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Benh viem khop do thuoc

Nhieu loai thuoc co the gay viem khop, voi cac bieu hien tai cho hay kem theo cac bieu hien he thong. Vi du kinh dien nhu thuoc loi tieu co the gay ra cac con gut cap hay thuoc chen beta giao cam co the nen luput do thuoc. Tuy nhien viem khop do dung interferon alpha hay viem mach do thuoc van con it duoc biet toi. Neu biet rang thuoc cung co the la nguyen nhan gay viem khop thi co the giai quyet duoc viem khop rat thuan loi khi ngung thuoc la nguyen nhan.

Cac loai thuoc gay viem khop

Ton thuong khop ban tay do viem.

Nguoi ta da thong ke duoc 32 thuoc co the gay nen hay khoi dong viem khop. Dau tien phai ke den mot so loai thuoc khang sinh nhu trimethoprim, ampicillin, norfloxacin, perfloxacin, isoniazid. Mot so thuoc chong virut cung nam trong danh sach nay nhu zinovudin, interferon. Sau do la mot so loai vaccin duoc su dung rong rai hien nay, dac biet la vaccin viem gan B. Ngoai ra mot so thuoc khac cung co the gay viem khop nhu  retinoid, acid hyaluronic, cortivalzol, quinidin, symvastatin...

 Dac diem viem khop do dung mot so loai thuoc

- Ton thuong khop do dung thuoc khang sinh quinolon

Ton thuong khop hiem gap nhung co bieu hien ro hon khi dung pefloxacin. Cac khop bi ton thuong thuong la co tay, khop goi va co chan, thuong xay ra sau hai tuan dieu tri. Cac nghien cuu thuc nghiem cho thay fluoroquinolon co tac dung co hai len soi collagen va proteoglycan cua sun khop. Cac bieu hien khop quan sat thay trong 1,3% benh nhan. Cac bieu hien dau khop hay dau co kha thuong gap. O mot so benh nhan phat trien viem khop thuc su, co the co tran dich khop. Tuy nhien khong co hoi chung viem sinh hoc va Xquang khop binh thuong. Ngoai ra dung khang sinh nhom quinolon con co nguy co bi viem gan. Ty le viem gan Achille do thuoc la 1,5%, dut gan la 0,08%. Sau 60 tuoi, nguy co tuong doi cua viem gan Achille tang len tu 3,2 lan trong truong hop dung quinolon don doc, den 6,2 lan khi ket hop voi corticoid. Su dung ket hop nay nen tranh o nguoi cao tuoi va chi dung khi khong con giai phap nao khac.

- Ton thuong khop do dung interferon

Interferon alpha duoc dung rong rai trong dieu tri viem gan B va C, cung nhu trong ung thu (leuxemi kinh dong tuy, mot so loai u lympho, ung thu than, u sac to da ac tinh, da u tuy xuong). Duoi tac dung cua interferon alpha co the xuat hien cac benh tu mien cua tuyen giap, thieu mau huyet tan, giam tieu cau tu mien, hoi chung luput. Viem khop hiem gap, chi moi bao cao khoang vai chuc truong hop, thuong la viem da khop doi xung, dau khop don thuan, hay viem mot hoac vai khop. Toc do mau lang tang cao trong 1/3 truong hop, khang the khang nhan duong tinh trong 3/4 truong hop. Neu cac trieu chung nhe thi co the duy tri dung interferon, ket hop voi thuoc chong viem khong steroid hay tham chi corticoid. Neu dung interferon thi tien trien benh khop thuan loi gap trong khoang 3/4 cac truong hop. Trong truong hop dung lai interferon, dau hieu khop tai phat trong 2/3 truong hop. Trong nghien cuu cua Nesher, su dung prednison va hydroxychloroquin cho phep phong duoc tai phat khi dung lai interferon. Viem da khop do dung interferon beta chi gap trong vai truong hop, mac du duoc dung rong rai trong xo cung cot ben thanh mang, chu yeu tren co dia di truyen, co HLA DR B1*404.

- Viem khop do dung vaccin viem gan B va vaccin khac

Sau khi tiem vaccin viem gan B co the thay nhieu bieu hien viem khop o cac muc do khac nhau. Dau khop don thuan gap trong it hon 1% truong hop. Viem vai  khop hay viem da khop hiem gap hon. Cac trieu chung khoi phat tu 1 - 4 tuan sau mui tiem dau tien hay mui thu hai. Dau khop bien mat sau vai tuan hay vai thang khi dung thuoc chong viem khong steroid. Nguoi ta ghi nhan mot so truong hop xuat hien viem khop dang thap sau tiem vaccin viem gan B, nhung van chua biet do la nguyen nhan hay trung hop ngau nhien, hay tiem vaccin chi la yeu to khoi dong tren mot co dia man cam.

-  Viem khop sau khi tiem noi khop acid hyaluronic

Phan ung viem khop gap trong 2-4% benh nhan, thuong tu mui tiem thu hai, xuat hien vai gio den 24 gio sau khi tiem. Khop goi sung va dau. Dieu tri tuong tu nhu tren, trong mot so truong hop co the dung tiem noi khop corticoid co the lam giam nhanh chong cac trieu trung. Tuy nhien cac lan tiem sau van co the hoan toan binh thuong. Co nhieu nguyen nhan giai thich hien tuong nay. Do la phan ung cua he mien dich chong lai cac yeu to ngoai lai tiem vao, kich thich truc tiep cac chat trung gian gay viem, di chuyen bach cau, lang dong tinh the pyrophosphat calci, giam thai tiet dich khop do thuoc lam tang do nhot cua dich khop, kich thich phan mem canh khop do khong tiem vao trong khop gay phan ung tao u hat.

- Ton thuong khop do dung thuoc retinoid

Retinoid duoc dung rong rai trong dieu tri vay nen. Rieng o Phap chi co acitretin, dan chat hoat tinh cua etretinat, hien nay la thuoc duy nhat duoc dung. Khi dung thuoc co the xuat hien dau khop, chu khong thay viem khop hay viem da khop thuc su. Tuy nhien khi dung thuoc keo dai co the thay xuat hien gai xuong dot song, khuyu tay, khop goi, vai, co chan. Mot so truong hop viem khop quan sat thay khi dung isotretinoid, thuoc danh cho dieu tri trung ca muc do nang.

Tom lai hien nay cac thong tin ve thuoc dang tai tren cac tap chi va internet giup co the tra cuu de dang cac tac dung phu cua thuoc. Dieu do thuc su bo ich cho cac bac si khi ke toa cung nhu theo doi va du phong duoc tac dung phu cua thuoc co the phat sinh trong qua trinh dieu tri.

TS.BS. Nguyen Vinh Ngoc (Khoa khop Benh vien Bach Mai)