臨床整形外科46巻9号

2011年09月発行

症例報告

強直性脊椎炎に対し両人工股関節置換術，低用量（3mg/kg）インフリキシマブで加療した1例

著者： 加茂健太¹ 原口和史²

所属機関： ¹JR九州病院整形外科 ²済生会八幡総合病院整形外科

ページ範囲：P.879 - P.883

　症例は51歳の男性であり，強直性脊椎炎に対し，22年あまり非ステロイド性抗炎症薬で加療され，両股関節の破壊を来していた．両人工股関節置換術後，歩容は著明に改善したが，術後も疾患活動性は高かった．低用量(3mg/kg)インフリキシマブ(INF)投与でCRPは陰性化したが，効果は不十分だった．INF5mg/kgに増量したことにより，BASDAI(Bath Ankylosing Spondylitis Disease Activity Index)は4.5から増量後12週で2.8と改善を認めた．

参考文献

1) Calin A, Garret S, Whitelock H, et al:A new approach to defining functional ability in ankylosing spondylitis:the development of the bath ankylosing Spondylitis functional index. J Rheumatol 21:2281-2285, 1994

2) Dougados M, Behier JM, Jolchine I, et al:Efficacy of celecoxib, a cyclooxygenase 2-specific inhibitor, in the treatment of ankylosing spondylitis:a six-week controlled study with comparison against placebo and against a conventional nonsteroidal antiinflammatory drug. Arthritis Rheum:44:180-185, 2001

3) Fukuda S, Minami M, Saito T, et al:Spondyloarthropathies in Japan. Nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society. J Rheumatol 28:554-559, 2001

4) Garret S, Jenkinson T, Kennedy LG, et al:A new approach to defining disease status in ankylosing spondylitis:the bath ankylosing spondylitis disease activity index. J Rheumatol 21:2286-2291, 1994

5) Heijde D, Dijkmans B, Geusens P, et al:Efficacy and safety of infliximab in patients with ankylosing spondylitis results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 52:582-591, 2005

6) Heijde D, Tubergen A, Braun J, et al:Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum 58:3063-3070, 2008

7) Inman RD, Maksymowych WP:A double-blind, placebo-controlled trial of low dose infliximab in ankylosing spondylitis. J Rheumatol 37:1203-1210, 2010

8) Jois RN, Leeder J, Gibb A, et al:Low-dose infliximab treatment for ankylosing spondylitis-clinically- and cost effective. Rheumatology (Oxford) 45:1566-1569, 2006

9) Keeling S, Oswald A, Russell AS, et al:Prospective observational analysis of the efficacy and safety of low-dose (3 mg/kg) infliximab in ankylosing spondylitis:4-year followup. J Rheumatol 33:558-561, 2006

10) Kilgus DJ, Namba RS, Gorek JE, et al:Total hip replacement for patients who have ankylosing spondylitis. The importance of the formation of heterotopic bone and of the durability of fixation of cemented components. J Bone Joint Surg Am 72:834-839, 1990

11) Maksymowych WP, S Gian, Jhangri S, et al:Infliximab in ankylosing spondylitis:A prospective observational inception cohort analysis of efficacy and safety. J Rheumatol 29:959-965, 2002

12) Sidiropoulos P, Kritikos HD, Siakka P, et al:Low dose of infliximab is inadequate in most patients with spondylarthropathies. Clin Exp Rheumatol 23:513-516, 2005

13) Spoorenberg A, Heijde D, Klerk E, et al:Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 26:980-984, 1999

14) Sweeney S, Gupta R, Taylor G, et al:Total hip arthroplasty in ankylosing spondylitis:outcome in 340 patients. J Rheumatol 28:1862-1866, 2001

15) 浦野房三：症例から学ぶ脊椎関節炎．新興医学出版社，東京，pp88-92，2008

16) Vander CB, Muñoz-Gomariz E, Font P, et al:Hip involvement in ankylosing spondylitis:epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford) 49:73-81, 2010

17) Wanders A, Heijde D, Landewe R, et al:Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis. Arthritis Rheum 52:1756-1765, 2005