annals the amategeko y'ivyuma vy'amajwi "Halo Sign").
• Ishirahamwe ry’Ubwongereza ry’Ivy’Imitsi y’Imitsi (BSR, Ubwongereza): Itegeko ry’Ishirahamwe ry’Ubwongereza ry’Ivy’Imitsi y’Imitsi ku Gupima no Kuvura indwara y’Imitsi y’Imitsi y’Imitsi y’Ibihaha (Mackie et al., Rheumatology).
• Ishure ry’ubuvuzi bw’amaso ryo muri Amerika (AAO, Leta Zunze Ubumwe za Amerika) n’ishirahamwe ry’ubuvuzi bw’amaso ryo muri Amerika y’Uburaruko (NANOS): Ivyerekeye ubuvuzi ku bijanye no gucungera indwara y’amaso y’imbere (A-AION) no kwirinda ubuhumyi bw’amaso y’abandi.
• Ishure ry’abaganga b’amaso ry’Ubwami (RCOphth, Ubwongereza) na NICE: Inzira zihuta z’indwara y’amaso n’ugufasha mu gihe c’ugutakaza amaso mu buryo bwihutirwa.