Kodi anthu omwe ali ndi matenda a Ehlers-Danlos angapeze mpumulo kudzera m'njira zosiyanasiyana zosapanga opaleshoni kuti achepetse kusakhazikika pamodzi?
Introduction
Kulumikizana ndi mitsempha yozungulira minofu ndi mafupa amalola kuti kumtunda ndi kumunsi kukhazikike kukhazikika kwa thupi ndikukhala mafoni. Minofu yosiyana siyana ndi minyewa yofewa yomwe imazungulira mafupawo imawathandiza kuti asavulale. Zinthu zachilengedwe kapena zovuta zikayamba kukhudza thupi, anthu ambiri amakhala ndi zovuta zomwe zimapangitsa kuti pakhale mbiri yowopsa, zomwe zimakhudza kukhazikika kwa mafupa. Chimodzi mwa zovuta zomwe zimakhudza mafupa ndi minofu yolumikizana ndi EDS kapena Ehlers-Danlos syndrome. Kusokonezeka kwa minofu yamtunduwu kungapangitse kuti ziwalo za thupi zikhale hypermobile. Zingayambitse kusakhazikika kwa mgwirizano kumtunda ndi kumunsi, motero kumasiya munthu kukhala wopweteka nthawi zonse. Nkhani ya lero ikukamba za matenda a Ehlers-Danlos ndi zizindikiro zake komanso momwe pali njira zopanda opaleshoni zothetsera vutoli. Timakambirana ndi azachipatala ovomerezeka omwe amaphatikiza zambiri za odwala athu kuti awone momwe matenda a Ehlers-Danlos angagwirizane ndi matenda ena a minofu ndi mafupa. Timadziwitsanso ndikuwatsogolera odwala momwe mankhwala osiyanasiyana osagwiritsa ntchito opaleshoni angathandizire kuchepetsa zizindikiro zowawa komanso kusamalira matenda a Ehlers-Danlos. Timalimbikitsanso odwala athu kuti afunse othandizira awo azachipatala mafunso ambiri ovuta komanso ofunikira okhudza kuphatikiza njira zosiyanasiyana zochiritsira zosachita opaleshoni monga gawo la zochitika zawo zatsiku ndi tsiku kuti athe kuthana ndi zotsatira za matenda a Ehlers-Danlos. Dr. Jimenez, DC, akuphatikizapo izi monga ntchito ya maphunziro. chandalama.
Kodi Ehlers-Danlos Syndrome Ndi Chiyani?
Kodi nthawi zambiri mumatopa kwambiri tsiku lonse, ngakhale mutagona usiku wonse? Kodi mumavulazidwa mosavuta ndikudabwa kuti mikwingwirima iyi ikuchokera kuti? Kapena mwawona kuti muli ndi kuchuluka kwamitundu yambiri pamalumikizidwe anu? Zambiri mwazinthuzi nthawi zambiri zimagwirizanitsidwa ndi matenda otchedwa Ehlers-Danlos syndrome kapena EDS omwe amakhudza ziwalo zawo ndi minofu yolumikizana. EDS imakhudza minyewa yolumikizana m'thupi. Mitsempha yolumikizana m'thupi imathandiza kupereka mphamvu ndi kusungunuka kwa khungu, mafupa, komanso makoma a mitsempha ya magazi, kotero pamene munthu akulimbana ndi EDS, zingayambitse kusokonezeka kwakukulu kwa minofu ndi mafupa. EDS imapezeka makamaka m'chipatala, ndipo madokotala ambiri azindikira kuti jini ya collagen ndi mapuloteni omwe amalumikizana m'thupi angathandize kudziwa mtundu wa EDS umene umakhudza munthu. (Miklovic & Sieg, 2024)
Zizindikiro zake
Mukamvetsetsa EDS, ndikofunikira kudziwa zovuta za matenda olumikizana ndi minofu iyi. EDS imagawidwa m'mitundu yambiri yokhala ndi mawonekedwe osiyanasiyana komanso zovuta zomwe zimasiyana malinga ndi kuuma kwake. Imodzi mwa mitundu yodziwika bwino ya EDS ndi hypermobile Ehlers-Danlos syndrome. Mtundu uwu wa EDS umadziwika ndi hypermobility wamba, kusakhazikika kwamagulu, komanso kupweteka. Zina mwa zizindikiro zomwe zimagwirizanitsidwa ndi hypermobile EDS zimaphatikizapo kugwedezeka, kusokonezeka, ndi kuvulala kwa minofu yofewa yomwe imakhala yofala ndipo imatha kuchitika mwadzidzidzi kapena kupwetekedwa kochepa. (Hakim, 1993) Izi nthawi zambiri zingayambitse ululu wopweteka kwambiri pamagulu omwe ali pamwamba ndi pansi. Pokhala ndi zizindikiro zambiri komanso momwe chikhalidwecho chilili, ambiri nthawi zambiri samazindikira kuti kuphatikizika kwa mgwirizano kumakhala kofala pakati pa anthu ambiri ndipo sikungakhale ndi zovuta zomwe zimasonyeza kuti ndi matenda okhudzana ndi minofu. (Gensemer et al., 2021) Kuphatikiza apo, hypermobile EDS ingayambitse kupunduka kwa msana chifukwa cha kuchuluka kwa khungu, mafupa, ndi kufooka kwa minofu yosiyanasiyana. The pathophysiology of spinal deformity kugwirizana ndi hypermobile EDS makamaka chifukwa cha minofu hypotonia ndi ligament laxity. (Uehara et al., 2023) Izi zimapangitsa kuti anthu ambiri achepetse kwambiri moyo wawo komanso zochita za tsiku ndi tsiku. Komabe, pali njira zothandizira EDS ndi zizindikiro zake zogwirizana kuti muchepetse kusakhazikika pamodzi.
Movement Medicine: Chiropractic Care-Video
Njira Zowongolera EDS
Pankhani yofunafuna njira zothandizira EDS kuti muchepetse ululu ndi kusakhazikika kwamagulu, mankhwala osachita opaleshoni angathandize kuthana ndi zochitika zakuthupi ndi zamaganizo. Thandizo lopanda maopaleshoni kwa anthu omwe ali ndi EDS nthawi zambiri limayang'ana kwambiri pakuwongolera magwiridwe antchito amthupi pomwe amapangitsa kuti minyewa ikhale yolimba komanso kukhazikika kwamagulu. (Buryk-Iggers et al., 2022) Anthu ambiri omwe ali ndi EDS amayesa kuphatikizira njira zowongolera ululu ndi chithandizo chamankhwala komansogwiritsani ntchito zingwe ndi zida zothandizira kuchepetsa zotsatira za EDS ndikusintha moyo wawo.
Chithandizo Chopanda Opaleshoni cha EDS
Mankhwala osiyanasiyana osapanga opaleshoni monga MET (njira yamphamvu ya minofu), electrotherapy, chithandizo chopepuka, chisamaliro cha chiropractic, ndi kutikita minofu. zingathandize kulimbikitsa pamene toning minofu yozungulira kuzungulira mafupa, kupereka mpumulo wokwanira wa ululu, ndi kuchepetsa kudalira mankhwala kwa nthawi yaitali. (Broida et al., 2021) Kuonjezera apo, anthu omwe ali ndi EDS amafunitsitsa kulimbikitsa minofu yomwe yakhudzidwa, kukhazikika m'malo olumikizirana mafupa, komanso kukonza mayendedwe ake. Thandizo lopanda opaleshoni limalola munthuyo kukhala ndi ndondomeko ya chithandizo chokhazikika cha kuopsa kwa zizindikiro za EDS ndikuthandizira kuchepetsa ululu wokhudzana ndi vutoli. Anthu ambiri, akamadutsa dongosolo lawo lamankhwala motsatizana kuti athe kusamalira EDS yawo ndikuchepetsa zizindikiro zonga zowawa, amawona kusintha kwazizindikiro. (Khokhar et al., 2023) Izi zikutanthauza kuti mankhwala osagwiritsa ntchito opaleshoni amalola anthu kuti aziganizira kwambiri za matupi awo ndi kuchepetsa zotsatira zopweteka za EDS, motero amalola anthu ambiri omwe ali ndi EDS kukhala ndi moyo wokwanira, womasuka popanda kumva ululu ndi kusamva bwino.
Zothandizira
Broida, SE, Sweeney, AP, Gottschalk, MB, & Wagner, ER (2021). Kusamalira kusakhazikika kwa mapewa mu hypermobility-type Ehlers-Danlos syndrome. JSES Rev Rep Tech, 1(3), 155-164. doi.org/10.1016/j.xrrt.2021.03.002
Buryk-Iggers, S., Mittal, N., Santa Mina, D., Adams, SC, Englesakis, M., Rachinsky, M., Lopez-Hernandez, L., Hussey, L., McGillis, L., McLean , L., Laflamme, C., Rozenberg, D., & Clarke, H. (2022). Kuchita Zolimbitsa Thupi ndi Kukonzanso Kwa Anthu Omwe Ali ndi Ehlers-Danlos Syndrome: Kubwereza Mwadongosolo. Arch Rehabil Res Clin Transl, 4(2), 100189. doi.org/10.1016/j.arrct.2022.100189
Gensemer, C., Burks, R., Kautz, S., Judge, DP, Lavallee, M., & Norris, RA (2021). Hypermobile Ehlers-Danlos Syndromes: Zovuta za phenotypes, matenda ovuta, komanso zifukwa zomwe sizikumveka bwino. Dev Dyn, 250(3), 318-344. doi.org/10.1002/dvdy.220
Hakim, A. (1993). Hypermobile Ehlers-Danlos Syndrome. MP Adam, J. Feldman, GM Mirzaa, RA Pagon, SE Wallace, LJH Bean, KW Gripp, & A. Amemiya (Eds.), GeneReviews((R)). www.ncbi.nlm.nih.gov/pubmed/20301456
Khokhar, D., Powers, B., Yamani, M., & Edwards, MA (2023). Ubwino Wa Chithandizo Cha Osteopathic Manipulative Pa Wodwala Ali ndi Ehlers-Danlos Syndrome. Cureus, 15(5), e38698. doi.org/10.7759/cureus.38698
Uehara, M., Takahashi, J., & Kosho, T. (2023). Kuwonongeka kwa Msana mu Ehlers-Danlos Syndrome: Yang'anani pa Mtundu wa Musculocontractural. Genes (Basel), 14(6). doi.org/10.3390/genes14061173
Kodi kumvetsetsa mfundo za mahinji amthupi ndi momwe zimagwirira ntchito kungathandize kuthana ndi vuto la kuyenda ndi kusinthasintha ndikuwongolera momwe zinthu zilili kwa anthu omwe ali ndi vuto lopindika kapena kutambasula zala, zala, zigongono, akakolo, kapena mawondo?
Mgwirizano wa Hinge
Mgwirizano umapanga pamene fupa limodzi limagwirizanitsa ndi lina, kulola kuyenda. Mitundu yosiyanasiyana yamagulu imasiyana mosiyana ndi kayendetsedwe kake malinga ndi malo awo. Izi zikuphatikizapo hinge, mpira ndi socket, planar, pivot, saddle, ndi ellipsoid joints. (Zopanda malire. General Biology, ND) Mahinji olowa ndi ma synovial olowa omwe amadutsa munjira imodzi yoyenda: kupindika ndi kukulitsa. Kulumikizana kwa hinge kumapezeka mu zala, zigongono, mawondo, akakolo, ndi zala ndikuwongolera kayendetsedwe ka ntchito zosiyanasiyana. Kuvulala, osteoarthritis, ndi matenda a autoimmune amatha kukhudza mafupa a hinge. Kupumula, mankhwala, ayezi, ndi chithandizo chamankhwala chingathandize kuchepetsa ululu, kulimbitsa mphamvu ndi kuyenda kosiyanasiyana, ndikuthandizira kuthetsa mikhalidwe.
Anatomy
Mgwirizano umapangidwa ndi kulumikizana kwa mafupa awiri kapena kuposerapo. Thupi la munthu lili ndi magulu atatu akuluakulu a mafupa, omwe amagawidwa ndi momwe angasunthire. Izi zikuphatikizapo: (Zopanda malire. General Biology, ND)
Awa ndi malo olumikizirana oyenda momasuka omwe amalola kusuntha mbali zingapo.
Mafupa omwe amapanga mafupa amapangidwa ndi articular cartilage ndipo amatsekedwa mu capsule yophatikizana yodzaza ndi synovial fluid yomwe imalola kuyenda kosalala.
Magulu a Synovial amagawidwa m'mitundu yosiyanasiyana kutengera kusiyana kwa kapangidwe kake komanso kuchuluka kwa ndege zoyenda zomwe amalola. Mgwirizano wa hinge ndi mgwirizano wa synovial womwe umalola kuyenda mu ndege imodzi, mofanana ndi hinge ya chitseko yomwe imapita kutsogolo ndi kumbuyo. Mkati mwa olowa, mapeto a fupa limodzi amakhala opindikira / kuloza kunja, ndi ena ozungulira / ozungulira mkati kuti malekezero agwirizane bwino. Chifukwa ma hinge olowa amangoyenda munjira imodzi, amakhala okhazikika kuposa ma synovial ena. (Zopanda malire. General Biology, ND) Zophatikiza za hinge zimaphatikizapo:
Chala ndi zala zala - kulola zala ndi zala kupindika ndi kutambasula.
Mgwirizano wa chigongono - umalola kuti chigongono chipinde ndi kufalikira.
Mgwirizano wa bondo - umalola kuti bondo lipinde ndi kufalikira.
Mgwirizano wa talocrural wa bondo - umalola bondo kusunthira mmwamba / dorsiflexion ndi pansi / plantarflexion.
Mahinji amalumikiza miyendo, zala, ndi zala zapamapazi kutalikirana ndi kupindikira ku thupi. Kusunthaku ndi kofunikira pazochitika za tsiku ndi tsiku, monga kusamba, kuvala, kudya, kuyenda, kuyimirira, ndi kukhala pansi.
zokwaniritsa
Osteoarthritis ndi kutupa kwa nyamakazi kungakhudze mgwirizano uliwonse (Arthritis Foundation. ND) Matenda a nyamakazi, kuphatikizapo nyamakazi ndi psoriatic nyamakazi, amatha kuchititsa kuti thupi liziwombera mafupa ake. Izi nthawi zambiri zimakhudza mawondo ndi zala, zomwe zimapangitsa kutupa, kuwuma, ndi kupweteka. (Kamata, M., Tada, Y. 2020) Gout ndi matenda otupa a nyamakazi omwe amayamba chifukwa cha kuchuluka kwa uric acid m'magazi ndipo nthawi zambiri amakhudza ma hinge a chala chachikulu chakuphazi. Zina zomwe zimakhudza ma hinge joints ndi:
Kuvulala kwa cartilage mkati mwa ziwalo kapena mitsempha yomwe imakhazikika kunja kwa mafupa.
Mitsempha ya ligament kapena misozi imatha chifukwa cha zala kapena zala zopindika, akakolo opindika, kuvulala kopindika, komanso kukhudzidwa mwachindunji pabondo.
Kuvulala kumeneku kungakhudzenso meniscus, chiwombankhanga cholimba mkati mwa bondo chomwe chimathandiza kugwedeza ndi kuyamwa mantha.
konzanso
Zinthu zomwe zimakhudza mafupa a hinge nthawi zambiri zimayambitsa kutupa ndi kutupa, zomwe zimapangitsa kupweteka komanso kuyenda kochepa.
Pambuyo pa kuvulala kapena panthawi yotupa, kuchepetsa kusuntha ndi kupumula mgwirizano womwe wakhudzidwa kungathandize kuchepetsa nkhawa komanso ululu.
Kupaka ayezi kumatha kuchepetsa kutupa ndi kutupa.
Kwa anthu omwe akumva kupweteka kwa ma hinge joints kuchokera ku autoimmune condition, mankhwala a biologic kuti achepetse ntchito ya autoimmune ya thupi amaperekedwa kudzera mu infusions yomwe imaperekedwa kwa milungu ingapo kapena miyezi ingapo. (Kamata, M., Tada, Y. 2020)
Majekeseni a Cortisone angagwiritsidwenso ntchito kuchepetsa kutupa.
Ku Injury Medical Chiropractic ndi Functional Medicine Clinic, timayang'ana kwambiri pochiza kuvulala kwa odwala ndi ma syndromes opweteka kwambiri komanso kuwongolera luso kudzera mu kusinthasintha, kuyenda, ndi kulimba mtima zomwe zimayenderana ndi munthu. Othandizira athu amagwiritsa ntchito njira yophatikizirapo kupanga mapulani osamalira anthu omwe amaphatikizapo Functional Medicine, Acupuncture, Electro-Acupuncture, ndi Sports Medicine protocol. Cholinga chathu ndi kuthetsa ululu mwachibadwa mwa kubwezeretsa thanzi ndi ntchito ku thupi. Ngati munthuyo akufunika chithandizo china, adzatumizidwa ku chipatala kapena dokotala yemwe angamuyenerere. Dr. Jimenez adagwirizana ndi madokotala ochita opaleshoni, akatswiri a zachipatala, ofufuza zachipatala, ndi opereka chithandizo chamankhwala kuti apereke chithandizo chamankhwala chothandiza kwambiri.
Kamata, M., & Tada, Y. (2020). Kuchita bwino ndi Chitetezo cha Biologics kwa Psoriasis ndi Psoriatic Arthritis ndi Zotsatira Zawo pa Comorbidities: Kubwereza Zolemba. Nyuzipepala yapadziko lonse ya sayansi ya molekyulu, 21(5), 1690. doi.org/10.3390/ijms21051690
Kwa anthu omwe akumva kupweteka kwa mapewa ndi kumtunda kwa msana, kodi periscapular bursitis ikhoza kukhala chifukwa chotheka?
Periscapular Bursitis
Tsamba la scapula / phewa ndi fupa lomwe limasuntha malo ndi thupi lapamwamba ndi mapewa. Kuyenda kwa scapula ndikofunika kwambiri pakugwira ntchito bwino kwa mapewa ndi msana. Pamene kusuntha kwa mapewa kwachilendo kapena mwadzidzidzi kumachitika, kutupa ndi zizindikiro zowawa zimatha kuyamba. (Augustine H. Conduah et al., 2010)
Normal Scapula Ntchito
Scapula ndi fupa la triangular kumtunda kumbuyo kunja kwa nthiti. Mbali yake yakunja kapena yakumbali ili ndi socket / glenoid ya mapewa, pomwe fupa lonse limakhala ngati malo olumikizirana pamapewa ndi minofu yakumbuyo. The scapula imasuntha pa nthiti pamene ikusuntha mkono kutsogolo ndi kumbuyo. Kusunthaku kumatchedwa mayendedwe a scapulothoracic ndipo ndi yofunika kwambiri pa ntchito yachibadwa ya kumtunda wapamwamba ndi mgwirizano wa mapewa. Pamene scapula sikuyenda molumikizana, ntchito ya torso ndi mapewa imatha kukhala yolimba komanso yowawa. (JE Kuhn et al., 1998)
Scapular Bursa
Bursa ndi thumba lodzaza madzimadzi lomwe limalola kuyenda kosalala, koyenda pakati pa zomanga, minofu ya thupi, mafupa, ndi tendon. Bursae amapezeka m'thupi lonse, kuphatikizapo omwe ali kutsogolo kwa kneecap, kunja kwa chiuno, ndi pamapewa. Pamene bursa itenthedwa ndikukwiyitsidwa, kusuntha kwabwino kumakhala kowawa. Pali bursae kuzungulira scapula kumtunda kumbuyo. Awiri mwa matumba a bursa ali pakati pa mafupa ndi minofu ya serratus anterior yomwe imayang'anira kayendedwe ka scapular pa khoma la chifuwa. Thumba limodzi la bursa lili pamwamba pa ngodya ya scapula, pafupi ndi msana pamunsi pa khosi, ndipo ina ili pansi pa ngodya ya scapula, pafupi ndi mkatikati mwa kumbuyo. Zikwama zonse ziwiri za bursa zimatha kukhudzidwa ndi periscapular bursitis. Palinso ma bursa ena ozungulira scapula ndi ma tendon ozungulira, koma matumba awiri a ngodya amayamba kukhala bursae oyambirira omwe amapanga periscapular bursitis.
Kutupa
Ma bursae akatupa ndi kukwiya, kutupa, ndi kukhuthala, zomwe zimatchedwa bursitis zimayamba. Pamene bursitis imapezeka pafupi ndi scapula, kusuntha kwa minofu, ndi mapewa kungayambitse kupweteka ndi kupweteka. Zizindikiro zodziwika bwino za periscapular bursitis ndi izi:
Kumverera kosadziwika bwino kwa scapular ndi mayendedwe
Kuwunika kwa scapula kungasonyeze kusuntha kwachilendo kwa mapewa. Izi zingayambitse kuzunguza, komwe tsamba la mapewa silinagwire bwino panthiti ndipo limatuluka molakwika. Anthu omwe ali ndi kuchuluka kwa scapula nthawi zambiri amakhala ndi machitidwe osagwirizana ndi mapewa chifukwa mapewa amasinthidwa.
Chithandizocho chikhoza kupititsa patsogolo makina a scapular kotero kuti kuvulala sikupitirire komanso kubwereza.
Kusuntha kosazolowereka kwa scapula pa nthiti sikungangoyambitsa chitukuko cha bursitis, koma ngati mawotchi osadziwika bwinowa sanayankhidwe, vutoli likhoza kubwereranso.
Mankhwala Oletsa Kutupa
Mankhwala osagwiritsa ntchito steroidal odana ndi kutupa amagwiritsidwa ntchito poletsa kutupa kwakanthawi kochepa. (Augustine H. Conduah et al., 2010)
Mankhwalawa angathandize kuletsa kuyankha kotupa.
Asanamwe mankhwala aliwonse, anthu ayenera kutsimikizira ndi achipatala kuti ali otetezeka.
Cortisone jakisoni
Chithandizo chopambana ndi kuwombera kwa cortisone ndi chizindikiro chakuti opaleshoni idzakhala yothandiza kwambiri kwa anthu omwe angafunikire opaleshoni.
Majekeseni a Cortisone atha kukhala othandiza kwambiri popereka mlingo wamphamvu woletsa kutupa mwachindunji pamalo otupa. (Augustine H. Conduah et al., 2010)
Majekeseni a Cortisone ayenera kukhala ochepa ponena za kuchuluka kwa majekeseni omwe amaperekedwa kwa munthu payekha, koma mu mlingo wochepa ukhoza kukhala wothandiza kwambiri.
Komabe, kuwombera kwa cortisone kuyenera kuchitidwa pokhapokha matendawa atatsimikiziridwa.
Opaleshoni
Opaleshoni siifunika kaŵirikaŵiri koma imatha kukhala yothandiza kwa anthu omwe sangathe kupeza mpumulo ndi chithandizo chanthawi zonse.
Opaleshoni nthawi zambiri imagwiritsidwa ntchito kwa anthu omwe ali ndi scapular anatomy, monga zotupa za mafupa kapena zotupa.
Ku chipatala cha Injury Medical Chiropractic ndi Functional Medicine Clinic, timachiza kuvulala ndi ma syndromes opweteka kwambiri mwa kupititsa patsogolo luso la munthu kupyolera mu kusinthasintha, kuyenda, ndi mapulogalamu a agility ogwirizana ndi magulu onse azaka ndi olumala. Mapulani athu osamalira a chiropractor ndi ntchito zachipatala ndizopadera ndipo zimayang'ana kwambiri kuvulala komanso kuchira kwathunthu. Ngati chithandizo china chikufunika, anthu adzatumizidwa ku chipatala kapena dokotala woyenerera kuvulala, chikhalidwe, ndi / kapena matenda awo.
Mapiko a Scapular Mwakuya
Zothandizira
Conduah, AH, Baker, CL, 3rd, & Baker, CL, Jr (2010). Kasamalidwe kachipatala ka scapulothoracic bursitis ndi snapping scapula. Umoyo wamasewera, 2 (2), 147-155. doi.org/10.1177/1941738109338359
Kuhn, JE, Plancher, KD, & Hawkins, RJ (1998). Symptomatic scapulothoracic crepitus ndi bursitis. The Journal of the American Academy of Orthopedic Surgeons, 6 (5), 267-273. doi.org/10.5435/00124635-199809000-00001
de Souza, AM, & Bispo Júnior, RZ (2014). Osteochondroma: kunyalanyaza kapena kufufuza? Revista brasileira de ortopedia, 49 (6), 555-564. doi.org/10.1016/j.rboe.2013.10.002
Kodi anthu omwe ali ndi vuto la hypermobility angapeze mpumulo kupyolera mu chithandizo chosapanga opaleshoni chochepetsera ululu ndi kubwezeretsanso kuyenda kwa thupi?
Introduction
Munthu akamasuntha thupi lake, minofu yozungulira, ziwalo, ndi mitsempha zimaphatikizidwa mu ntchito zosiyanasiyana zomwe zimawalola kutambasula ndi kusinthasintha popanda kupweteka kapena kusokonezeka. Zoyenda zambiri zobwerezabwereza zimathandiza munthuyo kupitiriza chizolowezi chake. Komabe, pamene mafupa, minofu, ndi minyewa yatambasulidwa motalikirapo kuposa momwe zimakhalira m’mwamba ndi m’munsi popanda kupweteka, zimatchedwa hypermobility. Matenda okhudzana ndi minofuwa amatha kugwirizana ndi zizindikiro zina zomwe zimakhudza thupi ndikupangitsa anthu ambiri kupeza chithandizo kuti athe kuthana ndi zizindikiro za hypermobility. M'nkhani ya lero, tiona hypermobility olowa ndi mmene zosiyanasiyana osachita opaleshoni mankhwala angathandizire kuchepetsa ululu chifukwa olowa hypermobility ndi kubwezeretsa kuyenda thupi. Timalankhula ndi opereka chithandizo chamankhwala ovomerezeka omwe amaphatikiza chidziwitso cha odwala athu kuti awone momwe ululu wawo ungagwirizanitsidwe ndi hypermobility yamagulu. Timadziwitsanso ndikuwatsogolera odwala momwe kuphatikizira mankhwala osiyanasiyana osachita opaleshoni kungathandizire kukonza magwiridwe antchito olumikizana ndikuwongolera zizindikiro zomwe zikugwirizana nazo. Timalimbikitsa odwala athu kuti afunse opereka chithandizo omwe amalumikizana nawo mafunso ovuta komanso ozindikira okhudza kuphatikiza mankhwala osachita opaleshoni monga gawo lachizoloŵezi chawo kuti achepetse ululu ndi kusamva bwino kwa hypermobility yamagulu. Dr. Jimenez, DC, akuphatikizapo izi monga ntchito ya maphunziro. chandalama.
Kodi Joint Hypermobility Ndi Chiyani?
Kodi nthawi zambiri mumamva kuti mafupa anu atatsekedwa m'manja mwanu, m'manja, m'mawondo, ndi m'zigongono? Kodi mumamva kupweteka ndi kutopa m'malo olumikizirana mafupa anu pomwe thupi lanu limakhala lotopa nthawi zonse? Kapena pamene mutambasula malekezero anu, kodi amatambasula kutali kuposa masiku onse kuti mumve mpumulo? Zambiri mwazinthu izi nthawi zambiri zimayenderana ndi anthu omwe ali ndi hypermobility yolumikizana. Joint hypermobility ndi matenda obadwa nawo omwe ali ndi machitidwe akuluakulu a autosomal omwe amadziwika ndi hyperlaxity ndi kupweteka kwa minofu m'kati mwa thupi. (Carbonell-Bobadilla et al., 2020) Mkhalidwe wamtunduwu wamtunduwu nthawi zambiri umagwirizana ndi kusinthasintha kwa minyewa yolumikizidwa monga mitsempha ndi tendon m'thupi. Chitsanzo chingakhale ngati chala chachikulu cha munthu chikukhudza mkono wawo wamkati popanda kumva kupweteka kapena kusamva bwino, amakhala ndi hypermobility. Kuphatikiza apo, anthu ambiri omwe ali ndi vuto la hypermobility nthawi zambiri amakhala ndi vuto lozindikira chifukwa amatha kufooka pakhungu ndi minofu pakapita nthawi, zomwe zimayambitsa zovuta za minofu ndi mafupa. (Tofts et al., 2023)
Pamene anthu amakumana ndi hypermobility yolumikizana pakapita nthawi, nthawi zambiri amakhala ndi chizindikiro cha hypermobility. Adzakhala ndi zizindikiro za musculoskeletal ndi systemic zomwe zimapangitsa kuti chigoba chiwoneke, kufooka kwa minofu ndi khungu, komanso kusiyana kwa kachitidwe ka thupi. (Nicholson et al., 2022) Zina mwazizindikiro zomwe hypermobility yolumikizana imawonetsedwa pakuzindikirika ndi izi:
Polimbana ndi hypermobility yamagulu, anthu ambiri amafunika kupeza chithandizo kuti achepetse ululu wofanana ndi zizindikiro za hypermobility ndikuthandizira kuthetsa maondo a thupi ndikubwezeretsa kuyenda. Mankhwala ena abwino kwambiri opangira ma hypermobility ophatikizana ndi machiritso osagwiritsa ntchito opaleshoni omwe sawononga, odekha pamfundo ndi minofu, komanso otsika mtengo. Thandizo losiyanasiyana losakhala la opaleshoni likhoza kusinthidwa kwa munthu malinga ndi momwe kuphatikizika kwawo ndi zovuta kumakhudzira thupi la munthuyo. Thandizo lopanda opaleshoni lingathe kuchepetsa thupi ku hypermobility ya mgwirizano pochiza zomwe zimayambitsa ululu mwa kuchepetsa ndi kukulitsa mphamvu zogwirira ntchito ndikubwezeretsanso moyo wa munthu. (Atwell et al., 2021) Mankhwala atatu osagwiritsa ntchito opaleshoni omwe ali abwino kwambiri kuti achepetse ululu kuchokera ku hypermobility yamagulu ndikuthandizira kulimbikitsa minofu yozungulira ili pansipa.
Chisamaliro cha Chiropractic
Chisamaliro cha Chiropractic chimagwiritsa ntchito kuponderezedwa kwa msana ndikuthandizira kubwezeretsanso kuyenda kwamagulu m'thupi kuti muchepetse zotsatira za hypermobility yolumikizana mwa kukhazikika kwa ziwalo zomwe zakhudzidwa kuchokera ku ma hypermobile extremities. (Boudreau et al., 2020) Madokotala amaphatikizapo kugwiritsira ntchito makina ndi manja ndi njira zosiyanasiyana zothandizira anthu ambiri kuti azikhala bwino poganizira kwambiri matupi awo ndikugwira ntchito ndi mankhwala ena ambiri kuti agogomeze kayendetsedwe ka kayendetsedwe kake. Ndi zovuta zina zomwe zimagwirizanitsidwa ndi hypermobility pamodzi, monga kupweteka kwa msana ndi khosi, chisamaliro cha chiropractic chingachepetse zizindikiro za comorbidity ndikulola munthuyo kuti ayambenso kukhala ndi moyo wabwino.
kutema mphini
Chithandizo china chosapanga opaleshoni chomwe anthu ambiri atha kuphatikizira kuti achepetse kuphatikizika kwa mafupa ndi ma comorbidities ake ndi acupuncture. Acupuncture amagwiritsa ntchito singano zing'onozing'ono, zoonda, zolimba zomwe akatswiri ochita opaleshoni amagwiritsa ntchito kuti atseke zolandirira ululu ndi kubwezeretsa mphamvu za thupi. Pamene anthu ambiri akukumana ndi hypermobility yamagulu, malekezero awo m'miyendo, manja, ndi mapazi amamva ululu pakapita nthawi, zomwe zingayambitse thupi kukhala losakhazikika. Zomwe acupuncture imachita ndikuthandizira kuchepetsa ululu womwe umabwera chifukwa cha hypermobility yolumikizana ndi malekezero ndikubwezeretsanso magwiridwe antchito amthupi (Luan et al., 2023). Izi zikutanthauza kuti ngati munthu akulimbana ndi kuuma ndi kupweteka kwa minofu kuchokera ku hypermobility ya mafupa, acupuncture ingathandize kubwezeretsa ululuwo mwa kuika singano mu acupoints a thupi kuti apereke mpumulo.
Thandizo la Thupi
Thandizo lolimbitsa thupi ndi njira yomaliza yopanda opaleshoni yomwe anthu ambiri amatha kuphatikizira pazochitika zawo za tsiku ndi tsiku. Thandizo la thupi lingathandize kuthana ndi hypermobility yamagulu omwe amapangidwira kuti athandize kulimbikitsa minofu yofooka yomwe ili pafupi ndi ziwalo zomwe zakhudzidwa, kupititsa patsogolo kukhazikika kwa munthu ndikuthandizira kuchepetsa chiopsezo cha kusokonezeka. Kuphatikiza apo, anthu ambiri amatha kugwiritsa ntchito masewera olimbitsa thupi ocheperako kuti awonetsetse kuyendetsa bwino kwamagalimoto mukamachita masewera olimbitsa thupi pafupipafupi popanda kusokoneza kwambiri mafupa. (Russek et al., 2022)
Mwa kuphatikiza chithandizo chamankhwala osachita opaleshoni atatuwa ngati gawo la chithandizo chokhazikika cha hypermobility yamagulu, anthu ambiri ayamba kumva kusiyana pakati pawo. Sadzamva kupweteka pamodzi mwa kusamala kwambiri ndi thupi komanso kuphatikizapo kusintha kwakung'ono muzochita zawo. Ngakhale kukhala ndi hypermobility yolumikizana kungakhale kovuta kwa anthu ambiri, mwa kuphatikiza ndi kugwiritsa ntchito njira zochiritsira zosapanga opaleshoni, ambiri amatha kukhala ndi moyo wokangalika komanso wokhutiritsa.
Zothandizira
Atwell, K., Michael, W., Dubey, J., James, S., Martonffy, A., Anderson, S., Rudin, N., & Schrager, S. (2021). Kuzindikira ndi Kuwongolera kwa Hypermobility Spectrum Disorders mu Primary Care. J Am BAK BAK, 34(4), 838-848. doi.org/10.3122/jabfm.2021.04.200374
Boudreau, PA, Steiman, I., & Mior, S. (2020). Kasamalidwe kachipatala ka benign joint hypermobility syndrome: mndandanda wamilandu. J Can Chiropr Assoc, 64(1), 43-54. www.ncbi.nlm.nih.gov/pubmed/32476667
Carbonell-Bobadilla, N., Rodriguez-Alvarez, AA, Rojas-Garcia, G., Barragan-Garfias, JA, Orrantia-Vertiz, M., & Rodriguez-Romo, R. (2020). [Joint hypermobility syndrome]. Chithunzi cha Acta Ortop Mex, 34(6), 441-449. www.ncbi.nlm.nih.gov/pubmed/34020527 (Sindrome de hipermovilidad articular.)
Luan, L., Zhu, M., Adams, R., Witchalls, J., Pranata, A., & Han, J. (2023). Zotsatira za acupuncture kapena chithandizo chofananira chosowa pa ululu, umwini, kulingalira, ndi ntchito yodziwonetsera yokha mwa anthu omwe ali ndi vuto losakhazikika la akakolo: kuwunika mwadongosolo ndi kusanthula meta. Wothandizira Ther Med, 77, 102983. doi.org/10.1016/j.ctim.2023.102983
Nicholson, LL, Simmonds, J., Pacey, V., De Wandele, I., Rombaut, L., Williams, CM, & Chan, C. (2022). Maonedwe Apadziko Lonse pa Kuphatikizika Kophatikizana: Kaphatikizidwe ka Sayansi Yapano Kuti Atsogolere Njira Zachipatala ndi Kafukufuku. J Clin Rheumatol, 28(6), 314-320. doi.org/10.1097/RHU.0000000000001864
Russek, LN, Block, NP, Byrne, E., Chalela, S., Chan, C., Comerford, M., Frost, N., Hennessey, S., McCarthy, A., Nicholson, LL, Parry, J ., Simmonds, J., Stott, PJ, Thomas, L., Treleaven, J., Wagner, W., & Hakim, A. (2022). Presentation and physical therapy management of upper cervical instability in the symptomatic generalized joint hypermobility: International expert consensus recommendations. Front Med (Lausanne), 9, 1072764. doi.org/10.3389/fmed.2022.1072764
Tofts, LJ, Simmonds, J., Schwartz, SB, Richheimer, RM, O'Connor, C., Elias, E., Engelbert, R., Cleary, K., Tinkle, BT, Kline, AD, Hakim, AJ , van Rossum, MAJ, & Pacey, V. (2023). Kuphatikizika kwa ana: njira yowunikira komanso kuwunikiranso nkhani. Orphanet J Rare Dis, 18(1), 104. doi.org/10.1186/s13023-023-02717-2
Kodi anthu omwe ali ndi ululu wa msana m'khosi ndi kumbuyo angagwiritse ntchito chithandizo cha decompression kuti abwezeretse kutalika kwa msana ndikupeza mpumulo?
Introduction
Anthu ambiri sadziwa kuti thupi likamakula, msana umayambanso. Msana ndi gawo la musculoskeletal system lomwe limapereka chithandizo chokhazikika ku thupi polisunga mowongoka. Minofu yozungulira, mitsempha, ndi minyewa yozungulira msana imathandizira kukhazikika komanso kuyenda, pomwe ma disc a msana ndi ziwalo zimapatsa chidwi kuchokera pakulemera kwake. Pamene munthu akuyenda ndi ntchito zawo za tsiku ndi tsiku, msana ukhoza kulola kuti munthuyo azitha kuyenda popanda kupweteka kapena kusokonezeka. Komabe, pakapita nthawi, msana umadutsa kusintha kosasinthika komwe kungayambitse kupweteka ndi kusokonezeka kwa thupi, motero kumasiya munthu kuti athane ndi zochitika zowonongeka zomwe zingakhudze khosi ndi kumbuyo. Kufikira pamenepo, anthu ambiri amafunafuna mankhwala kuti achepetse ululu womwe umakhudza msana wawo ndikubwezeretsa kutalika kwa disc m'matupi awo. Nkhani ya lero ikuyang'ana momwe kupweteka kwa msana kumakhudzira khosi ndi msana wa munthu komanso momwe mankhwala ochiritsira monga kupweteka kwa msana angachepetse kupweteka kwa msana ndikubwezeretsanso kutalika kwa disc. Timayankhula ndi opereka chithandizo chamankhwala ovomerezeka omwe amaphatikiza chidziwitso cha odwala athu kuti awone momwe ululu wa msana ungakhudzire kwambiri ubwino wa munthu ndi moyo wabwino m'matupi awo. Timadziwitsanso ndikuwatsogolera odwala momwe kuphatikizira kuwonongeka kwa msana kungathandize kuchepetsa ululu wa msana ndi kubwezeretsa kutalika kwa msana. Timalimbikitsa odwala athu kuti afunse opereka chithandizo omwe amalumikizana nawo mafunso ovuta komanso ofunikira okhudza kuphatikiza mankhwala osachita opaleshoni muzaumoyo komanso thanzi labwino kuti athetse ululu wa msana ndikubwezeretsanso moyo wawo. Dr. Jimenez, DC, akuphatikizapo izi monga ntchito ya maphunziro. chandalama.
Momwe Kupweteka kwa Msana Kumakhudzira Pakhosi & Kumbuyo kwa Munthu
Kodi mumamva kupweteka kwa minofu nthawi zonse m'khosi ndi msana? Kodi munakumanapo ndi kuuma komanso kusayenda pang'ono mukamapindika? Kapena kodi zinthu zolemetsa zimayambitsa kupsinjika kwa minofu mukamayenda kuchokera kumalo ena kupita kwina? Anthu ambiri adzakhala akuyenda ndikukhala m'malo odabwitsa osamva kuwawa komanso kusamva bwino zikafika pamsana. Izi ndichifukwa cha minofu yozungulira ndi minyewa yomwe imatambasulidwa ndipo ma discs a msana amatenga kuthamanga kowongoka pamsana. Komabe, pamene zinthu zachilengedwe, kuvulala koopsa, kapena kukalamba kwachilengedwe kumayamba kukhudza msana, kungayambitse kukula kwa ululu wa msana. Izi ndichifukwa chakuti gawo lakunja la msana wa msana ndilokhazikika, ndipo gawo lamkati la diski likukhudzidwa. Pamene kupsyinjika kwachilendo kumayamba kuchepetsa madzi omwe amamwa mkati mwa diski, amatha kulimbikitsa mkati mwa ma receptor opweteka popanda zizindikiro za mitsempha mkati mwa diski. (Zhang et al., 2009) Izi zimapangitsa anthu ambiri kuthana ndi kupweteka kwa khosi ndi msana m'matupi awo ndikuchepetsa moyo wawo.
Kupweteka kwa msana kumatha kuyambitsa mbiri yowopsa yomwe imapangitsa anthu ambiri kuthana ndi ululu wammbuyo komanso kupweteka kwapakhosi, zomwe zimapangitsa kuti minofu yozungulira ikhale yofooka, yolimba, komanso yotambasuka. Panthawi imodzimodziyo, mizu ya mitsempha yozungulira imakhudzidwanso pamene mitsempha ya mitsempha imazungulira kunja ndi mkati mwa diski ya msana, yomwe imayambitsa kupweteka kwa nociceptive ku khosi ndi m'dera lakumbuyo ndipo kumabweretsa ululu wa discogenic. (Coppes et al., 1997) Pamene anthu ambiri akulimbana ndi ululu wa minofu yogwirizana ndi ma discs a msana, zimayambitsa kupweteka-kupweteka kwapakati-kupweteka komwe kungakhudze matupi awo chifukwa chosasuntha mokwanira komanso kuchititsa ntchito zopweteka za minofu pamene akuyesera kukhala oyendayenda. (Roland, 1986) Munthu akakhala ndi zochepa zoyenda chifukwa akukumana ndi ululu wa msana, kutalika kwake kwa disk kwachibadwa kumachepa pang'onopang'ono, kumayambitsa zovuta zambiri ku matupi awo komanso mavuto a chikhalidwe cha anthu. Mwamwayi, pamene anthu ambiri akukumana ndi ululu wa msana, mankhwala ambiri amatha kuchepetsa ululu wa msana ndikubwezeretsa kutalika kwa disc.
Movement Medicine- Kanema
Momwe Kuwonongeka kwa Msana Kumachepetsa Kupweteka kwa Msana
Pamene anthu akufunafuna chithandizo cha ululu wawo wa msana, ambiri amafunafuna chithandizo cha opaleshoni kuti achepetse ululu wawo, koma zidzakhala zotsika mtengo. Komabe, anthu ambiri amasankha chithandizo chosapanga opaleshoni chifukwa cha kuthekera kwawo. Thandizo lopanda opaleshoni ndi lopanda mtengo komanso lokhazikika pakumva ululu ndi kusamva bwino kwa munthu. Kuyambira chisamaliro cha chiropractic kupita ku acupuncture, malingana ndi kukula kwa ululu wa munthuyo, ambiri adzapeza mpumulo umene akufuna. Chimodzi mwazinthu zatsopano zothandizira kuchepetsa ululu wa msana ndi kupsinjika kwa msana. Kuwonongeka kwa msana kumapangitsa kuti munthuyo amangirire patebulo loyendetsa. Izi ndichifukwa choti imakoka msana pang'onopang'ono kuti ikonzenso msana pochepetsa kukakamiza kwa msana kuti ipemphe machiritso achilengedwe kuti athetse ululu. (Ramos & Martin, 1994) Kuonjezera apo, pamene anthu ambiri akugwiritsa ntchito kuponderezedwa kwa msana, kutsekemera kofewa kumapereka kusokoneza kwa injini ku msana komwe kungapangitse kusintha kwa thupi ku msana wa msana ndikuthandizira kubwezeretsa kayendetsedwe kake, kusinthasintha, ndi kuyenda. (Amjad et al., 2022)
Kusokonezeka kwa Msana Kubwezeretsa Msana Chimbale Kutalika
Munthu akamangiriridwa mu makina otsekemera a msana, kutsekemera kofewa kumathandiza kuti msana wa msana ubwerere ku msana, kulola kuti madzi ndi zakudya zitsitsimutse msana, kuonjezera kutalika kwa msana. Izi ndichifukwa chakuti kusokonezeka kwa msana kumapangitsa kuti pakhale kupanikizika kosautsa pa msana, kulola kuti diski ya msana ibwerere ku msinkhu wake wapachiyambi ndikupereka mpumulo. Kuphatikiza apo, chodabwitsa chomwe chiwopsezo cha msana chimatha kuphatikizidwa ndi chithandizo chamankhwala kuti chithandizire kutambasula ndi kulimbikitsa minofu yozungulira pafupi ndi msana kuti ikhale yokhazikika komanso yokhazikika. (Vanti et al., 2023) Izi zimathandiza kuti munthuyo azikumbukira kwambiri matupi awo ndikuyamba kuphatikizira kusintha kwa chizolowezi chochepa kuti achepetse ululu wobwerera. Anthu ambiri akayamba kuganizira za thanzi lawo ndi thanzi lawo popita kuchipatala, amapezanso moyo wabwino ndikubwerera ku zochitika zawo za tsiku ndi tsiku popanda zovuta zomwe zimakhudza msana wawo.
Zothandizira
Amjad, F., Mohseni-Bandpei, MA, Gilani, SA, Ahmad, A., & Hanif, A. (2022). Zotsatira za chithandizo chopanda opaleshoni chopanda opaleshoni kuwonjezera pa chithandizo chamankhwala chokhazikika pa zowawa, kuyenda kosalekeza, kupirira, kulemala kwa ntchito ndi khalidwe la moyo motsutsana ndi chithandizo chamankhwala chokhazikika chokha kwa odwala omwe ali ndi lumbar radiculopathy; kuyesedwa kosasinthika. BMC Musculoskelet Disord, 23(1), 255. doi.org/10.1186/s12891-022-05196-x
Coppes, MH, Marani, E., Thomeer, RT, & Groen, GJ (1997). Innervation ya "zowawa" lumbar discs. Mpaka (Phila Pa 1976), 22(20), 2342-2349; zokambirana 2349-2350. doi.org/10.1097/00007632-199710150-00005
Ramos, G., & Martin, W. (1994). Zotsatira za vertebral axial decompression pa intradiscal pressure. J Neurosurgery, 81(3), 350-353. doi.org/10.3171/jns.1994.81.3.0350
Roland, MO (1986). Ndemanga yovuta ya umboni wa kupweteka-spasm-pain cycle mu matenda a msana. Clin Biomech (Bristol, Avon), 1(2), 102-109. doi.org/10.1016/0268-0033(86)90085-9
Vanti, C., Saccardo, K., Panizzolo, A., Turone, L., Guccione, AA, & Pillastrini, P. (2023). Zotsatira za kuwonjezera kwa makina opangira chithandizo chamankhwala pa ululu wochepa wammbuyo? Kuwunika mwadongosolo ndi meta-analysis. Acta Orthop Traumatol Turc, 57(1), 3-16. doi.org/10.5152/j.aott.2023.21323
Zhang, YG, Guo, TM, Guo, X., & Wu, SX (2009). Kuzindikira kwachipatala kwa discogenic low back ululu. Int J Biol Sci, 5(7), 647-658. doi.org/10.7150/ijbs.5.647
Chimodzi mwazinthu zakale kwambiri za njira zopanda opaleshoni komanso zokhazikika zochepetsera kutupa ndikuwongolera lupus ndi acupuncture. Kutema mphini kumaphatikizapo singano zolimba, zopyapyala zomwe zimagwiritsidwa ntchito ndi akatswiri ophunzitsidwa bwino kuti aziyika m'malo enieni amthupi kuti azitha kulinganiza qi (mphamvu) ya thupi polimbikitsa dongosolo lamanjenje ndi kutulutsa mankhwala opindulitsa muminofu yokhudzidwa, msana, ndi ubongo. Kuphatikiza apo, acupuncture, yokhala ndi zotsatira zake zochepa komanso njira yokhazikika, imatha kuthandizira kuthana ndi lupus. Izi ndichifukwa choti singano za acupuncture zikayikidwa pa acupoints a thupi, zimatha kusokoneza zizindikiro zowawa zomwe zimabweretsa ululu m'dera lomwe lakhudzidwa ndikuwongolera ma cytokines otupa kuchokera ku lupus kuti apereke mpumulo. (Wang et al., 2023) Izi zili choncho chifukwa cha nzeru zake zothana ndi ululu wakuthupi komanso zizindikiro zamaganizo ndi zamaganizo zokhala ndi matenda aakulu monga lupus.
Kuonjezera apo, kutema mphini kungathandize kubwezeretsanso kuyenda pamodzi pamene mukuyendetsa lupus kupyolera muzotsatira zochiritsira, monga momwe anthu ambiri amaonera kuti kuyenda kwawo kwa mgwirizano kumakula ndipo ululu wawo umachepa. Izi ndichifukwa choti kuyika ndi kusintha kwa singano mu ma acupoints am'thupi kumayambitsa kusintha kwamalingaliro amtundu wapakati pamanjenje, zomwe zimawonjezera chisangalalo cha alpha motoneuron ndikuchepetsa kutupa. (Kim et al., 2020) Pamene anthu akudwala lupus ndipo akuyesera kupeza njira zina zonse zochepetsera kutupa ndi kupweteka kwa mafupa chifukwa cha lupus, acupuncture, ndi mankhwala osachita opaleshoni angapereke chiyembekezo chothetsera mavuto a tsiku ndi tsiku a lupus.
Zothandizira
Di Matteo, A., Smerilli, G., Cipolletta, E., Salaffi, F., De Angelis, R., Di Carlo, M., Filippucci, E., & Grassi, W. (2021). Kujambula Kuphatikizidwa kwa Mafupa ndi Ofewa mu Systemic Lupus Erythematosus. Curr Rheumatol Rep, 23(9), 73. doi.org/10.1007/s11926-021-01040-8
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