{"id":2220,"date":"2023-09-30T13:30:00","date_gmt":"2023-09-30T06:30:00","guid":{"rendered":"https:\/\/khoatritruong.com\/?p=2220"},"modified":"2024-07-23T22:06:50","modified_gmt":"2024-07-23T15:06:50","slug":"viem-khop-dang-thap-co-ngung-dieu-tri-duoc-khong","status":"publish","type":"post","link":"https:\/\/khoatritruong.com\/index.php\/2023\/09\/30\/viem-khop-dang-thap-co-ngung-dieu-tri-duoc-khong\/","title":{"rendered":"Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p c\u00f3 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c kh\u00f4ng?"},"content":{"rendered":"<span class=\"rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">\u23f3Th\u1eddi gian \u0111\u1ecdc: <\/span> <span class=\"rt-time\">6<\/span> <span class=\"rt-label rt-postfix\">ph\u00fat<\/span><\/span>\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"2220\" class=\"elementor elementor-2220\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b8f5d73 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b8f5d73\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0a7726c\" data-id=\"0a7726c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-02e42e2 elementor-widget elementor-widget-text-editor\" data-id=\"02e42e2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 14-09-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\tM\u1ed9t nh\u1eefng \u0111i\u1ec1u khi\u1ebfn ng\u01b0\u1eddi b\u1ec7nh s\u1ed1c nh\u1ea5t khi m\u1eafc vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (VKDT) l\u00e0 vi\u1ec7c b\u00e1c s\u0129 b\u1ea3o h\u1ecd r\u1eb1ng \u0111\u00e2y l\u00e0 b\u1ec7nh d\u00f9ng thu\u1ed1c v\u00e0 t\u00e1i kh\u00e1m su\u1ed1t \u0111\u1eddi. B\u00e0i vi\u1ebft n\u00e0y s\u1ebd t\u00ecm hi\u1ec3u v\u1ec1 nguy c\u01a1 b\u00f9ng ph\u00e1t b\u1ec7nh khi ng\u1eebng thu\u1ed1c \u0111\u1eb7c tr\u1ecb trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, c\u00f2n g\u1ecdi DMARD (Disease-modifying antirheumatic drug, thu\u1ed1c ch\u1ed1ng th\u1ea5p thay \u0111\u1ed5i di\u1ec5n ti\u1ebfn b\u1ec7nh).\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2a564d2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2a564d2\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-51c1aba\" data-id=\"51c1aba\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9f78152 elementor-widget elementor-widget-text-editor\" data-id=\"9f78152\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<em>Ch\u00fa th\u00edch:<\/em>\n<ul>\n \t<li>DMARD chia l\u00e0m c\u1ed5 \u0111i\u1ec3n, sinh h\u1ecdc v\u00e0 thu\u1ed1c ph\u00e2n t\u1eed nh\u1ecf, \u0111\u1ec1u l\u00e0 thu\u1ed1c ki\u1ec3m so\u00e1t b\u1ec7nh trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p \u0111\u1ec3 gi\u1ea3m v\u00e0 ng\u01b0ng glucocorticoid.<\/li>\n \t<li>C\u00e1c thang \u0111i\u1ec3m nh\u01b0 DAS28, SDAI, CDAI d\u00f9ng \u0111\u00e1nh gi\u00e1 ho\u1ea1t t\u00ednh b\u1ec7nh, kh\u1ea3o s\u00e1t \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb khi \u0111\u1ea1t \u0111\u01b0\u1ee3c ho\u1ea1t t\u00ednh b\u1ec7nh th\u1ea5p ho\u1eb7c l\u00ed t\u01b0\u1edfng l\u00e0 lui b\u1ec7nh.<\/li>\n<\/ul>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e127cbf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e127cbf\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-02ae07c\" data-id=\"02ae07c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-48d5cbe elementor-widget elementor-widget-heading\" data-id=\"48d5cbe\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 14-09-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Nguy c\u01a1 b\u00f9ng ph\u00e1t khi ng\u1eebng thu\u1ed1c DMARD<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ab71c08 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ab71c08\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4cc5935\" data-id=\"4cc5935\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0151d46 elementor-widget elementor-widget-text-editor\" data-id=\"0151d46\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tNhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 kh\u1ea3o s\u00e1t t\u1ec9 l\u1ec7 b\u00f9ng ph\u00e1t b\u1ec7nh tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng VKDT ho\u1ea1t t\u00ednh b\u1ec7nh th\u1ea5p ho\u1eb7c \u0111\u1ea1t lui b\u1ec7nh khi ng\u1eebng thu\u1ed1c DMARD sinh h\u1ecdc ho\u1eb7c DMARD c\u1ed5 \u0111i\u1ec3n.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fe90ab1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"fe90ab1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2814fba\" data-id=\"2814fba\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fec3b6f elementor-widget elementor-widget-text-editor\" data-id=\"fec3b6f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tEmery v\u00e0 c\u1ed9ng s\u1ef1 nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng VKDT ch\u01b0a \u0111i\u1ec1u tr\u1ecb, cho h\u1ecd d\u00f9ng etanercept 50mg (<em>thu\u1ed1c kh\u00e1ng TNF, 1 lo\u1ea1i DMARD sinh h\u1ecdc<\/em>) k\u1ebft h\u1ee3p methotrexate (<em>MTX, DMARD c\u1ed5 \u0111i\u1ec3n n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb<\/em>) trong 52 tu\u1ea7n. T\u1ea5t c\u1ea3 \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 \u0111\u00e1p \u1ee9ng (ho\u1ea1t t\u00ednh b\u1ec7nh th\u1ea5p v\u1edbi DAS28 \u22643.2 v\u00e0o tu\u1ea7n 39 v\u00e0 lui b\u1ec7nh v\u1edbi DAS28 &lt;2.6 v\u00e0o tu\u1ea7n 52) \u0111\u01b0a v\u00e0o pha m\u00f9 \u0111\u00f4i. \u0110\u1ed1i t\u01b0\u1ee3ng \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean t\u1ec9 l\u1ec7 1:1:1 v\u00e0o 3 nh\u00f3m: etanercept 25mg k\u1ebft h\u1ee3p MTX, MTX \u0111\u01a1n tr\u1ecb v\u00e0 gi\u1ea3 d\u01b0\u1ee3c trong 39 tu\u1ea7n. T\u1ea1i tu\u1ea7n 39, t\u1ea5t c\u1ea3 \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u00e1p \u1ee9ng c\u1ee7a giai \u0111o\u1ea1n m\u00f9 \u0111\u00f4i \u0111\u01b0\u1ee3c ng\u01b0ng to\u00e0n b\u1ed9 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i \u0111\u1ebfn tu\u1ea7n 65 (pha ng\u01b0ng thu\u1ed1c).\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-23f279b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"23f279b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7263675\" data-id=\"7263675\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-03018aa elementor-widget elementor-widget-text-editor\" data-id=\"03018aa\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>K\u1ebft qu\u1ea3 193 \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o pha m\u00f9 \u0111\u00f4i v\u00e0 131 ng\u01b0\u1eddi \u0111i ti\u1ebfp v\u00e0o pha ng\u01b0ng thu\u1ed1c. Trong pha m\u00f9 \u0111\u00f4i, nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c c\u00f3 s\u1ed1 ng\u01b0\u1eddi b\u1ecb b\u00f9ng ph\u00e1t l\u1ea1i VKDT cao nh\u1ea5t (77%), theo sau l\u00e0 nh\u00f3m ch\u1ec9 d\u00f9ng MTX c\u00f3 t\u1ec9 l\u1ec7 b\u00f9ng ph\u00e1t VKDT 60% so v\u1edbi nh\u00f3m ph\u1ed1i h\u1ee3p thu\u1ed1c l\u00e0 37%. T\u1ea1i tu\u1ea7n 65 c\u1ee7a pha ng\u01b0ng thu\u1ed1c, t\u1ec9 l\u1ec7 b\u00f9ng ph\u00e1t VKDT v\u1eabn cao nh\u1ea5t \u1edf nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c, kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1edbi nh\u00f3m ph\u1ed1i h\u1ee3p thu\u1ed1c.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e4af46e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e4af46e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-88b70ad\" data-id=\"88b70ad\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7701c88 elementor-widget elementor-widget-text-editor\" data-id=\"7701c88\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tK\u1ebft lu\u1eadn t\u1eeb nghi\u00ean c\u1ee9u n\u00e0y cho th\u1ea5y khi ng\u01b0ng DMARD sinh h\u1ecdc ho\u1eb7c DMARD c\u1ed5 \u0111i\u1ec3n \u0111\u1ec1u g\u00e2y t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t b\u1ec7nh r\u1ea5t cao.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ae483b6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ae483b6\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5aa1310\" data-id=\"5aa1310\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1485647 elementor-widget elementor-widget-text-editor\" data-id=\"1485647\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tG\u1ea7n \u0111\u00e2y h\u01a1n, c\u00e1c t\u00e1c gi\u1ea3 H\u00e0n Qu\u1ed1c th\u1ef1c hi\u1ec7n nghi\u00ean c\u1ee9u xem c\u00f3 th\u1ec3 ng\u01b0ng MTX \u1edf ng\u01b0\u1eddi b\u1ec7nh VKDT \u0111\u00e3 ng\u01b0ng \u00edt nh\u1ea5t 10 n\u0103m. \u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u bao g\u1ed3m c\u1ea3 nh\u1eefng ng\u01b0\u1eddi \u0111\u01a1n tr\u1ecb MTX, MTX k\u1ebft h\u1ee3p DMARD c\u1ed5 \u0111i\u1ec3n kh\u00e1c, DMARD sinh h\u1ecdc hay thu\u1ed1c ph\u00e2n t\u1eed nh\u1ecf (<em>ts\u2014targeted synthetic\u2014DMARD<\/em>). C\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1ec1u \u1edf ho\u1ea1t t\u00ednh b\u1ec7nh th\u1ea5p ho\u1eb7c lui b\u1ec7nh khi ng\u01b0ng MTX v\u00e0 \u00edt nh\u1ea5t \u0111\u00e3 d\u00f9ng MTX li\u1ec1u \u1ed5n \u0111\u1ecbnh &gt;6 th\u00e1ng tr\u01b0\u1edbc \u0111\u00f3. T\u1ea5t c\u1ea3 \u0111\u1ed1i t\u01b0\u1ee3ng theo d\u00f5i \u0111\u1ee3t b\u00f9ng ph\u00e1t sau 6 th\u00e1ng (DAS28 t\u0103ng &gt;1.2 v\u00e0 th\u1ecfa \u00edt nh\u1ea5t 1 \u0111i\u1ec1u ki\u1ec7n: d\u00f9ng l\u1ea1i MTX, th\u00eam DMARD m\u1edbi ho\u1eb7c t\u0103ng li\u1ec1u glucocorticoid).\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-dbbcc51 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"dbbcc51\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-69daff4\" data-id=\"69daff4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-347fd7a elementor-widget elementor-widget-text-editor\" data-id=\"347fd7a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>97 \u0111\u1ed1i t\u01b0\u1ee3ng tham gia nghi\u00ean c\u1ee9u, th\u1eddi gian d\u00f9ng MTX trung v\u1ecb l\u00e0 19 n\u0103m (10 \u2013 22), th\u1eddi gian trung v\u1ecb \u0111i\u1ec1u tr\u1ecb \u1ed5n \u0111\u1ecbnh l\u00e0 5.7 (0.7 \u2013 20.6) n\u0103m v\u00e0 kh\u00f4ng d\u00f9ng glucocorticoid l\u00e0 4.8 (0.7 \u2013 20.7) n\u0103m. Li\u1ec1u MTX trung v\u1ecb tr\u01b0\u1edbc ng\u01b0ng c\u0169ng kh\u00e1 th\u1ea5p (12.5mg). Kho\u1ea3ng 1\/4 \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u01a1n tr\u1ecb MTX v\u00e0 3\/4 \u0111\u1ed1i t\u01b0\u1ee3ng k\u00e9m \u0111\u00e1p \u1ee9ng MTX, c\u1ea7n \u0111\u1ebfn DMARD sinh h\u1ecdc\/tsDMARD.&nbsp;<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4b639b0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4b639b0\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-dbf6c81\" data-id=\"dbf6c81\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4326be2 elementor-widget elementor-widget-text-editor\" data-id=\"4326be2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>K\u1ebft qu\u1ea3 c\u0169ng kh\u00f4ng b\u1ea5t ng\u1edd v\u1edbi t\u1ec9 l\u1ec7 \u0111\u1ee3t b\u00f9ng ph\u00e1t l\u00e0 44,3% v\u00e0 th\u1eddi gian trung v\u1ecb \u0111\u1ebfn b\u00f9ng ph\u00e1t l\u00e0 99 ng\u00e0y (kho\u1ea3ng t\u1ee9 ph\u00e2n v\u1ecb: 28 \u2013 168). V\u1eady, k\u1ebft qu\u1ea3 n\u00e0y cho th\u1ea5y d\u00f9ng MTX l\u00e2u t\u1eadn 10 n\u0103m m\u00e0 ng\u01b0ng thu\u1ed1c th\u00ec nguy c\u01a1 b\u00f9ng ph\u00e1t v\u1eabn cao.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b8088da elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b8088da\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e7a9923\" data-id=\"e7a9923\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-aa4deb3 elementor-widget elementor-widget-text-editor\" data-id=\"aa4deb3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Tr\u00ean \u0111\u00e2y l\u00e0 2 v\u00ed d\u1ee5 trong s\u1ed1 nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u1ec1u cho th\u1ea5y t\u1ec9 l\u1ec7 b\u00f9ng ph\u00e1t l\u1ea1i VKDT sau khi ng\u01b0ng thu\u1ed1c DMARD c\u1ed5 \u0111i\u1ec3n hay sinh h\u1ecdc \u0111\u1ec1u cao kh\u00f4ng ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-76b2e7c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"76b2e7c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-36b629d\" data-id=\"36b629d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9552ab3 elementor-widget elementor-widget-heading\" data-id=\"9552ab3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n b\u00f9ng ph\u00e1t sau ng\u01b0ng thu\u1ed1c<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9b147a1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9b147a1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cd6fcf8\" data-id=\"cd6fcf8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5ea3ea2 elementor-widget elementor-widget-text-editor\" data-id=\"5ea3ea2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tNh\u01b0 1 l\u1ebd t\u1ef1 nhi\u00ean, ng\u01b0\u1eddi ta c\u0169ng \u0111i t\u00ecm y\u1ebfu t\u1ed1 n\u00e0o d\u1ef1 b\u00e1o VKDT t\u00e1i ph\u00e1t khi ng\u01b0ng thu\u1ed1c DMARD.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e7b3854 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e7b3854\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d2b624d\" data-id=\"d2b624d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-38f7d2d elementor-widget elementor-widget-text-editor\" data-id=\"38f7d2d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tKameda v\u00e0 c\u1ed9ng s\u1ef1 kh\u1ea3o s\u00e1t 36 \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u00e3 \u0111\u1ea1t lui b\u1ec7nh theo \u0111i\u1ec3m SDAI \u22643.3 \u00edt nh\u1ea5t 3 th\u00e1ng s\u1eb5n s\u00e0ng ng\u01b0ng thu\u1ed1c DMARD sinh h\u1ecdc. C\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u01b0\u1ee3c theo d\u00f5i ti\u1ebfn c\u1ee9u trong 2 n\u0103m. K\u1ebft c\u1ee5c ch\u00ednh l\u00e0 \u0111\u1ee3t b\u00f9ng ph\u00e1t x\u00e1c \u0111\u1ecbnh b\u1edfi DAS28-ESR (t\u1ed1c \u0111\u1ed9 l\u1eafng m\u00e1u) \u2265 3.2 k\u00e8m t\u0103ng t\u1eeb \u0111i\u1ec3m ban \u0111\u1ea7u > 0.6 trong v\u00f2ng 2 n\u0103m sau khi ng\u01b0ng DMARD sinh h\u1ecdc.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f255aec elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f255aec\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-466f3d1\" data-id=\"466f3d1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-eab8b33 elementor-widget elementor-widget-text-editor\" data-id=\"eab8b33\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>K\u1ebft qu\u1ea3 ghi nh\u1eadn th\u1eddi gian b\u1ec7nh trung v\u1ecb l\u00e0 5.2 n\u0103m, ng\u01b0ng DMARD sinh h\u1ecdc trung v\u1ecb 2.1 n\u0103m (kho\u1ea3ng t\u1ee9 ph\u00e2n v\u1ecb: 1.4 \u2013 3.5) v\u00e0 th\u1eddi gian trung v\u1ecb \u0111\u1ea1t lui b\u1ec7nh l\u00e0 20 th\u00e1ng (9 \u2013 31). T\u1ec9 l\u1ec7 b\u1ecb b\u00f9ng ph\u00e1t trong v\u00f2ng 2 n\u0103m l\u00e0 55.6% v\u1edbi th\u1eddi gian t\u00e1i ph\u00e1t trung v\u1ecb 115 ng\u00e0y (43 \u2013 651). May m\u1eafn thay, 90% \u0111\u1ed1i t\u01b0\u1ee3ng quay l\u1ea1i lui b\u1ec7nh khi d\u00f9ng l\u1ea1i lo\u1ea1i thu\u1ed1c DMARD tr\u01b0\u1edbc \u0111\u00f3. C\u00e1c y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n b\u00f9ng ph\u00e1t VKDT g\u1ed3m n\u1ed3ng \u0111\u1ed9 th\u1ee5 th\u1ec3 TNF1 h\u00f2a tan cao, n\u1ed3ng \u0111\u1ed9 IL-2 th\u1ea5p.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-892b852 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"892b852\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-817d799\" data-id=\"817d799\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-557e2cd elementor-widget elementor-widget-text-editor\" data-id=\"557e2cd\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tM\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u c\u0169 h\u01a1n ghi nh\u1eadn th\u1eddi gian b\u1ec7nh d\u00e0i, anti CCP d\u01b0\u01a1ng t\u00ednh, t\u1ed5n th\u01b0\u01a1ng h\u1ee7y kh\u1edbp tr\u00ean X quang v\u00e0 b\u1ec7nh c\u00f2n ho\u1ea1t t\u00ednh li\u00ean quan \u0111\u1ebfn b\u00f9ng ph\u00e1t b\u1ec7nh khi ng\u01b0ng DMARD sinh h\u1ecdc. Nghi\u00ean c\u1ee9u c\u1ee7a Kameda v\u00e0 c\u1ed9ng s\u1ef1 tuy th\u1eddi gian b\u1ec7nh, anti CCP d\u01b0\u01a1ng t\u00ednh, v\u00e0 DAS28-ESR cao h\u01a1n \u1edf nh\u00f3m b\u00f9ng ph\u00e1t b\u1ec7nh nh\u01b0ng kh\u00f4ng kh\u00e1c bi\u1ec7t \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1edbi nh\u00f3m kh\u00f4ng b\u00f9ng ph\u00e1t, c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch do c\u1ee1 m\u1eabu nh\u1ecf (36 ng\u01b0\u1eddi).\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3708dfd elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3708dfd\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-eff6966\" data-id=\"eff6966\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c57badc elementor-widget elementor-widget-text-editor\" data-id=\"c57badc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Nghi\u00ean c\u1ee9u c\u1ee7a c\u00e1c t\u00e1c gi\u1ea3 H\u00e0n Qu\u1ed1c k\u1ec3 tr\u00ean, m\u00f4 h\u00ecnh h\u1ed3i quy logistic \u0111\u01a1n bi\u1ebfn c\u0169ng ghi nh\u1eadn y\u1ebfu t\u1ed1: n\u1ed3ng \u0111\u1ed9 CRP, ESR t\u1ea1i th\u1eddi \u0111i\u1ec3m ng\u01b0ng thu\u1ed1c, ESR trung b\u00ecnh trong 6 th\u00e1ng tr\u01b0\u1edbc ng\u01b0ng thu\u1ed1c, li\u1ec1u MTX m\u1ed7i tu\u1ea7n tr\u01b0\u1edbc ng\u01b0ng thu\u1ed1c, ph\u1ed1i h\u1ee3p c\u00e1c DMARD c\u1ed5 \u0111i\u1ec3n kh\u00e1c l\u00e0m t\u0103ng nguy c\u01a1 b\u00f9ng ph\u00e1t b\u1ec7nh. Nh\u01b0ng khi ph\u00e2n t\u00edch \u0111a bi\u1ebfn, ch\u1ec9 c\u00f2n li\u1ec1u MTX m\u1ed7i tu\u1ea7n tr\u01b0\u1edbc ng\u01b0ng thu\u1ed1c c\u00f3 li\u00ean quan t\u0103ng nguy c\u01a1 b\u00f9ng ph\u00e1t (OR: 1.014, kho\u1ea3ng tin c\u1eady 95%: 1.014 \u2013 1.342, p = 0.031).<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-54813fc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"54813fc\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5d9769d\" data-id=\"5d9769d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2879269 elementor-widget elementor-widget-heading\" data-id=\"2879269\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">L\u1ee1 c\u1ea7n ng\u01b0ng MTX ng\u1eafn h\u1ea1n th\u00ec sao?<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-88084c9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"88084c9\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ffdb30b\" data-id=\"ffdb30b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f16e717 elementor-widget elementor-widget-text-editor\" data-id=\"f16e717\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>C\u00e1c t\u00e1c gi\u1ea3 ng\u01b0\u1eddi H\u00e0n nghi\u00ean c\u1ee9u v\u1ec1 kh\u1ea3 n\u0103ng ng\u01b0ng MTX trong 2 ho\u1eb7c 4 tu\u1ea7n tr\u01b0\u1edbc ti\u00eam ng\u1eeba c\u00fam m\u00f9a. \u0110\u1ed1i v\u1edbi th\u1eddi gian ng\u01b0ng MTX 4 tu\u1ea7n, \u0111i\u1ec3m DAS28 t\u0103ng nhi\u1ec1u h\u01a1n tr\u01b0\u1edbc khi quay l\u1ea1i b\u00ecnh th\u01b0\u1eddng khi d\u00f9ng l\u1ea1i MTX. T\u1ec9 l\u1ec7 \u0111\u1ee3t b\u00f9ng ph\u00e1t \u1edf nh\u00f3m ng\u01b0ng thu\u1ed1c 4 tu\u1ea7n l\u00e0 20.5%, cao h\u01a1n nh\u00f3m 2 tu\u1ea7n (10.8%) v\u00e0 nh\u00f3m ti\u1ebfp t\u1ee5c d\u00f9ng MTX (5.8%), kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1edbi p &lt; 0.01. Thay \u0111\u1ed5i \u0111i\u1ec3m DAS28 so v\u1edbi m\u1ee9c n\u1ec1n c\u0169ng cao h\u01a1n \u1edf nh\u00f3m ng\u01b0ng thu\u1ed1c 4 tu\u1ea7n so v\u1edbi nh\u00f3m ti\u1ebfp t\u1ee5c MTX (p = 0.005).<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bc84159 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bc84159\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4899f00\" data-id=\"4899f00\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fc62dd1 elementor-widget elementor-widget-text-editor\" data-id=\"fc62dd1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tQua \u0111\u00f3, k\u1ebft lu\u1eadn t\u1eeb nghi\u00ean c\u1ee9u cho r\u1eb1ng ng\u01b0ng thu\u1ed1c MTX ng\u1eafn h\u1ea1n 2 tu\u1ea7n c\u00f3 th\u1ec3 an to\u00e0n trong khi ng\u01b0ng 4 tu\u1ea7n th\u00ec t\u0103ng t\u1ec9 l\u1ec7 \u0111\u1ee3t b\u00f9ng ph\u00e1t v\u00e0 ho\u1ea1t t\u00ednh b\u1ec7nh VKDT tho\u00e1ng qua.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b9301a4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b9301a4\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6919e25\" data-id=\"6919e25\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ec5131b elementor-widget elementor-widget-heading\" data-id=\"ec5131b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Khuy\u1ebfn c\u00e1o tr\u00ean th\u1ebf gi\u1edbi n\u00f3i g\u00ec?<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d170836 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d170836\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4204e0f\" data-id=\"4204e0f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a8c626b elementor-widget elementor-widget-text-editor\" data-id=\"a8c626b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Tuy nguy c\u01a1 b\u00f9ng ph\u00e1t hay m\u1ea5t ki\u1ec3m so\u00e1t b\u1ec7nh cao nh\u01b0 v\u1eady nh\u01b0ng ch\u00fang ta v\u1eabn c\u00f3 c\u00e1ch \u0111\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n gi\u1ea3m thu\u1ed1c. C\u1ea3 2 hi\u1ec7p h\u1ed9i l\u1edbn t\u1eeb M\u1ef9 (ACR) v\u00e0 Ch\u00e2u \u00c2u (EULAR) \u0111\u1ec1u \u0111\u1ed3ng thu\u1eadn kh\u00f4ng n\u00ean ng\u01b0ng thu\u1ed1c ho\u00e0n to\u00e0n v\u00ec nguy c\u01a1 t\u00e1i ph\u00e1t cao v\u00e0 nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng kh\u1edbp kh\u00f4ng h\u1ed3i ph\u1ee5c, m\u00e0 n\u00ean duy tr\u00ec \u00edt nh\u1ea5t 1 DMARD.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d4219d5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d4219d5\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-778a361\" data-id=\"778a361\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0ef02db elementor-widget elementor-widget-text-editor\" data-id=\"0ef02db\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tT\u1eeb \u0111\u1ea7u \u0111\u1ebfn gi\u1edd m\u00ecnh kh\u00f4ng nh\u1eafc \u0111\u1ebfn nguy c\u01a1 khi ng\u01b0ng glucocorticoid v\u00ec c\u1ea3 ACR v\u00e0 EULAR \u0111\u1ed3ng thu\u1eadn b\u1eaft bu\u1ed9c ph\u1ea3i ng\u01b0ng glucocorticoid tr\u01b0\u1edbc khi t\u00ednh \u0111\u1ebfn chuy\u1ec7n gi\u1ea3m DMARD.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bcdec56 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bcdec56\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f91cc09\" data-id=\"f91cc09\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8b6c040 elementor-widget elementor-widget-text-editor\" data-id=\"8b6c040\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>ACR v\u00e0 EULAR \u0111\u1ec1u \u0111\u1ed3ng thu\u1eadn v\u1ec1 vi\u1ec7c ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u1ea1t lui b\u1ec7nh ho\u1eb7c ho\u1ea1t t\u00ednh b\u1ec7nh th\u1ea5p \u00edt nh\u1ea5t 6 th\u00e1ng tr\u01b0\u1edbc khi c\u00e2n nh\u1eafc chuy\u1ec7n gi\u1ea3m li\u1ec1u hay ng\u01b0ng thu\u1ed1c. Chi\u1ebfn l\u01b0\u1ee3c c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng g\u1ed3m gi\u00e3n li\u1ec1u thu\u1ed1c ho\u1eb7c gi\u1ea3m li\u1ec1u thu\u1ed1c \u0111\u1ec1u \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f358530 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f358530\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b6c3bf9\" data-id=\"b6c3bf9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8c361e0 elementor-widget elementor-widget-text-editor\" data-id=\"8c361e0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Ri\u00eang ACR, khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n v\u1ec1 gi\u1ea3m li\u1ec1u d\u1ea7n v\u00e0 ng\u01b0ng MTX thay v\u00ec ng\u01b0ng DMARD sinh h\u1ecdc hay tsDMARD v\u1edbi l\u00ed do ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n d\u00f9ng DMARD sinh h\u1ecdc ho\u1eb7c tsDMARD b\u1ea3n th\u00e2n do k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi MTX. Tuy nhi\u00ean, ACR c\u0169ng l\u01b0u \u00fd m\u1ed9t s\u1ed1 thu\u1ed1c sinh h\u1ecdc (vd: adalimumab, infliximab) s\u1ebd c\u1ea7n k\u1ebft h\u1ee3p MTX \u0111\u1ec3 gi\u1ea3m h\u00ecnh th\u00e0nh kh\u00e1ng th\u1ec3 kh\u00e1ng thu\u1ed1c.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-530a9cc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"530a9cc\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-90c5989\" data-id=\"90c5989\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-70ef582 elementor-widget elementor-widget-text-editor\" data-id=\"70ef582\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>C\u1ea3 2 h\u01b0\u1edbng d\u1eabn \u0111\u1ec1u r\u1ea5t nh\u1ea5n m\u1ea1nh th\u1ea3o lu\u1eadn gi\u1eefa b\u00e1c s\u0129 N\u1ed9i c\u01a1 x\u01b0\u01a1ng kh\u1edbp v\u00e0 ng\u01b0\u1eddi b\u1ec7nh v\u1ec1: mong mu\u1ed1n v\u00e0 t\u00e0i ch\u00ednh v\u1ec1 vi\u1ec7c ng\u01b0ng DMARD sinh h\u1ecdc hay ng\u01b0ng DMARD c\u1ed5 \u0111i\u1ec3n. \u1ede Vi\u1ec7t Nam, gi\u00e1 c\u1ea3 thu\u1ed1c DMARD sinh h\u1ecdc v\u1eabn c\u00f2n kh\u00e1 cao so v\u1edbi m\u1eb7t b\u1eb1ng chung thu nh\u1eadp b\u00ecnh qu\u00e2n c\u1ee7a ng\u01b0\u1eddi d\u00e2n. \u0110i\u1ec3m kh\u00e1c bi\u1ec7t v\u1edbi H\u01b0\u1edbng d\u1eabn c\u1ee7a Hoa K\u00ec (ACR) hay c\u00e1c n\u01b0\u1edbc \u0111\u00e3 ph\u00e1t tri\u1ec3n kh\u00e1c l\u00e0 b\u00e1c s\u0129 Vi\u1ec7t Nam th\u01b0\u1eddng c\u00f3 xu h\u01b0\u1edbng gi\u00e3n li\u1ec1u ho\u1eb7c gi\u1ea3m li\u1ec1u DMARD sinh h\u1ecdc \u0111\u1ec3 gi\u1ea3m gi\u00e1 th\u00e0nh \u0111i\u1ec1u tr\u1ecb thay v\u00ec gi\u1ea3m DMARD c\u1ed5 \u0111i\u1ec3n<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-13d89f7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"13d89f7\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d9a1d57\" data-id=\"d9a1d57\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a52b99e elementor-widget elementor-widget-heading\" data-id=\"a52b99e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">L\u1eddi k\u1ebft<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-50315e5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"50315e5\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8d4e72f\" data-id=\"8d4e72f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-dad716c elementor-widget elementor-widget-text-editor\" data-id=\"dad716c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tT\u00f3m l\u1ea1i, ng\u01b0\u1eddi b\u1ec7nh VKDT kh\u00f4ng n\u00ean ng\u01b0ng ho\u00e0n to\u00e0n \u0111i\u1ec1u tr\u1ecb m\u00e0 n\u00ean duy tr\u00ec \u00edt nh\u1ea5t 1 DMARD v\u00ec nguy c\u01a1 t\u00e1i ph\u00e1t cao (kho\u1ea3ng 40-50%). Vi\u1ec7c gi\u00e3n li\u1ec1u hay gi\u1ea3m li\u1ec1u DMARD ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi lui b\u1ec7nh duy tr\u00ec >6 th\u00e1ng.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b7111da elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b7111da\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4bb576c\" data-id=\"4bb576c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-47d9368 elementor-widget elementor-widget-heading\" data-id=\"47d9368\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1dcfe2f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1dcfe2f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-44caf23\" data-id=\"44caf23\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b5189fb elementor-widget elementor-widget-text-editor\" data-id=\"b5189fb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ol>\n<li><a href=\"doi:10.1056\/NEJMoa1316133\">Emery P, Hammoudeh M, FitzGerald O, et al. Sustained remission with etanercept tapering in early rheumatoid arthritis. N Engl J Med. 2014;371(19):1781-1792.<\/a><\/li>\n<li><a href=\"doi:10.1111\/1756-185X.13888\">Lee JS, Oh JS, Hong S, Kim YG, Lee CK, Yoo B. Six-month flare risk after discontinuing long-term methotrexate treatment in patients having rheumatoid arthritis with low disease activity. Int J Rheum Dis. 2020;23(8):1076-1081.<\/a><\/li>\n<li><a href=\"doi:10.1038\/s41598-021-86335-7\">Kameda H, Hirata A, Katagiri T, et al. Prediction of disease flare by biomarkers after discontinuing biologics in patients with rheumatoid arthritis achieving stringent remission. Sci Rep. 2021;11(1):6865.<\/a><\/li>\n<li><a href=\"doi:10.1007\/s10067-019-04857-y\">Park JK, Kim MJ, Choi Y, Winthrop K, Song YW, Lee EB. Effect of short-term methotrexate discontinuation on rheumatoid arthritis disease activity: post-hoc analysis of two randomized trials. Clin Rheumatol. 2020;39(2):375-379.<\/a><\/li>\n<li><a href=\"doi:10.1002\/acr.24596\">Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2021;73(7):924-939.<\/a><\/li>\n<li><a href=\"doi:10.1136\/ard-2022-223356\">Smolen JS, Landew\u00e9 RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3-18.<\/a><\/li>\n<\/ol>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p><span class=\"rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">\u23f3Th\u1eddi gian \u0111\u1ecdc: <\/span> <span class=\"rt-time\">6<\/span> <span class=\"rt-label rt-postfix\">ph\u00fat<\/span><\/span> M\u1ed9t nh\u1eefng \u0111i\u1ec1u khi\u1ebfn ng\u01b0\u1eddi b\u1ec7nh s\u1ed1c nh\u1ea5t khi m\u1eafc vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (VKDT) l\u00e0 vi\u1ec7c b\u00e1c s\u0129 b\u1ea3o h\u1ecd r\u1eb1ng \u0111\u00e2y l\u00e0 b\u1ec7nh d\u00f9ng thu\u1ed1c v\u00e0 t\u00e1i kh\u00e1m su\u1ed1t \u0111\u1eddi. B\u00e0i vi\u1ebft n\u00e0y s\u1ebd t\u00ecm hi\u1ec3u v\u1ec1 nguy c\u01a1 b\u00f9ng ph\u00e1t b\u1ec7nh khi ng\u1eebng thu\u1ed1c \u0111\u1eb7c tr\u1ecb trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, c\u00f2n &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/khoatritruong.com\/index.php\/2023\/09\/30\/viem-khop-dang-thap-co-ngung-dieu-tri-duoc-khong\/\"> <span class=\"screen-reader-text\">Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p c\u00f3 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c kh\u00f4ng?<\/span> Read More &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":2221,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","footnotes":""},"categories":[16],"tags":[26,15],"class_list":["post-2220","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-viem-khop-dang-thap","tag-danh-cho-nhan-vien-y-te","tag-viem-khop-dang-thap"],"aioseo_notices":[],"rttpg_featured_image_url":{"full":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal.png",1640,924,false],"landscape":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal.png",1640,924,false],"portraits":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal.png",1640,924,false],"thumbnail":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal-150x150.png",150,150,true],"medium":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal-300x169.png",300,169,true],"large":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal-1024x577.png",1024,577,true],"1536x1536":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal-1536x865.png",1536,865,true],"2048x2048":["https:\/\/khoatritruong.com\/wp-content\/uploads\/2023\/09\/DMARD-withdrawal.png",1640,924,false]},"rttpg_author":{"display_name":"Tr\u01b0\u01a1ng Tr\u00ed Khoa","author_link":"https:\/\/khoatritruong.com\/index.php\/author\/khoatritruong-com\/"},"rttpg_comment":28,"rttpg_category":"<a href=\"https:\/\/khoatritruong.com\/index.php\/category\/viem-khop-dang-thap\/\" rel=\"category tag\">Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/a>","rttpg_excerpt":"\u23f3Th\u1eddi gian \u0111\u1ecdc: 6 ph\u00fat M\u1ed9t nh\u1eefng \u0111i\u1ec1u khi\u1ebfn ng\u01b0\u1eddi b\u1ec7nh s\u1ed1c nh\u1ea5t khi m\u1eafc vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (VKDT) l\u00e0 vi\u1ec7c b\u00e1c s\u0129 b\u1ea3o h\u1ecd r\u1eb1ng \u0111\u00e2y l\u00e0 b\u1ec7nh d\u00f9ng thu\u1ed1c v\u00e0 t\u00e1i kh\u00e1m su\u1ed1t \u0111\u1eddi. 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