
systemic scleroderma

systemic scleroderma ledhaa systemic sclerosis anedi oka swayam pratirakshaka rheumatic vyaadhi, idhi charmam mariyu antargata avayavaalalo mariyu chinna dhamanulaku gayalu kavadam dwara fibrosis anie piluvabade collagen yokka adhika utpatti mariyu perukupovadam dwara vargeekarinchabadutundi. charma prameyam yokka paridhi aadhaaramgaa systemic sclerosis yokka rendu pradhana upa samuuhaalu unnaih parimita mariyu vyaapti. parimita roopam diguva praantaalanu prabhaavitam chestundi, conny paina kaadu, mochetulu mariyu mokaallu mukham yokka prameyam ledhaa lekunda. eee vyaapti roopam mochetulu mariyu mokaalla paina unna charmanni kooda prabhaavitam chestundi mariyu mondem varaku kooda vyaapinchavacchu. moothrapindaalu, gunde, oopiritittulu mariyu jeernasayaantara pregulatho sahaa viseral avayavalu kooda fibrotic prakriya dwara prabhaavitamavutaayi.
rooga niruupana vyaadhi yokka roopam mariyu viseral prameyam yokka paridhi dwara nirnayinchabadutundi. parimita daihika sclerosis unna rogulu diffuse roopam unnavaari kante merugaina rooga niroopananu kaligi untaaru. maranam chaalaa tarachugaa oopiritittulu, gunde mariyu moothrapindaala prameyam valla sambhavistundi. cancer vachhe pramaadam koddigaa perugutundi.
moothrapindaala vaiphalyaaniki samarthavanthamaina chikitsato manugada raetlu baga perigayi. chikitsalalo roganirodhaka saktini tagginche mandulu, mariyu konni sandarbhaallo, glucocarticoids untaayi.
sankethaalu mariyu lakshanaalu.
calcinosis, raynades drugvishayam, annanaala panicheyakapovadam, sclerodactyly mariyu telangiectasia (crest syndrome) parimita sclerodermatho sambandham kaligi untaayi. itara lakshanaalu
charma lakshanaalu.
charmamlo, systemic sclerosis gattipadatam mariyu macchalaku kaaranamavutundi. charmam bigutugaa, erragaa ledhaa pokkulu galadigaa kanipinchavacchu. rakta naalaalu kooda marinta spashtamgaa kanipinchavacchu. pedda praantaalu prabhaavitamaina chota, kovvu mariyu kandaraala vrudhaa avayavalanu balaheenaparustundi mariyu roopaanni prabhaavitam chestundi. rogulu pedda charma praantaalalo teevramaina mariyu punaraavruta duradanu nivedistaaru. eee lakshanaala teevrata rogulalo chaalaa bhinnamgaa untundih kondaru charmam yokka parimita praantam (vellu vantivi) matrame scleroderma kaligi untaaru mariyu antarleena kanajaalam yokka takkuva prameyam kaligi untaaru, marikondaru pragatiseela charma prameyam kaligi untaaru. digital alsarlu-mukhyamgaa chetivellapai mariyu takkuva saadhaaranamgaa pidikili meeda unna gayalu-asaadhaaranam kaadu.
itara avayavalu.
diffuse scleroderma kandaraala kanajaalam, pulmonary, jeernasayaantara, moothrapindaalu mariyu itara samasyalaku kaaranamavutundi. charma sambandhamaina prameyam ekkuvagaa unna rogulu antargata kanajaalaalu mariyu avayavaala prameyam kaligi unde avakaasam ekkuvagaa untundi. chaalaa mandhi rogulaku (80 saataaniki paiga) vascular lakshanaalu mariyu renad drugvishayam untaayi, idhi jalubuku pratispandanagaa chetulu mariyu paadaala rangu maaradaaniki daariteestundi. raynades saadhaaranamgaa vellu mariyu kaali vellanu prabhaavitam chestundi. systemic scleroderma mariyu raynades vellapai ledhaa kaali meeda baadhaakaramaina puutalaku kaaranamavutaayi, veetini digital puutala anie pilustaaru. calcinosis (charmam kinda gaddalalo calcium nikshepana) kooda daihika sclerodermalo saadhaaranam, mariyu tarachugaa mochetulu, mokaalu ledhaa itara keella sameepamlo kanipistundi.
scleroderma unna rogulaku unde modati ummadi lakshanaalu saadhaaranamgaa nirdishtam kaani keella noppulu, ivi artharaitisku daariteestaayi ledhaa snaayuvulu ledhaa kandaraalalo asoukaryaanni kaligistaayi. ummadi kadalika, mukhyamgaa chethi yokka chinna keella, calcinosis ledhaa charmam mandamgaa undatam dwara parimitam kaavacchu. rogulu vyaadhi ledhaa daani chikitsala nundi kandaraala balaheenata ledhaa mayopatini abhivruddhi cheyavachu.
oopiritittula paniteerulo kontha balaheenata anedi pulmonary function pareekshalo diffuse scleroderma unna rogulalo daadaapu vishwavyaaptamgaa kanipistundi, conny idhi swaasa aadakapovadam vanti lakshanaalanu kaliginchadu. kontamandi rogulu pulmonary hyper tension ledhaa pulmonary aartareela ottidilo perugudalanu abhivruddhi cheyavachu. idhi pragatiseelamgaa undavacchu, mariyu kudi vaipuna gunde vaiphalyaaniki daariteeyavachchu. dheeni yokka mottamodati abhivyakti pulmonary function pareekshalo taggina vyaapti saamarthyam kaavacchu. marinta adhunaatana vyaadhiloo itara pulmonary samasyalalo aspiration pneumonia, pulmonary hemorrhage mariyu pneumothorax unnaayi.
diffuse scleroderma jeernasayaantara pregu maargamloni yea bhaganni ayina prabhaavitam chestundi. annavaahikalo atyanta saadhaarana abhivyakti refluxes annavahika shotha, idhi annavahika yokka kathinamaina ledhaa nirapaayamaina irukaina kaaranamgaa sanklishtamgaa undavacchu. assid nippu kosam protan pump inhibitorsto praarambhamlo dheeniki uttama chikitsa chestaaru, conny kathinamaina sandarbhamlo bogii dilatation avasaram kaavacchu.
scleroderma jeernasayaantara pregulalo ekkadainaa chalanaseelatanu taggistundi. taggina chalanaseelataku atyanta saadhaarana muulam annavahika mariyu diguva annanaala spinkter, idhi diasphagea mariyu chaatii noppiki daariteestundi. scleroderma abhivruddhi chendutunna koddi, pragatiseela fibrosis (macchalu) kaaranamgaa taggina chalanaseelatalo asaadhaaranatala nundi annanaala prameyam marinta digajaaravachu. dheenini chikitsa cheyakunda vadilesthe, kadupu nundi vachhe aamlam tirigi annavaahikaloki cheravacchu, idhi annavahika vaapu mariyu jeernasayaantara refluxes vyaadhiki kaaranamavutundi. takkuva annavahikaku assid nashtam nundi marinta macchalu chaalaa saarlu fibrotic irukaina abhivruddhiki daariteestundi, dheenini strictures anie kooda pilustaaru, dheeniki vistarana dwara chikitsa cheyavachu.
neuromuscular rugmatalu, mukhyamgaa pragatiseela daihika sclerosis mariyu viseral mayopati unna rogulalo, dudenum tarachugaa paalgontundi. vistarana sambhavinchavachhu, idhi tarachugaa rendava, moodava mariyu nalgava bhagalalo ekkuvagaa kanipistundi. vistarinchina duodenum nemmadigaa khaliga undavacchu, mariyu sthuulamgaa vistarinchina, atanic avayavam sump prabhavanni utpatti cheyavachu.
chinna pregu kooda indulo paalgontundi, idhi bacteria perugudala mariyu pitta lavanaalu, kovvulu, carbohydratelu, proteins mariyu vitaminla durviniyogaaniki daariteestundi. peddapregu prameyam undavacchu, mariyu nakilee-addanki ledhaa ischemic peddapreguku kaaranam kaavacchu.
arudaina samasyalalo neumatosis systoids pregu, ledhaa pregu godalo gyaas pockets, peddapregu mariyu annavaahikalo vistruta noti diverticula mariyu kaaleya fibrosis unnaayi. teevramaina jeernasayaantara prameyam unna rogulu teevra poeshakaahaara lopaniki gurikaavacchu.
scleroderma gastric antral vascular ectassiatho kooda sambandham kaligi undavacchu, dheenini "puchchakaaya kadupu" anie kooda pilustaaru. idhi saadhaaranamgaa kadupu yokka pilarus chuttoo radial cemetric namoonaalo, asaadhaarana rakta naalaalu vistarinche paristhiti. idhi scleroderma unna rogulalo eguva jeernasayaantara raktasraavam ledhaa iron-lopam raktaheenataku kaaranam kaavacchu.
sclerodermalo moothrapindaala prameyam, paelavamaina rooga niruupana karakamga mariyu tarachugaa maranaaniki kaaranamgaa pariganinchabadutundi.
moothrapindaalatho kuudina scleroderma yokka atyanta mukhyamaina clinical samasya scleroderma moothrapindaala sankshobham (src), dheeni lakshanaalu praanaantaka raktapotu (teevramaina avayava nashtam yokka saakshyamto adhika raktapotu), hyperreninemia (adhika renin sthaayilu), azotemia (raktamlo vyardha utpattula perukupovadamto moothrapindaala vaiphalyam), mariyu microngiopathic haemolitic anaemia (erra rakta kanaala naasanam). adhika raktapotu kakunda, hematuria (moothramlo raktam) mariyu proteinuria (moothramlo protein nashtam) src suuchimchavachchu.
gatamlo, src daadaapu ekareetigaa praanaantakam. aes inhibitors vaadakamtho phalitaalu gananeeyamgaa merugupadinappatiki, rooga niruupana tarachugaa rakshinchabadutundi, endukante gananeeyamaina sankhyalo rogulu chikitsaku vakreekaristaaru mariyu moothrapindaala vaiphalyaanni abhivruddhi chestaaru. daadaapu anni diffuse cutaneous scleroderma rogulalo vaari vyaadhi samayamlo edho oka samayamlo moothrapindaala sankshobham abhivruddhi chendutundi. vaegamgaa charma sambandhamaina rogulaku moothrapindaala samasyalu vachhe pramaadam ekkuvagaa untundi. idhi diffuse cutaneous sclerodermalo chaalaa saadhaaranam, mariyu tarachugaa rna polymeraseku vyatiraekamgaa pratiroedhakaalatoe mudipadi untundi (59 saatam kesulalo). chaalaa mandhi dialysis kuu velataaru, ayithe idhi moodinta oka vanthu kesulalo moodu samvatsaraalalo aapavacchu. adhika vayassu mariyu (viruddhamgaa) pradarsanalo takkuva raktapotu dialysis avasaramayye avakaasam ekkuvagaa untundi.
src chikitsalalo aes inhibitors untaayi. moothrapindaala sankshobham abhivruddhi chendadaaniki mundu eee mandulatho chikitsa pondina rogilo paelavamaina rooga niroopananu iteevali dayta suuchistunnanduna aes inhibitors yokka roganirodhaka upayogam prastutam sifaarsu cheyabadaledu. marpidi cheyabadina moothrapindaalu scleroderma dwara prabhaavitamavutaayani, mariyu prarambha moothrapindaala vyaadhi unna rogulu (scleroderma nirdhaarana jarigina oka samvatsaramlone) punaraavrutamayye pramaadam ekkuvagaa untundani bhaavistunnaaru.
kaaranaalu.
scleroderma mariyu systemic sclerosisku spashtamaina kaaranam gurtinchabadaledu. janyu samarasyam takkuvagaa unnanduna janyu siddhata parimitam anipistundi; ayinappatikee, swayam pratirakshaka vyaadhiki kutumba puurvasthiti tarachugaa kanipistundi. koola1yea2" mariyu "tgf-beata1" looni bahuroopatalu vyaadhi yokka teevrata mariyu abhivruddhini prabhaavitam cheyavachu. roganirodhaka praticharya yokka asalu epitopga cytomegalovirus (cmv) nuu soochinche aadharalu parimitamgaa unnaayi, alaage parvovirus bii19. sendriya draavakaalu mariyu itara rasayana agentlu sclerodermatho mudipadi unnaayi.
autoimmune drugvishayam venuka unna anumaanita yantraamgaalalo okati microchimerism uniki, antey.ii. talli raktamlo prasarana chendutunna pindam kanaalu, videshee padaarthamgaa bhaavinche vatiki roganirodhaka pratispandananu prerepistaayi.
deerghakaalika moothrapindaala vaiphalyam unna rogulalo scleroderma mariyu systemic sclerosis yokka pratyeka roopam abhivruddhi chendavacchu. eee roopam, nephrogenic fibrossing dermopathy ledhaa nephrogenic systemic fibrosis, gadolinium kaligina radiocontrastku gurikaavadamtoe mudipadi undhi.
bliomycin (oka chemotherapy agent) mariyu bahusha taxane chemotherapy sclerodermacu kaaranam kaavacchu, mariyu draavakaalaku vruttiparamaina bahirgatam daihika sclerosis pramaadaanni penchutundi.
pathophysiology.
collagen yokka adhika utpatti swayam pratirakshaka panicheyakapovadam valla sambhavistundani bhaavistaaru, dheenilo roganirodhaka vyavastha chromosomela kinetocorpy daadi cheyadam praarambhistundi. idhi sameepamloni janyuvula janyuparamaina vaiphalyaaniki daariteestundi. tii kanaalu charmamlo perukupotayi; ivi collagen nikshepananu prerepinche saitokinlu mariyu itara proteinlanu sravistaayani bhaavistaaru. mukhyamgaa fibroblast yokka uddeepana, vyaadhi prakriyaku keelakamainadigaa anipistundi, mariyu adhyayanalu eee prabhavanni utpatti chese sambhaavya karakalapai kalustaayi.
eee prakriyaloo mukhyamaina aatagadu vruddhi karakanni (tgfbt) marchadam. eee protein atigaa utpatti cheyabadinatlu kanipistundi, mariyu fibroblast (bahusha itara uddeepanalaku pratispandanagaa) kooda eee madhyavarti kosam grahakanni atigaa prerepistundi. collagen nikshepanaku baadhyata vahinche proteins mariyu enjaimla transcription prerepinche dviteeya sandesha vyavasthaku oka intracellular maargam ("smad2"/"smad3", "smad4", mariyu inhibitor "smad7" thoo koodi untundi) baadhyata vahistundi. "sp1" anedi eee sandarbhamlo atyanta daggaragaa adhyayanam cheyabadina transcription karakam. tgfbta kakunda, bandhana kanajaala perugudala karakam (ctgf) kii saadhyamaina paatra undhi. nijaaniki, systemic sclerosislo perigina sthaayilo oka saadhaarana "ctgf" janyu polymorphism untundi.
endothelianku nashtam anedi scleroderma abhivruddhilo prarambha asaadhaaranata, mariyu idhi kooda fibroblastla dwara collagen perukupovadam valla anie telustondi, ayithe saitokinlu, platelet antukune mariyu type II hypersensitivity praticharya dwara pratyaksha maarpulu adevidhamgaa chikkukunnayi. endotheline peragadam mariyu vasodilation taggadam namodu cheyabaddaayi.
gymenez mariyu derk scleroderma abhivruddhi gurinchi moodu siddhaantaalanu vivaristaaruh
rooga nirdhaarana.
1980loe, american college off rheumatology scleroderma kosam roganirdhaarana pramaanaalapai angeekarinchindi.
clinical anumanam, autoantibodyla uniki (pratyaekamgaa anticentromer mariyu anty-scl 70/antitopoisomerase antibodies), mariyu appudappudu biopsy dwara roganirdhaarana jarugutundi. pratirodhakaalalo, 90 saatam gurtinchadagina antinuclear antibodyni kaligi untaayi. anticentromer antibody anedi diffuse roopamlo (10 saatam) kante parimita roopamlo (80-90%) sarvasaadhaaranam, mariyu anty-scl70 anedi diffuse roopamlo (30-40%) mariyu african-american rogulalo (systemic roopaaniki ekkuva avakaasam unnavaaru) sarvasaadhaaranam.
itara paristhitulu charmam gattipadataaniki kaaranamavadam dwara systemic sclerosisnu anukarinchavacchu. renad yokka drugvishayam lekapovadam, chetulapai charmamlo asaadhaaranatalu lekapovadam, antargata avayava prameyam lekapovadam mariyu saadhaarana antinuclear antibodies pareeksha phalitam vantivi maroka rugmataku kaaranamavutaayani roganirdhaarana suuchanalu suuchistunnaayi.
chikitsa.
scalerodermaku etuvanti nivaarana teliyadu, ayithe charmam mruduvugaa mariyu vaapunu tagginche mandulatho sahaa konni lakshanaalaku chikitsalu unnaayi. kontamandi rogulu vediki gurikavadam valla prayojanam pondavacchu. rogula vidya sthaayini batti roogi vidyatho kuudina rogula samagra samrakshana vyaadhi lakshanaalu mariyu purogati yokka sanklishta swabhaavaanni drushtilo unchukuni upayogapadutundi.
samayochita/rogalakshana.
scleroderma yokka charma maarpulaku samayochita chikitsa vyaadhi marganni maarchadu, conny noppi mariyu vranotpattini meruguparachavacchu. naproxen vanti naan steroid anty inflammatory aushadhaala shrenini baadhaakaramaina lakshanaalanu tagginchadaaniki upayoginchavacchu. pridnisone vanti steroidla nundi prayojanam parimitam. renad drugvishayam yokka bhagalu konnisaarlu nephedipine ledhaa itara calcium chaanal blackerlaku pratispandistaayi; teevramaina digital vranotpatti prostassiclin analog iloprostku pratispandinchavachhu, mariyu dual endotheline-receptor virodhi bosenton renad drugvishayaaniki prayojanakaramgaa undavacchu. charma bigutu methotrexate mariyu siclosporin thoo vyavastheekrutamgaa chikitsa cheyavachu. mariyu charmam mandaanni pensillamaintho chikitsa cheyavachu.
moothrapindaala vyaadhi.
scleroderma moothrapindaala sankshobham (src) anedi systemic sclerosis yokka praanaantaka samasya, idhi vyaadhi yokka prarambha abhivyakti kaavacchu.  moothrapindaala vascular gaayam (collagen nikshepana kaaranamgaa) moothrapindaala ischemiaku daariteestundi, dheeni phalitamgaa renin-angiotensin-aldosteron vyavastha (raas) kriyaaseelakam avutundi.  idhi raktapotunu penchutundi mariyu moothrapindaala vasculaturenu marinta debbateestundi, idhi adhvaannamaina raktapotu mariyu moothrapindaala panicheyakapovadam (udhaa.zii., elevated creatinine, edema).  end-orgaon disfunctiontho adhika raktapotu atyavasara paristhiti (udhaa.zii.encephalopathy, retina raktasraavamu) anedi saadhaaranam.  thrombocytopenia mariyu microngiopathic haemolitic raktaheenata chudavachu.  mootravisarjana saadhaaranamgaa saadhaaranam, conny eee rogilo telikapati proteinurianu chuupavachchu; castlu oohinchanivi.
src chikitsalo pradhana aadharam aes inhibitors, ivi raas karyakalapalanu taggistaayi mariyu moothrapindaala paniteeru mariyu raktapotunu meruguparustaayi.  short-acting aes inhibitors (saadhaaranamgaa captopril) upayoginchabadataayi endukante avi vaegamgaa up titrate cheyabadataayi.  eee janabhalo aes inhibitarlaku perigina seeram creatinine sthaayi vyatiraekata kaadu, mariyu aushadha prarambha samayamlo creatininlo swalpa perugudhala saadhaaranam.
scleroderma moothrapindaala sankshobham, teevramaina moothrapindaala gaayam mariyu praanaantaka raktapotu (avayava nashtam yokka saakshyamto chaalaa adhika raktapotu) scleroderma unna vyaktulalo aes inhibitors taragati nundi mandulatho samarthavantamgaa chikitsa chestaaru. aes inhibitors yokka prayojanam vaari moothrapindaala vyaadhiki chikitsa cheyadaaniki dialysis praarambhinchaalsina vaariki kooda vistaristundi mariyu moothrapindaala punahstaapana chikitsanu nilipiveyadaaniki anumatinchadaaniki taginanta prayojanaanni ivvavacchu.
oopiritittula vyaadhi.
kriyaaseela alviolitis tarachugaa cyclophosphamide pulls thoo chikitsa cheyabadutundi, tarachugaa steroids yokka chinna motaadutoe kalisi. eee jokyam yokka prayojanam niraadambaramainadi.
pulmonary hyper tension kuu apoprostenol, treprostinil, bosenton mariyu bahusha aerolysed iloprostho chikitsa cheyavachu. systemic sclerosis-sambandhita interstitial lung disease (ssc-silled) unna rogulalo pulmonary functionlo ksheenata retunu tagginchadaaniki united states phud und drugg administrationlo september 6,2019naa upayoginchadaaniki nintendanib aamodinchabadindi.
inko.
scleroderma yokka daihika roopaaniki chikitsa cheyadaaniki plasmapheresis (chikitsa plasma marpidi) nuu upayoginchavacchani konni aadharalu suuchistunnaayi. italeelo, idhi prabhutvam aamodinchina chikitsa empika. rakta plaasmaanu albumin kaligina dravam thoo bharti cheyadam dwara idhi jarugutundi, mariyu scleroderma autoantibodyla prasarananu tagginchadam dwara vyaadhini dhooramgaa unchutundani bhaavistaaru.
epidemiology.
systemic scleroderma anedi oka arudaina vyaadhi, vaarshika sambhavam vividha janabhalo maarutuu untundi. united kingdom mariyu airopalo 3.7 nundi 43 varaku, japaanlo 7.2 varaku, taivaanlo 10.9 varaku, australialo 12.8 nundi 22.8 varaku, united stateslo 13.9 nundi 21.0 varaku, mariyu buenous airslo 21.2 varaku sambhavinche (prati million prajalaku kotta kesulu) anchanaalu unnaayi. garishta sthaayi prarambham 30 samvatsaraala vayassulo praarambhamai 50 samvatsaraala vayassulo mugustundi.
prapanchavyaaptamgaa, praabalyam yokka anchanaalu prati millionku 31 nundi 658.6 prabhaavita prajala varaku maarutuu untaayi. systemic sclerosis streeh purusha nishpatti 3:1 (madhya nundi chivari biddaku janmanicche samvatsaraalalo 8:1) kaligi untundi. african americanlalo eee vyaadhi yokka sambhavam rendu retlu ekkuvagaa undhi. oklahomaaloni puurti-rakta choktav sthaanika americanlu prapanchamlone atyadhika praabalyam kaligi unnaaru (100,000 mandiki 469).
eee vyaadhiki kontha vamsapaaramparya anubandham undhi. idhi vairasku roganirodhaka pratispandana (molecular mimikri) ledhaa taxins valla kooda sambhavinchavachhu.
samajam mariyu samskruti.
maddatu samuuhaalu.
juvenile scleroderma network anedi juvenile sclerodermatho nivasistunna tallidandrulu mariyu vaari pillalaku bhavodvega maddatu mariyu vidya samacharanni andinchadaaniki, juvenile sclerodermacu kaaranaanni mariyu nivaarananu gurtinchadaaniki mariyu praja avagahananu penchadaaniki pediatric parisoedhanaku maddatu ivvadaaniki ankitamaina samstha.
americalo, scleroderma foundation vyaadhi gurinchi avagahana penchadaaniki mariyu prabhaavitamaina vaariki sahayam cheyadaaniki ankitam cheyabadindi.
scleroderma research foundation eee paristhitipai parisoedhananu spaansar chestundi. hasyanatudu mariyu television presenter baab sagate, srf boardu sabhyudu, 1996 ebisi tv chitraaniki darsakatvam vahinchaaru, indulo danna delany natinchaaru, idhi scleroderma dwara pranantakamga prabhaavitamaina oka yuvatini varnistundi; eee chitram sagate sodari swalinga samparkula anubhavaala aadhaaramgaa roopondinchabadindi.
scleroderma mariyu raynades yuke anedi scleroderma unna vyaktulaku maddatu ivvadaaniki mariyu paristhitipai parisoedhanaku nidhulu samakuurchadaaniki 2016loe rendu chinna samsthala vileenam dwara erpadina british swachchanda samstha.
rooga niruupana.
2018 adhyayanam upa rakam aadhaaramgaa bhedam lekunda, 10 samvatsaraala manugada retlanu 88 saatamgaa unchindi. vistarinchina daihika sclerosis, antargata avayava samasyalu mariyu rooga nirdhaarana samayamlo vruddhaapyam marinta adhvaannamaina rooga niroopanhatho mudipadi untaayi.
parisoedhana.
scleroderma chikitsalo ibbandi unnanduna, chinna aadhaaramtho chikitsalu tarachugaa vyaadhini niyantrinchadaaniki prayatnistaaru. veetilo antithymocyte globulin mariyu mycophenolate mofettle unnaayi; konni nivedikalu charma lakshanaalalo merugudalalanu choopinchaayi, alaage daihika vyaadhi purogatini alasyam chesaayi, conny rendoo pedda clinical trials kuu lobadi laevu.
roganirodhaka vyavastha yokka tella rakta kanaalu sareerampai daadi chesinappudu systemic sclerosis vanti swayam pratirakshaka vyaadhulu sambhavistaayane oohapai autologus hematopoitic stem sell transplantation (hchst) aadharapadi untundi. eee chikitsalo, roogi raktam nundi muula kanaalanu velikiteesi vaatini samrakshinchadaaniki nilva chestaaru. roogi yokka tella rakta kanaalu cyclophosphamide mariyu tella rakta kanaalaku vyatiraekamgaa kundelu pratiroedhakaalatoe naasanam cheyabadataayi. appudu, nilva chesina raktam roogi yokka raktapravaahaaniki tirigi ivvabadutundi, idhi sareerampai daadi cheyani aarogyakaramaina raktam mariyu roganirodhaka vyavasthanu punarnirmistundi. dasha-III vichaarana phalitaalu, 156 mandhi rogulatho autologus stem sell transplantation international scleroderma (austis) trial, 2014loe prachurinchabaddaayi. hchsttlo adhika chikitsa maranaala raetu undhi, kabatti modati samvatsaramlo, chikitsa samuuhamloo rogula manugada placebo samuuham kante takkuvagaa undhi, conny 10 samvatsaraala chivarilo, chikitsa samuuhamloo manugada gananeeyamgaa ekkuvagaa undhi. hchst nundi bayatapadataaniki taginanta aarogyakaramaina rogulaku parimitam cheyabadithe hchst prabhaavavantamgaa undavacchani rachayitalu nirdhaarinchaaru. anduvalla, hchstt vyaadhi yokka purogati praarambhamlo, adhi debbatinadaaniki mundu ivvali. gunde jabbulu unna rogulu, sigaretlu taagina rogulu, batike avakaasam takkuvagaa undedi. maroka vichaarana, muula kana marpidi verses. cyclophosphamide (scott) trial konasagutondi.