{"id":13471,"date":"2024-09-04T11:42:38","date_gmt":"2024-09-04T11:42:38","guid":{"rendered":"https:\/\/hilol-med.uz\/?p=13471"},"modified":"2024-09-04T11:47:27","modified_gmt":"2024-09-04T11:47:27","slug":"revmatoid-artrit-sabablari-klinikasi-tasnifi-tashxislash-va-davolash-usullari-xaqida","status":"publish","type":"post","link":"https:\/\/hilol-med.uz\/uz\/revmatoid-artrit-sabablari-klinikasi-tasnifi-tashxislash-va-davolash-usullari-xaqida\/","title":{"rendered":"Revmatoid artrit \u2014 sabablari, klinikasi, tasnifi, tashxislash va davolash usullari xaqida"},"content":{"rendered":"\n<p><strong>Revmatoid artrit \u2014 sabablari, klinikasi, tasnifi, tashxislash va davolash usullari xaqida<\/strong><\/p>\n\n\n\n<p><strong>Revmatoid artrit<\/strong>&nbsp;(rus.&nbsp;<em>\u0420\u0435\u0432\u043c\u0430\u0442\u043e\u0438\u0434\u043d\u044b\u0439 \u0430\u0440\u0442\u0440\u0438\u0442<\/em>) \u2014 murakkab autoimmun patogenezli noaniq etiologiyali eroziv-destruktiv poliartrit tipi bo\u2019yicha asosan mayda, proksimal falangalar aro&nbsp; bo\u2019g\u2019imlarning shikastlanishi bilan kechadigan biriktiruvchi to\u2019qimalarning tizimli kasalligidir.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"660\" src=\"https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA-1024x660.jpg\" alt=\"\" class=\"wp-image-13472\" srcset=\"https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA-1024x660.jpg 1024w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA-300x194.jpg 300w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA-768x495.jpg 768w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA-1536x991.jpg 1536w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA-370x239.jpg 370w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA.jpg 1600w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p>Kasallikning nomi qadimgi yunon tilidan olingan bo\u2019lib,&nbsp;\u1fe5\u03b5\u1fe6\u03bc\u03b1&nbsp;\u2014&nbsp;oqim,&nbsp;<em>oid<\/em>&nbsp;suffiksi \u2014&nbsp;kabi, o\u2019xshash,&nbsp;\u1f04\u03c1\u03b8\u03c1\u03bf\u03bd&nbsp;\u2014&nbsp;bo\u2019g\u2019im&nbsp;va \u2014<em>it<\/em>&nbsp;(yun. \u2014&nbsp;<em>itis<\/em>) suffiksi yallig\u2019lanish ma\u2019nosini beradi.<\/p>\n\n\n\n<p>Bugungi kunda kasallikning rivojlanishi sabablari noma\u2019lum. Bilvosita ma\u2019lumotlar: qonda leykotsitlar sonining va eritrositlar cho\u2019kish tezligining (ECHT) ortishi \u2014 jarayonning infektsion tabiatli ekanligiga ishora qiladi. Taxmin qilinishicha, kasallik irsiy moyilligi bo\u2019lgan shaxslarda immun tizimining buzilishiga olib keladigan infektsiya natijasida rivojlanadi; bunda to\u2019qimalarda saqlanadigan va bo\u2019g\u2019imlarning zararlanishiga olib keladigan immun komplekslari (antitanalar, viruslardan va boshqalardan iborat) hosil bo\u2019ladi. Ammo revmatoid artritni antibiotiklar bilan davolashning samarasizligi, ehtimol, bu taxminning noto\u2019g\u2019riligidan dalolat beradi.<\/p>\n\n\n\n<p>Kasallik juda erta sodir bo\u2019ladigan yuqori nogironlik (70%) bilan ajralib turadi. Kasallik tufayli o\u2019limning asosiy sabablari infektsion asoratlar va\u00a0buyrak yetishmovchiligi\u00a0hisoblanadi.<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p><strong><em>Bizning Hilol Med klinikamizda 7 yillik tajribaga ega revmatolog shifokor Omonov Bekzod Xasanovich, Professor Miraxmedova Hilola To\u2019xtasinovnalar birgalikda tizimli autoimmune kasalliklar, jumladan Revmatoid artrit bilan og\u2019rigan bemorlarni davolashadi. Sizda yoki yaqinlaringizda revmatoid artrit bo\u2019lsa xoziroq ro\u2019yxatdan o\u2019tib <a href=\"https:\/\/hilol-med.uz\/uz\/contacts\" target=\"_blank\" rel=\"noreferrer noopener\">qabulga yoziling<\/a><\/em><\/strong> <\/p>\n<\/blockquote>\n\n\n\n<p>Revmatoid artritni davolash asosan og\u2019riqni yengillashtirish, kasallikning rivojlanishini sekinlashtirish va jarrohlik aralashuvi yordamida zararlangan to\u2019qimalarni tiklashga qaratilgan. Zamonaviy vositalar yordamida kasallik erta aniqlansa, uning bo\u2019g\u2019imlar va boshqa to\u2019qimalarga yetkazishi mumkin bo\u2019lgan zarari sezilarli darajada kamayadi.<\/p>\n\n\n\n<p>Kasallik birinchi marta o\u2019zini og\u2019ir jismoniy zo\u2019riqish, hissiy shok, charchoq, gormonal moslashuv paytida, noxush omillar yoki infektsiyaning ta\u2019siri natijasida namoyon qiladi.<\/p>\n\n\n\n<p><strong>Epidemiologiya<\/strong><\/p>\n\n\n\n<p>Revmatoid artrit butun dunyoda tarqalgan bo\u2019lib, barcha etnik guruhlarga ta\u2019sir ko\u2019rsatadi. Tarqalganligi 0.5-1% (keksalarda 5% gacha). Har yili 100 000 aholidan 5-50 tasi kasallikka yo\u2019liqadi. 2010 yilda 49 mingga yaqin odam revmatoid artritdan vafot etgan.<\/p>\n\n\n\n<p>Kasallik boshlanadigan o\u2019rtacha yosh ayollar uchun 40-50 yoshni tashkil qiladi, erkaklar uchun esa biroz ko\u2019proq. Ushbu kasallikka ayollar erkaklarga qaraganda 3-5 marta ko\u2019proq chalinishadi.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Sabablari<\/strong><\/p>\n\n\n\n<p><strong>Autoimmun kasalliklarning ko\u2019pchiligida bo\u2019lgani kabi, revmatoid artrit rivojlanishida uchta asosiy omilni (revmatologik triada) arjatib ko\u2019rsatish mumkin:<\/strong><\/p>\n\n\n\n<p><strong>1. Genetik (irsiy) moyillik<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Autoimmun reaksiyalariga irsiy moyillik.<\/li>\n\n\n\n<li>MHC II sinfining ma\u2019lum bir antigeni: HLA-DR1, DR4 tashuvchilarida ko\u2019proq kuzatiladi<\/li>\n<\/ul>\n\n\n\n<p><strong>2. Infektsion omil<\/strong>: Revmatik kasalliklarning gipotetik triggerlari<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Paramiksoviruslar \u2014 parotit, qizamiq, respirator-sintsitsial infektsiyalar, viruslar;<\/li>\n\n\n\n<li>Gepatoviruslar \u2014\u00a0gepatit B\u00a0virusi;<\/li>\n\n\n\n<li>Gerpresviruslar \u2014\u00a0oddiy gerpes\u00a0viruslari, o\u2019rab oluvchi lishay,\u00a0sitomegalovirus;<\/li>\n\n\n\n<li>Epshteyn-Barr virusi;<\/li>\n\n\n\n<li>Retroviruslar \u2014 T-limfotrop virus.<\/li>\n<\/ul>\n\n\n\n<p><strong>3. Boshlovchi omillar<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gipotermiya, giperinsolyatsiya, zaharlanishlar, mutagen dorilar, endokrinopatiyalar,\u00a0stresslar va boshqalar.<\/li>\n<\/ul>\n\n\n\n<p>Ayollarda emizish davomiyligi revmatoid artrit rivojlanish ehtimolini pasaytiradi. 24 oy va undan ko\u2019proq vaqt davomida emizish RA rivojlanishining xavfini ikki martaga kamaytir\u0438\u0448\u0438 mumkin.<\/p>\n\n\n\n<p><strong>Patogenez<\/strong><\/p>\n\n\n\n<p>Revmatoid artrit mutaxassislar tomonidan autoimmun kasalliklar guruhiga kiritiladi. Ushbu guruh kasalliklari uchun himoya hujayralari \u2014 limfositlarning o\u2019zini tutishi xarakterlidir. Ular yot bakteriyalar, zamburug\u2019lar, viruslarni faol aniqlash va yo\u2019q qilish o\u2019rniga o\u2019zlarining sog\u2019lom hujayralariga hujum qila boshlaydi. Immun reaktsiyada immun tizimi hujayralari o\u2019zaro ta\u2019sirlashishi buzilishining ushbu patologik jarayoni quyidagi bosqichlardan iborat:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sinoviositlar makrofaglar xususiyatlarini oladi, proyallig\u2019lanishli sitokinlar ajratadi (birinchi navbatda o\u2019sma nekroz omili alfa, interleykin 1), antigen-taqdim etuvchi hujayralarga aylanib, 1 turdagi T-helperlarni faollashtiradi.<\/li>\n\n\n\n<li>Bo\u2019g\u2019imning sinovial membranasi va sinovial suyuqlik hujayralarida gamma- interferon va makrofaglarni faollashtiradigan ko\u2019p miqdorda 1 turdagi T-helperlar paydo bo\u2019ladi.<\/li>\n\n\n\n<li>Faollashgan makrofaglar va monositlar proyallig\u2019lanishli sitokinlarni: o\u2019sma nekrozi omili alfa, IL-1 , IL-6 hosil qiladi.<\/li>\n\n\n\n<li>Sinovial suyuqlikda IL-8 kontsentratsiyasining ortishi uning tarkibidagi neytrofilllarning yuqori kontsentratsiyasiga olib keladi.<\/li>\n\n\n\n<li>IL-1\u00a0isitmaga, osteoklastlarning faollashishiga sabab bo\u2019ladi, bu subxondral suyak plastinkasining osteoporozi rivojlanishiga hissa qo\u2019shadi. O\u2019sma nekrozi omili endoteliositlarning yuzasida adgeziya molekulalarining paydo bo\u2019lishini keltirib chiqaradi va ekssudatsiyaga hissa qo\u2019shadi, vazn yo\u2019qotishiga, surunkali yallig\u2019lanish\u00a0anemiyasiga\u00a0olib keladi. I16 gepatositlarni faollashtirib, C-reaktiv oqsillarni ishlab chiqarilishining o\u2019sishiga olib keladi; B-limfotsitlarni faollashtiradi (ularni plazmatik hujayarlarga aylanishi).<\/li>\n\n\n\n<li>Qonda immunoglobulinlarni ishlab chiqaruvchi plazmatik hujayralar kontsentratsiyasi sezilarli darajada ko\u2019payadi.<\/li>\n\n\n\n<li>80% bemorlarda qon va sinovial suyuqlikda IgG`ning o\u2019zgargan Fc sohasiga IgM va IgG konsentratsiyasi keskin ravishda oshadi (revmatoid omillar).<\/li>\n\n\n\n<li>Endotelial o\u2019sish faktorining chiqarilishi sinovial to\u2019qimalarning kapillyarlarini o\u2019sib ketishiga yordam beradi. Angioneogenez va faol fibroplastlar, sinoviositlarning proliferatsiyasi \u2014&nbsp;<strong>pannus<\/strong>&nbsp;\u2014 suyakning bo\u2019gimli to\u2019qimasiga, tog\u2019ayga, boylam apparatiga kirib borishga qodir bo\u2019lgan o\u2019smaga o\u2019xshash o\u2019sish belgilariga ega bo\u2019lgan agressiv to\u2019qima&nbsp;shakllanishiga olib keladi.<\/li>\n\n\n\n<li>IgG`ning revmatoid omillar bilan o\u2019zaro ta\u2019sirlashishi natijasida qonda immunitet komplekslarining shakllanishi revmatoid artritining visseral namoyon bo\u2019lishini tushuntirib beruvchi mikrosirkulyator oqim shikastlanishi va komplement faollashishiga olib keladi.<\/li>\n<\/ul>\n\n\n\n<p>Revmatoid artritning so\u2019nggi bosqichlarida proliferativ jarayon (pannus o\u2019sishi) autoimmun mexanizmlarga bog\u2019liq bo\u2019lmasligi va avtonom tarzda qo\u2019llab-quvvatlanishi mumkin.<\/p>\n\n\n\n<p><strong>Klinikasi<\/strong><\/p>\n\n\n\n<p>Revmatoid artrit uch bosqichda progressiya qiladi.<\/p>\n\n\n\n<p><strong>Birinchi bosqichda<\/strong> sinovial xaltalarning periartikulyar shishi sodir bo\u2019lib, u og\u2019riq, mahalliy isitma va bo\u2019g\u2019imlar atrofida shishganlikni chaqiradi.<\/p>\n\n\n\n<p><strong>Ikkinchi bosqich<\/strong> \u2014 hujayralarning tez bo\u2019linishi bo\u2019lib, bu sinovial membrananing qalinlashishiga olib keladi.<\/p>\n\n\n\n<p><strong>Uchinchi bosqichda<\/strong> yallig\u2019langan hujayralar suyaklar va tog\u2019aylarni shikastlovchi ferment ishlab chiqaradi, bu ko\u2019pincha ta\u2019sirlangan bo\u2019g\u2019imlarning deformatsiyasiga, og\u2019riqni kuchayishiga va harakat funktsiyalarining yo\u2019qolishiga olib keladi.<\/p>\n\n\n\n<p>Odatda, kasallik boshida bir necha oy yoki yillar davomida klinik alomatlarning asta-sekin ochilishi bilan kechadi, kamroq hollarda \u2014 o\u2019tkir osti yoki o\u2019tkir ravishda. Taxminan 2\/3 holatlar poliartrit, qolgani esa mono- yoki oligoartrit bilan namoyon bo\u2019ladi, shu bilan birga bo\u2019g\u2019imli sindrom odatda klinik xususiyatlarga ega bo\u2019lmaydi, bu esa differentsial tashxisni sezilarli darajada murakkablashtiradi. Bo\u2019g\u2019imli (artikulyar) sindrom 30 daqiqadan ko\u2019proq davom etadigan ertalabki harakat cheklanganligi va tunning ikkinchi yarmida shunga o\u2019xshash alomatlar \u2014 \u00abtor qo\u2019lqop\u00bb, \u00abkorset\u00bb simptomlari namoyon bo\u2019lishi, bo\u2019g\u2019imlarda faol harakatlanishda kuchayadigan doimiy spontan og\u2019riqlar bilan tavsiflanadi. Ertalabki harakat cheklanganligining o\u2019tib ketishi jarayoning faolligiga bog\u2019liq: faolligi qanchalik ko\u2019p bo\u2019lsa, cheklanganlik davomiyligi shuncha ko\u2019p bo\u2019ladi. Revmatoid artritda artikulyar sindrom uchun monotonlik, davomiylik, davolanishdan keyin qoldiq hodislarning saqlanib qolishi xarakterlidir.<\/p>\n\n\n\n<p>Prodromal klinik ko\u2019rinishlar bo\u2019lishi mumkin (ahamiyatsiz o\u2019tkinchi og\u2019riq, og\u2019riqlarning meteorologik sharoitlar, vegetativ buzilishlar bilan bog\u2019liqligi). \u00abShikastlanish bo\u2019g\u2019imlari \u00bb va \u00abistisno bo\u2019g\u2019imlari\u00bb ajratiladi. Birinchisiga (kuzatilish chastotasi bo\u2019yicha): II va III kaft-barmoq falangalari, proksimal interfalangal va&nbsp;metatarsofalangal, tizza va bilak-kaft usti, tirsak va oshiq-boldir bo\u2019g\u2019imlari. \u00abIstisno bo\u2019g\u2019imlari\u00bb quyidagilardan iborat: distal interfalangeal, I kaft-barmoq falangal (qo\u2019lning bosh barmog\u2019i).<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"400\" height=\"300\" src=\"https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA2.jpg\" alt=\"\" class=\"wp-image-13474\" srcset=\"https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA2.jpg 400w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA2-300x225.jpg 300w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/RA2-370x278.jpg 370w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/figure>\n\n\n\n<p>Revmatoid artrit ko\u2019pincha boshqa bo\u2019g\u2019im kasalliklar bilan birgalikda kuzatiladi \u2014 osteoartroz,\u00a0revmatizm, biriktiruvchi to\u2019qimalarning tizimli kasalliklari.<\/p>\n\n\n\n<p><strong>Bo\u2019g\u2019imdan tashqari namoyon bo\u2019lishlar:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Yurak-tomir tizimi tomonidan<\/strong>: perikardit, vaskulit, klapanlarning granulematoz shikastlanishi,\u00a0ateroskleroz.<\/li>\n\n\n\n<li><strong>Nafas olish tizimi<\/strong>: plevrit, interstitsial kasalliklar.<\/li>\n\n\n\n<li><strong>Teri<\/strong>: revmatoid tugunchalar, qalinlashuv va gipotrofiya, vaskulit, retikulyar levido.<\/li>\n\n\n\n<li><strong>Asab tizimi<\/strong>: kompression neyropatiya, sensor-motor neyropatiya, ko\u2019plab mononevritlar, servikal mielit.<\/li>\n\n\n\n<li><strong>Ko\u2019rish a\u2019zolari<\/strong>: quruq keratokonyunktivit, episklerit, sklerit, periferik yarali keratopatiya.<\/li>\n\n\n\n<li><strong>Buyraklar<\/strong>: amiloidoz\u00a0 vaskulit,\u00a0nefrit, NYQP-nefropatiya;<\/li>\n\n\n\n<li><strong>Qon<\/strong>: anemiya, trombotsitoz, neytropeniya.<\/li>\n<\/ul>\n\n\n\n<p><strong>Klinik kechish variantlari<\/strong><\/p>\n\n\n\n<p><strong>Revmatoid artrit klinik kechishining quyidagi variantlari ajratiladi:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Klassik variant (kichik va katta bo\u2019g\u2019imlarning simmetrik shikastlanishi, kasalliknign sekin progressiyasi).<\/li>\n\n\n\n<li>Asosan yirik bo\u2019g\u2019imlarning shikastlanishi bilan kechuvchi (ko\u2019pincha tizza bo\u2019g\u2019imlari) mono- yoki oligoartrit. Kasallikning aniq boshlanishi va barcha namoyon bo\u2019lishlarni&nbsp;1-1,5 oy ichida ortga qaytarish mumkinligi (artralgiya migratsiyalovchi xarakterga ega, rentgenologik o\u2019zgarishlar kuzatilmaydi, yallig\u2019lanishga qarshi dori vositalari nisbatan ijobiy ta\u2019sir ko\u2019rsatadi; keyinchalik revmatoid artritga xos bo\u2019lgan barcha belgilar paydo bo\u2019ladi).<\/li>\n\n\n\n<li>Psevdoseptik sindromli revmatoid artrit (gektik tipli isitma, titroq,\u00a0gipergidroz, vazn yo\u2019qotish, amiotrofiya rivojlanishi, anemiya, vaskulit, vistserit rivojlanishi bilan, ba\u2019zi holatlarda artritning klinik belgilarini ikkinchi planga qaytadi).<\/li>\n\n\n\n<li>Felti sindromi (poliartrit va splenomegaliya kombinatsiyasi, splenomegaliysiz variant bo\u2019lishi ham mumkin, ammo leykotsitopeniya, neytropeniya, vistseritlar bilan).<\/li>\n\n\n\n<li>Still sindromi.<\/li>\n\n\n\n<li>Yuvenil revmatoid artrit (kasallikning 16 yoshgacha boshlanishi):<ul><li>allergoseptik sindrom;<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>chegaralangan vistseritlar bilan bo\u2019g\u2019im-vistseral shakl.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Bo\u2019g\u2019im-vistseral shakl:<ul><li>revmatoid vaskulit;<\/li><\/ul><ul><li>yurak, o\u2019pka, buyrak, oshqozon-ichak a\u2019zolarining shikastlanishi;<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>asab tizimining shikastlanishi.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><strong>Tasnifi<\/strong><\/p>\n\n\n\n<p><strong>I klinik ko\u2019rinishlarning bosqichlari<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u2014 juda erta: 6 oygacha bo\u2019lgan muddat;<\/li>\n\n\n\n<li>\u2014 erta: 6 \u2014 12 oy;<\/li>\n\n\n\n<li>\u2014 tarqalgan: bir yildan ortiq;<\/li>\n\n\n\n<li>\u2014 kech: ikki yildan ortiq.<\/li>\n<\/ul>\n\n\n\n<p><strong>II kasallikning faolliigi (DAS28)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>0 (remissiya): DAS28 2,6 dan kam;<\/li>\n\n\n\n<li>1 (past): DAS28 2,6 \u2014 3.2;<\/li>\n\n\n\n<li>2 (o\u2019rta): DAS28 3,2 \u2014 5,1;<\/li>\n\n\n\n<li>3 (yuqori): DAS28 5,1 dan ko\u2019p.<\/li>\n<\/ul>\n\n\n\n<p><strong>III Instrumental xususiyatlar<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Eroziyaning mavjudligi<\/li>\n\n\n\n<li>Rentgenologik bosqich (1-4)<\/li>\n<\/ul>\n\n\n\n<p><strong>IV Immunologik xususiyatlar<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Revmatoid omil: sero-ijobiy \/ sero-salbiy;<\/li>\n\n\n\n<li>Anti-CCP: sero-ijobiy \/ sero-salbiy.<\/li>\n<\/ul>\n\n\n\n<p><strong>V Funktsional sinf<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>I O\u2019z-o\u2019ziga xizmat ko\u2019rsata olish, kasbiy bo\u2019lmagan va kasbiy faoliyatning saqlanib qolishi<\/li>\n\n\n\n<li>II Kasbiy bo\u2019lmagan va o\u2019z-o\u2019ziga xizmat ko\u2019rsata olish qobiliyatining saqlanib qolishi, kasbiy faoliyatning buzilishi<\/li>\n\n\n\n<li>III O\u2019z-o\u2019ziga xizmat ko\u2019rsata olishning saqlanib qolishi, kasbiy va kasbiy bo\u2019lmagan faoliyatning buzilishi<\/li>\n\n\n\n<li>IV barcha faoliyatlarning buzilishi<\/li>\n<\/ul>\n\n\n\n<p><strong>Tashxis<\/strong><\/p>\n\n\n\n<p>Qonni tahlil qilayotganda ECHT, revmatoid omil (revmo-faktor), trombotsitlar soni va boshqalar tekshiriladi. Eng ilg\u2019or tahlillar antitanalarning sitrulin-saqlovchi siklik peptidga titri, anti-CCP hisoblanadi. Ushbu indikatorning o\u2019ziga xosligi taxminan 90% ni tashkil etadi, shu bilan birga u revmatoid artrit bilan xastalangan bemorlar zardobining 79% ida bo\u2019ladi.<\/p>\n\n\n\n<p>Diagnostik jihatdan muhim klinik xususiyatlar \u2014 yallig\u2019langan bo\u2019g\u2019imlar sirtidagi&nbsp;teri rangining o\u2019zgarishlari yo\u2019qligi, qo\u2019l barmoqlari bukuvchi yoki yozuvchilarining tendonsinovitlari rivojlanishi va amiotrofiyalar, tipik kaft deformatsiyalari (\u00abrevmatoid bilak\u00bb) shakllanishi.<\/p>\n\n\n\n<p><strong>Ijobiy bo\u2019lmagan prognoz mezonlari quyidagilardir:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Keyingi kuchayish paytida yangi bo\u2019g\u2019imlarning jalb qilinishi;<\/li>\n\n\n\n<li>Kasallikning tizimli xususiyatlari;<\/li>\n\n\n\n<li>Bir yildan ortiq muddat ichida remissiya yo\u2019q bo\u2019lganda kasallikning uzluksiz faolligi;<\/li>\n\n\n\n<li>ECHT`ning barqaror o\u2019sishi;<\/li>\n\n\n\n<li>Ta\u2019sirlangan bo\u2019g\u2019imlarda erta rentgenologik o\u2019zgarishlar (to\u2019rt oygacha) \u2014 destruktiv o\u2019zgarishlarning jadal rivojlanishi;<\/li>\n\n\n\n<li>HLA-DR4 antigenlarining tashuvchisi bo\u2019lish;<\/li>\n\n\n\n<li>Bazisli dorilarni yaxshi ko\u2019tara olmaslik.<\/li>\n<\/ul>\n\n\n\n<p><strong>Alomatlari<\/strong><\/p>\n\n\n\n<p>Revmatoid artrit har qanday bo\u2019g\u2019imdan boshlanishi mumkin, lekin ko\u2019pincha barmoqlar, qo\u2019llar va bilakdagi mayda bo\u2019g\u2019imlardan boshlanadi. Odatda, bo\u2019g\u2019imlarni shikastlanishi simmetrikdir, ya\u2019ni o\u2019ng qo\u2019lda bo\u2019g\u2019im og\u2019riyotgan bo\u2019lsa, demak chap tomondagi o\u2019sha bo\u2019g\u2019im ham og\u2019rishi kerak. Qanchalik ko\u2019proq bo\u2019g\u2019imlar shikastlangan bo\u2019lsa, kasallikning bosqichi shunchalik rivojlangan bo\u2019ladi.<\/p>\n\n\n\n<p><strong>Boshqa umumiy alomatlari:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Charchoq, astenovegetativ sindrom;<\/li>\n\n\n\n<li>Ertalabki harakat cheklanganligi. Odatda, cheklanganlik qanchalik ko\u2019p davom etsa, kasallik shunchalik faolroq bo\u2019ladi.<\/li>\n\n\n\n<li>Zaiflik;<\/li>\n\n\n\n<li>Grippga\u00a0o\u2019xshash alomatlar, shu jumladan biroz isitma;<\/li>\n\n\n\n<li>Uzoq muddat o\u2019tirgan holatda bo\u2019lganda og\u2019riq;<\/li>\n\n\n\n<li>Remissiya bilan hamrohlik qiluvchi kasallikning chaqnashlari;<\/li>\n\n\n\n<li>Mushak og\u2019rig\u2019i;<\/li>\n\n\n\n<li>Ishtahaning yo\u2019qolishi, depressiya, vazn yo\u2019qotish, kamqonlik, kaftlar va oyoqlar ter;ashi va \/ yoki yaxlashi;<\/li>\n\n\n\n<li>So\u2019lak va ko\u2019z yosh bezlari faoliyatining buzilishi, natijada ularning yetishmasligi kuzatiladi.<\/li>\n<\/ul>\n\n\n\n<p><strong>Revmatoid artritni davolash<\/strong><\/p>\n\n\n\n<p>Infektsiya mavjud bo\u2019lganda yoki unga shubha qilinganda (sil, iersinioz va hokazo) tegishli antibakterial preparat bilan terapiya kerak bo\u2019ladi. Bo\u2019g\u2019imlardan tashqari yorqin ko\u2019rinishlar bo\u2019lmaganda (masalan yuqori isitma, Felti sindromi yoki polinevropatiya) artikulyar sindromni davolash <strong>nosteroid yallig\u2019lanishga qarshi preparatlarni<\/strong> <strong>(NYQP)<\/strong> tanlash bilan boshlanadi. Bir vaqtning o\u2019zida eng ko\u2019p yallig\u2019langan bo\u2019g\u2019imlarga kortikosteroidlar kiritiladi. Kasallikning immunokompleks tabiati plazmaferez kurslarining o\u2019tkazilishiga ko\u2019rsatma beradi va bu aksariyat hollarda sezilarli ta\u2019sir ko\u2019rsatadi. Ushbu terapiya natijalarining beqarorligi bazisli vositalarni qo\u2019shilishiga ko\u2019rsatma bo\u2019lib hisoblanadi. Ushbu dori-darmonlar sekin ta\u2019sir ko\u2019rsatadi, shuning uchun kamida 6 oy davomida qo\u2019llanilishi kerak, agar terapiya ijobiy ta\u2019sir ko\u2019rsatsa, ular bilan davolanish yana davom ettiriladi (yillab).<\/p>\n\n\n\n<p>Revmatoid artritni davolashda\u00a0osteoporoz\u00a0profilaktikasi \u2014 ichakda so\u2019rilishini oshirish va uning organizmdan chiqib ketishini kamaytirish yo\u2019li orqali buzilgan kaltsiy muvozanatini tiklash muhim o\u2019rin tutadi. Osteoporozga qarshi chora-tadbirlarning muhim tarkibiy qismi o\u2019zida ko\u2019p miqdorda kaltsiy saqlagan parhez hisoblanadi. Kaltsiy manbalari sut mahsulotlari (ayniqsa qattiq pishloqlar, ularning 100g miqdorida 600-1000mg kaltsiy bo\u2019ladi, shuningdek eritilgan pishloqlar; kamroq miqdorda kaltsiy tvorog, sut va smetanada mavjud), bodom, o\u2019rmon yong\u2019oqlari va yong\u2019oq, shuningdek vitamin D yoki uning faol metabolitlari bilan birgalikda kaltsiy preparatlari sanaladi.<\/p>\n\n\n\n<p>Davolashda bo\u2019g\u2019imlarning maksimal harakatchanligini ta\u2019minlash va mushak massasini saqlab qolish uchun mo\u2019ljallangan terapevtik mashqlar muhim ahamiyatga ega.<\/p>\n\n\n\n<p>Fizioterapevtik muolajalar va sanatoriya-kurortli davolash ikkilamchi ahamiyatga ega va faqat artrit jiddiyligi yuqori bo\u2019lmaganida ishlatiladi.<\/p>\n\n\n\n<p>Barqaror mono- va oligorartritda bo\u2019g\u2019imga oltin, ittriy va boshqalar izotopini kiritish orqali, yoki jarrohlik yo\u2019li bilan sinovektomiya amalga oshiriladi. Bo\u2019g\u2019imlarning barqaror deformatsiyalarida rekonstruktiv operatsiyalar o\u2019tkaziladi.<\/p>\n\n\n\n<p><strong>Zamonaviy terapiya<\/strong><\/p>\n\n\n\n<p><strong>Tizimli medikamentoz terapiya to\u2019rt guruh preparatlarini qo\u2019llashni o\u2019z ichiga oladi:<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Simptomatik davolash \u2014 nosteroid yallig\u2019lanishga qarshi preparatlar (NYQP) va glyukokortikosteroidlar (GKS),<\/li>\n\n\n\n<li>Bazisli antirevmatik preparatlar,<\/li>\n\n\n\n<li>Sitostatik immunosupressantlar bilan gen-muhandislik biologik (kasallik kechishini nazorat qiluvchi) preparatlar.<\/li>\n<\/ol>\n\n\n\n<p><strong>Nosteroid yallig\u2019lanishga qarshi preparatlar<\/strong><\/p>\n\n\n\n<p>Zamonaviy NYQP`lar araxidon kislotasi metabolizmining asosiy fermenti bo\u2019lgan siklooksigenaza (SOG) faolligini bostirish orqali sezilarli yallig\u2019lanishga qarshi ta\u2019sirga ega. SOG-1 va SOG-2 deb ta\u2019riflangan va prostaglandinlar (PG) sintezini boshqarishda turlicha rol o\u2019ynaydigan ikkita SOG izoshakllarining kashf qilinishi alohida qiziqish taqdim etadi. NYQP`lar SOG izoshakllarining faolligini bostirishi isbotlangan, ammo ularning yallig\u2019lanishga qarshi faolligi aynan SOG-2 ingibitsiyasiga bog\u2019liq.<\/p>\n\n\n\n<p>Ko\u2019pchilik mashhur NYQP`lar avvalo SOG-1 faolligini bostirishadi, bu bilan indutsiyalangan NYQP gastropatiya (xususan, eroziya va yaralar hosil bo\u2019lishi), buyrak funktsiyalarining buzilishi, ensefalopatiya, gepatotoksiklik kabi asoratlar tushuntiriladi.<\/p>\n\n\n\n<p>Shunday qilib, SOG`ni bloklash tabiatiga qarab, NYQP`lar SOG-2 ingibitorlari (\u00abkoksiblar\u00bb) va noselektivlarga bo\u2019linadi.<\/p>\n\n\n\n<p>Nisbatan selektiv bo\u2019lgan SOG-2 ingibitorlari vakillari meloksikam, lornoksikam va \u00aboksikam\u00bblarning boshqa vakillari va nimesulid hisoblanadi. Yuqori selektiv SOG-2 ingibitorlari vakillari selekoksib va etorikoksib sanaladi. Ushbu preparat oshqozon-ichak tizimi tomonidan minimal nojo\u2019ya ta\u2019sirga ega va shu bilan birga yuqori yallig\u2019anishga qarshi va analgetik xususiyatlarini saqlab qolgan bo\u2019ladi. SOG-2 ingibitorlari barcha dasturlarida NYQP`lardan foydalanishni talab etadigan revmatoid artritni davolashning barcha kurslarida qo\u2019llanilishi mumkin. Terapiyaning boshlanishida yallig\u2019lanish jarayonining faol bo\u2019lganida meloksikam sutkasiga 15 mg dozada buyuriladi va keyinchalik qo\u2019llab-quvvatlovchi terapiya sifatida sutkasiga 7,5 mg dozagacha tushiriladi. Nimesulid 100 mg dozada bir kunda ikki marta buyuriladi.<\/p>\n\n\n\n<p>Selekoksib \u2014 SOG-2 ning maxsus ingibitori \u2014 sutkasiga ikki marta 100-200 mg`dan dozada buyuriladi. Keksa kishilar uchun preparatning dozirovkasini tanlash talab qilinmaydi. Ammo tana vazni o\u2019rtacha ko\u2019rsatkichdan (50 kg) past bo\u2019lgan bemorlarda davolashni tavsiya etilgan eng kam dozadan boshlash tavsiya etiladi.<\/p>\n\n\n\n<p>Ikki yoki undan ortiq NYQP`larning birgalikda qabul qilinishidan qochish kerak, chunki ularning samaradorligi o\u2019zgarishsiz qoladi, nojo\u2019ya ta\u2019siri esa kuchayadi.<\/p>\n\n\n\n<p><strong>Glyukokortikosteroidlar<\/strong><\/p>\n\n\n\n<p>Yuqori dozalarda GKS (\u00abpuls-terapiya\u00bb) va sekin ta\u2019sir qiluvchi vositalar kombinatsiyasini ishlatish (ular GKS samaradorligini oshiradi) yangicha yondashuv sanaladi: metotreksatning aminoxinolinli unumlari, oltin tuzlari, sulfasalazin, shuningdek selektiv immunosupressant siklosporin bilan kombinatsiyasi.<\/p>\n\n\n\n<p>Yallig\u2019lanish jarayonining yuqori darajada faol bo\u2019lganida GKS ishlatiladi, revmatoid artrit tizimli namoyon bo\u2019lishi hollarida \u2014 puls terapiya (faqat GKS yoki sitostatik \u2014 siklofosfamid bilan birgalikda), tizimli namoyon bo\u2019lishlarsiz hollarida esa&nbsp; \u2014 kursli davolash sifatida. GKS shuningdek boshqa dori vositalari samarasiz bo\u2019lganida qo\u2019llab-quvvatlovchi yallig\u2019lanishga qarshi terapiya sifatida ishlatiladi.<\/p>\n\n\n\n<p>Ba\u2019zi hollarda GKS mahalliy terapiya sifatida ishlatiladi. Ularni qo\u2019llash uchun ko\u2019rsatmalar:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Yirik bo\u2019g\u2019imlarning asosan mono yoki oligoartriti;<\/li>\n\n\n\n<li>Bo\u2019g\u2019imda cho\u2019zilib ketgan ekssudativ jarayon;<\/li>\n\n\n\n<li>\u00abMahalliy maqomning\u00bb tizimli maqomdan ustunligi;<\/li>\n\n\n\n<li>GKS`ni tizimli ishlatilishiga qarshi ko\u2019rsatmalar mavjudligi.<\/li>\n<\/ul>\n\n\n\n<p>Kortikosteroidlarning depo-shaklli bo\u2019g\u2019im ichiga kiritilishida preparat tizimli ta\u2019sir ham ko\u2019rsatadi. Tanlov preparati betametazon dipropionat (\u00abdiprospan\u00bb) bo\u2019lib, u uzoq muddatli ta\u2019sirga ega.<\/p>\n\n\n\n<p><strong>Bazisli antirevmatik preparatlar<\/strong><\/p>\n\n\n\n<p>Bazisli preparatlar haligacha revmatoid artritni davolashda birlamchi rol o\u2019ynaydi, lekin hozirda ularni belgilashga yangi yondashuv kuzatilmoqda. Taniqli bo\u2019lgan revmatoid artrit terapiyasini bosqichma-bosqich oshirishdan (\u00abpiramida tamoyili\u00bb) farqli o\u2019laroq, hozirda kasallik tashxislangan vaqtidan boshlaboq erta davrlarda bazisli preparatlar bilan agressiv davolash propaganda qilinmoqda, buning maqsadi revmatoid artrit kechishini o\u2019zgartirish va sifatli remissiyani ta\u2019minlashdir. Buning uchun asos bo\u2019lib revmatoid artritning erta davrlarida pannus, deformatsiyalar, osteopeniya, autoimmun mexanizmlar tomonidan chaqirilgan jiddiy asoratlar yo\u2019qligi, remissiya rivojlanishining yuqori ehtimolligi xizmat qiladi.<\/p>\n\n\n\n<p>Revmatoid artritning bazisli terapiyasi uchun asosiy dori vositalar:&nbsp; metotreksat, leflunomid, sulfasalazin, oltin preparatlari, penitsillamin, aminoxinolinli preparatlar (masalan gidroksixloroxin). Zaxira vositalariga siklofosfamid, azatioprin, siklosporin kiradi.<\/p>\n\n\n\n<p>1,5-3 oy mobaynida samarasiz bo\u2019lgan bazisli preparatlar boshqasiga almashtirilishi yoki ularning kichik dozalardagi GKS bilan kombinatsiyasi ishlatilishi kerak, oxirgilari bazisli vositalarning ta\u2019siri boshlanishiga qadar revmatoid artritning faolligini pasaytiradi. Kritik muhlat olti oy bo\u2019lib, bu davrgacha samarali bazisli terapiya tanlanib bo\u2019lishi kerak.<\/p>\n\n\n\n<p>Kasallikni bazisli preparatlar bilan davolash jarayonida kasallikning faolligi, shuningdek, nojo\u2019ya ta\u2019sirlarning namoyon bo\u2019lishi va rivojlanishi diqqat bilan kuzatib boriladi.<\/p>\n\n\n\n<p><strong>1. Sitokin \/ xemokin blokatorlari va ularning retseptorlari blokatorlari (antisitokin preparatlar):<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>O\u2019NO ingibitorlari:<ul><li>Adalimumab (\u00abXumira\u00bb)<\/li><\/ul><ul><li>Golimumab (\u00abSimponi\u00bb)<\/li><\/ul><ul><li>Infliksimab (\u00abRemikeyd\u00bb)<\/li><\/ul><ul><li>Sertolizumaba pegol (\u00abSimziya\u00bb)<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Etanersept (\u00abEnbrel\u00bb)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Interleykin-6 retseptorlariga monoklonal antitanalar \u2014 tosillizumab (\u00abAktemra\u00bb);<\/li>\n\n\n\n<li>Interleykin-1 retseptorlariga monoklonal antitanalar \u2014 anakinra (\u00abKineret\u00bb);<\/li>\n\n\n\n<li>Interleykin-12 va 23 retseptorlariga monoklonal antitanalar \u2014 ustekinumab (\u00abStelara\u00bb);<\/li>\n<\/ul>\n\n\n\n<p><strong>2.Antilimfositar preparatlar:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rituksimab (\u00abMabtera\u00bb)<\/li>\n\n\n\n<li>Abatasept (\u00abOrensia\u00bb)<\/li>\n<\/ul>\n\n\n\n<p><strong>3. jack-STAT signallarining hujayra ichida uzatilishi yo\u2019llarining peroral past molekulyar ingibitorlari \u2014 tofasitinib ( \u00abYakvinus\u00bb)<\/strong><\/p>\n\n\n\n<p>Revmatoid artritning progressiyalanishi davrida O\u2019NO bo\u2019g\u2019imda mavjud bo\u2019lgan immunokompetent hujayralar tomonidan ishlab chiqariladi va sinovial membranalarda yallig\u2019lanish jarayoni rivojlanishiga olib keladi. Revmatoid artrit bilan og\u2019rigan bemorlarda bo\u2019g\u2019imlar shikastlanishi suyaklararo bo\u2019g\u2019imli joyning torayishi va suyaklararo bo\u2019g\u2019imli joyning eroziyasi kuzatiladi. Monoklonal antitanalarning klinik tadqiqotlari ularning ishlatilishi bo\u2019g\u2019imlar shikastlanishini sekinlashtirishini ko\u2019rsatdi.<\/p>\n\n\n\n<p>Shuningdek T-limfositlar differinsirovkasi o\u2019ziga xos regulyatorlaridan foydalanish ham istiqbolli hisoblanadi, masalan galofuginon.<\/p>\n\n\n\n<p><strong>Miorelaksantlar<\/strong><\/p>\n\n\n\n<p>Miorelaksantlar revmatoid artritda og\u2019riqni yo\u2019qotish uchun samarali vosita emas.<\/p>\n\n\n\n<p><strong>Prognoz<\/strong><\/p>\n\n\n\n<p>Revmatoid artrit umr davomiyligini o\u2019rtacha 3-12 yilgacha qisqartiradi. 2005-yilda Mayo Klinikasi tomonidan o\u2019tkazilgan tadqiqot revmatoid artritdan aziyat chekadigan bemorlarda boshqa xavf omillaridan qat\u2019iy nazar (chekish, qandli diabet,\u00a0alkogolizm, semizlik va yuqori xolesterin miqdori kabi), yurak kasalliklari rivojlanishi xavfi ikki barobar yuqori ekanligini ko\u2019rsatdi. Yurak kasalliklari rivojlanishi xavfini oshiruvchi mexanizm noma\u2019lum; surunkali yallig\u2019lanish mavjudligi muhim omil hisoblanadi. Ehtimol, yangi biologik vositalardan foydalanish hayot davomiyligini uzaytiradi va yurak-qon tomir tizimi uchun xavfni kamaytiradi hamda ateroskleroz rivojlanishini sekinlashtiradi.<\/p>\n\n\n\n<p class=\"has-small-font-size\"><strong>Manbalar va adabiyotlar<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size\">Rossiya revmatologlar assotsiatsiyasining klinik tavsiyalari (Umumrossiya jamoat tashkiloti)<\/p>\n\n\n\n<p class=\"has-small-font-size\">Nasonov EL, Karateev DE, Balabanova RM. Romatoid artrit. Kitobda: Revmatologiya. Milliy yetakchilik. Ed. E.L. Nasonova, V.A. Nasonova. Moskva: GEOTAR-Media; 2008.S. 290-3318. Folomeeva OM, Galushko EA, Erdes ShF. Rossiya va AQShning kattalar aholisida revmatik kasalliklarning tarqalishi. Ilmiy va amaliy revmatologiya. 2008;46(4):4-13. 001:10.14412\/1995-4484-2008-529<\/p>\n\n\n\n<p class=\"has-small-font-size\">9. 2017 yilda Rossiyaning kattalar aholisining umumiy kasallanish darajasi. Statistik materiallar, IV qism, Moskva.2018.10. Karateev D.E., Olyunin Yu.A. Romatoid artritning tasnifi bo&#8217;yicha. Ilmiy va amaliy revmatologiya. 2008;46(1):5-16.<\/p>\n\n\n\n<p class=\"has-small-font-size\">&nbsp;25. Chichasova NV, Nasonov E31. Romatoid artrit uchun genetik jihatdan yaratilgan biologik preparatlardan foydalanish xavfsizligi. Zamonaviy revmatologiya. 2010; 1:46-58.39. Kirillova I.G., Novikova D.S., Popkova T.V., Udachkina E.V., Markelova E.I., Gorbunova Yu.N., Korsakova Yu.O., Gluxova S.N.<\/p>\n\n\n\n<p class=\"has-small-font-size\">Asosiy antirevmatik terapiyani tayinlashdan oldin erta revmatoid artritli bemorlarda surunkali yurak etishmovchiligi. Kardiologiyada ratsional farmakoterapiya 2020; 16(1):51-58. DOI:10.20996\/1819-6446-2020-01 -02 42. 31isitsyna T. A., Veltishchev D. Yu., Seravina O. F., Kovalevskaya O. B., Zeltyn A. E., Fofanova Yu. , Novikova T.V. Romatoid artritli bemorlarda ruhiy kasalliklar \/\/ Ilmiy va amaliy revmatologiya. 2011 yil. \u2116 3. 45. Nasonov E.L. Romatoid artritning farmakoterapiyasi: Rossiya va xalqaro tavsiyalar. Ilmiy va amaliy revmatologiya.<\/p>\n\n\n\n<p class=\"has-small-font-size\">52. Nasonov E31, Mazurov VI, Karateev DE va \u200b\u200bboshqalar &laquo;Rossiya revmatologlari assotsiatsiyasi&raquo; Butunrossiya jamoat tashkilotining revmatoid artritini davolash bo&#8217;yicha tavsiyalar loyihasi &#8211; 2014 yil (1-qism). Ilmiy va amaliy revmatologiya. 2014;52:477-494<\/p>\n\n\n\n<p class=\"has-small-font-size\">53.Nasonov E31, Karateev DE, Chichasova NV. Romatoid artritni davolash bo&#8217;yicha EULAR tavsiyalari &#8211; 2013: umumiy xususiyatlar va munozarali masalalar. Ilmiy va amaliy revmatologiya. 2013;51:609-622. 5<\/p>\n\n\n\n<p class=\"has-small-font-size\">6.Nasonov EL, Lkhno NN, Karateev AE, Alekseeva LI, Barinov AN va boshqalar. Mushak-skelet tizimining og&#8217;rig&#8217;ini davolashning umumiy tamoyillari: fanlararo konsensus. Ilmiy va amaliy revmatologiya<\/p>\n\n\n\n<p><strong><em>Bizning Hilol Med klinikamizda 7 yillik tajribaga ega revmatolog shifokor Omonov Bekzod Xasanovich, Professor Miraxmedova Hilola To\u2019xtasinovnalar birgalikda tizimli autoimmun kasalliklar, jumladan Revmatoid artrit bilan og\u2019rigan bemorlarni davolashadi. Sizda yoki yaqinlaringizda revmatoid artrit bo\u2019lsa xoziroq <a href=\"https:\/\/hilol-med.uz\/uz\/contacts\">ro\u2019yxatdan o\u2019ting<\/a> yoki +998712002303 ga qo\u2019ng\u2019iroq qiling. &nbsp;<\/em><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"768\" height=\"1024\" src=\"https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/bekzod-768x1024.jpg\" alt=\"\" class=\"wp-image-13478\" srcset=\"https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/bekzod-768x1024.jpg 768w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/bekzod-225x300.jpg 225w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/bekzod-370x493.jpg 370w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/bekzod-420x560.jpg 420w, https:\/\/hilol-med.uz\/wp-content\/uploads\/2024\/09\/bekzod.jpg 960w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/><\/figure>\n\n\n\n<p><strong>Revmatolog Omonov Bekzod Xasanovich<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Revmatoid artrit \u2014 sabablari, klinikasi, tasnifi, tashxislash va davolash usullari xaqida Revmatoid artrit&nbsp;(rus.&nbsp;\u0420\u0435\u0432\u043c\u0430\u0442\u043e\u0438\u0434\u043d\u044b\u0439 \u0430\u0440\u0442\u0440\u0438\u0442) \u2014 murakkab autoimmun patogenezli noaniq etiologiyali eroziv-destruktiv poliartrit tipi bo\u2019yicha asosan mayda, proksimal falangalar aro&nbsp; bo\u2019g\u2019imlarning shikastlanishi bilan kechadigan biriktiruvchi to\u2019qimalarning tizimli kasalligidir. Kasallikning nomi qadimgi yunon tilidan olingan bo\u2019lib,&nbsp;\u1fe5\u03b5\u1fe6\u03bc\u03b1&nbsp;\u2014&nbsp;oqim,&nbsp;oid&nbsp;suffiksi \u2014&nbsp;kabi, o\u2019xshash,&nbsp;\u1f04\u03c1\u03b8\u03c1\u03bf\u03bd&nbsp;\u2014&nbsp;bo\u2019g\u2019im&nbsp;va \u2014it&nbsp;(yun. \u2014&nbsp;itis) suffiksi yallig\u2019lanish ma\u2019nosini beradi. Bugungi kunda kasallikning [&hellip;]<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"_jet_sm_ready_style":"","_jet_sm_style":"","_jet_sm_controls_values":"","_jet_sm_fonts_collection":"","_jet_sm_fonts_links":"","footnotes":""},"categories":[142],"tags":[145,148,131,147,144,146,149,154,155,152,156,151,150,153],"class_list":["post-13471","post","type-post","status-publish","format-standard","hentry","category-revmatologiya","tag-artrit","tag-artroz","tag-klinika","tag-revmatizm","tag-revmatoid-artrit","tag-revmatolog","tag-tashkent","tag-154","tag-155","tag-152","tag-156","tag-151","tag-150","tag-153","no-thumb"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Revmatoid artrit \u2014 sabablari, klinikasi, tasnifi, tashxislash va davolash usullari xaqida % - Hilol Med<\/title>\n<meta name=\"description\" content=\"xususiy klinika\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/hilol-med.uz\/uz\/revmatoid-artrit-sabablari-klinikasi-tasnifi-tashxislash-va-davolash-usullari-xaqida\/\" \/>\n<meta property=\"og:locale\" content=\"uz_UZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Revmatoid artrit \u2014 sabablari, klinikasi, tasnifi, tashxislash va davolash usullari xaqida % - 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