臨床整形外科46巻9号

2011年09月発行

誌上シンポジウム 生物学的製剤が与えた関節リウマチの病態・治療の変化

生物学的製剤時代の関節破壊制御と整形外科手術

著者： 岩本卓士¹ 桃原茂樹¹

所属機関： ¹東京女子医科大学附属膠原病リウマチ痛風センター整形外科

ページ範囲：P.799 - P.803

　関節リウマチの治療は早期からの強力な薬物治療により寛解を導入し関節破壊の進行を抑制することが目標となってきている．疾患活動性を十分にコントロールすることで，破壊された関節が修復する可能性も示されており，手術適応も変化してきている．傾向として滑膜切除術は漸減している一方で，足趾の関節形成術，手指の人工関節といった小関節の形成手術が増加しており，より高い目標に向けた機能回復へと今後さらに変遷していくものと思われる．しかしながら生物学的製剤使用下での手術は感染の発症に十分な注意が必要であり，術前術後に一定期間の休薬を行うことが望ましいが，いずれの生物学的製剤に関しても休薬期間に関するエビデンスが不足しており，整形外科医からの情報発信が必要である．

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