臨床整形外科57巻7号

2022年07月発行

特集 整形外科医×関節リウマチ診療　今後の関わり方を考える

今後のリウマチ診療における整形外科リウマチ医の役割について

著者： 森優¹

所属機関： ¹東北大学大学院医学系研究科整形外科

ページ範囲：P.847 - P.851

関節リウマチ(RA)の薬物治療は生物学的製剤や，分子標的製剤の導入により急速な進歩を遂げた．これらが関連する重篤な感染症などの副反応は懸念事項であるが，RAの疾患活動性のコントロールは劇的に改善している．その結果，RAの整形外科手術は減少傾向ではあるものの，難治性のRA症例の存在もあり，一定数の整形外科手術は今後も継続するものと予想される．また，重要な周辺疾患である骨粗鬆症の治療や，RAに加えて脊椎関節炎などの治療においても運動器全般について精通した整形外科的治療アプローチの重要性は継続すると考える．

参考文献

1) Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs:2019 update. Ann Rheum Dis 2020;79(6):685-99.

2) Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target:2014 update of the recommendations of an international task force. Ann Rheum Dis 2016;75(1):3-15.

3) Singh JA, Cameron C, Noorbaloochi S, et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis:a systematic review and meta-analysis. Lancet 2015;386(9990):258-65.

4) Nagy G, Roodenrijs NMT, Welsing PM, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80(1):31-5.

5) de Hair MJH, Jacobs JWG, Schoneveld JLM, et al. Difficult-to-treat rheumatoid arthritis:an area of unmet clinical need. Rheumatology (Oxford) 2018;57(7):1135-44.

6) Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62(9):2569-81.

7) Shirai T, Mori Y, Izumiyama T, et al. Rheumatoid arthritis after cord blood cell transplantation. J Clin Rheumatol 2021;27(7):e276-7. doi:10.1097/RHU.0000000000001430.

8) Okuno H, Watanuki M, Kuwahara Y, et al. Clinical features and radiological findings of 67 patients with SAPHO syndrome. Mod Rheumatol 2018;28(4):703-8.

9) Mori Y, Kuwahara Y, Chiba S, et al. Efficacy of methotrexate and tumor necrosis factor inhibitors in Japanese patients with active psoriatic arthritis. Mod Rheumatol 2015;25(3):431-4.

10) Jin S, Hsieh E, Peng L, et al. Incidence of fractures among patients with rheumatoid arthritis:a systematic review and meta-analysis. Osteoporos Int 2018;29(6):1263-75.

11) Mori Y, Kuwahara Y, Chiba S, et al. Bone mineral density of postmenopausal women with rheumatoid arthritis depends on disease duration regardless of treatment. J Bone Miner Metab 2017;35(1):52-7.

12) Matsumoto T, Nishino J, Izawa N, et al. Trends in treatment, outcomes, and incidence of orthopedic surgery in patients with rheumatoid arthritis:an observational cohort study using the Japanese national database of rheumatic diseases. J Rheumatol 2017;44(11):1575-82.

13) Richter MD, Crowson CS, Matteson EL, et al. Orthopedic surgery among patients with rheumatoid arthritis:a population-based study to identify risk factors, sex differences, and time trends. Arthritis Care Res (Hoboken) 2018;70(10):1546-50.

14) Harb MA, Solow M, Newman JM, et al. Have the annual trends of total knee arthroplasty in rheumatoid arthritis patients changed? J Knee Surg 2018;31(9):841-5.

15) Cordtz R, Hawley S, Prieto-Alhambra D, et al. Reduction in upper limb joint surgery among rheumatoid arthritis patients:an interrupted time-series analysis using Danish health care registers. Arthritis Care Res (Hoboken) 2020;72(2):274-82.

16) Cordtz RL, Hawley S, Prieto-Alhambra D, et al. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs:an interrupted time-series analysis using nationwide Danish healthcare registers. Ann Rheum Dis 2018;77(5):684-9.