臨床整形外科59巻4号

2024年04月発行

特集 脊椎関節炎SpAを理解する—疾患概念・診断基準・最新治療

反応性関節炎の診断と治療

著者： 首藤敏秀¹

所属機関： ¹千代田病院リウマチ科・整形外科

ページ範囲：P.383 - P.390

反応性関節炎は，泌尿生殖器や腸管など関節以外の微生物感染症後に発症する無菌性，非化膿性の関節炎で，罹患関節からは微生物は培養同定されない．多くは急性発症で，典型例では先行感染の1〜4週間後に発症する．左右非対称性で下肢に多い少関節炎や付着部炎，指趾炎などを生じ，関節外症状として結膜炎・ぶどう膜炎，尿道炎，亀頭炎などを伴う．診断には先行感染を確認することが最も重要である．約50〜80％がHLA-B27を保有しているとされる．ほとんどの例は半年〜1年以内に寛解に至るため，まず対症療法が主体の治療となる．

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