診断・治療に迷ったSpondyloarthritisの1例
診断・治療に迷ったSpondyloarthritisの1症例を報告した．症例56歳，女性．42歳時より安静時腰背部痛，48歳頃より両胸鎖関節部の腫脹疼痛あり．52歳時，頸肩部痛を主訴に初診，XPにてC4/5，C6/7不整，C/5/6癒合あり．当初SAPHO症候群疑うが，皮膚症状．XP，MRIで両側の仙腸関節炎あり，Modified New York Criteriaを満たしておりASと診断した．NSAIDとSASPを投与したが，緩解増悪を繰り返えしていた．2014年1月より症状憎悪，PSL，MTX投与するも効果不十分で，Adalimumabの投与を開始した．...
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| Published in | 整形外科と災害外科 Vol. 65; no. 2; pp. 244 - 248 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
西日本整形・災害外科学会
2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0037-1033 1349-4333 |
| DOI | 10.5035/nishiseisai.65.244 |
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| Abstract | 診断・治療に迷ったSpondyloarthritisの1症例を報告した．症例56歳，女性．42歳時より安静時腰背部痛，48歳頃より両胸鎖関節部の腫脹疼痛あり．52歳時，頸肩部痛を主訴に初診，XPにてC4/5，C6/7不整，C/5/6癒合あり．当初SAPHO症候群疑うが，皮膚症状．XP，MRIで両側の仙腸関節炎あり，Modified New York Criteriaを満たしておりASと診断した．NSAIDとSASPを投与したが，緩解増悪を繰り返えしていた．2014年1月より症状憎悪，PSL，MTX投与するも効果不十分で，Adalimumabの投与を開始した． |
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| AbstractList | 診断・治療に迷ったSpondyloarthritisの1症例を報告した. 症例56歳, 女性. 42歳時より安静時腰背部痛, 48歳頃より両胸鎖関節部の腫脹疼痛あり. 52歳時, 頸肩部痛を主訴に初診, XPにてC4/5, C6/7不整, C/5/6癒合あり. 当初SAPHO症候群疑うが, 皮膚症状なし. XP, MRIで両側の仙腸関節炎あり, Modified New York Criteriaを満たしておりASと診断した. NSAIDとSASPを投与したが, 緩解増悪を繰り返えしていた. 2014年1月より症状憎悪, PSL, MTX投与するも効果不十分で, Adalimumabの投与を開始した. 「はじめに」近年, 脊椎関節炎(Spondyloarthritis, 以下SpA)の分野では, ASAS(Assesment of Spondylo-Arthritis International Society)による新しい分類基準の発表や, わが国でも生物学的製剤(Infliximab, Adalimumab)が保険適応となるなど, 大きな変革の流れの中にある. 診断・治療に迷ったSpondyloarthritisの1症例を報告した．症例56歳，女性．42歳時より安静時腰背部痛，48歳頃より両胸鎖関節部の腫脹疼痛あり．52歳時，頸肩部痛を主訴に初診，XPにてC4/5，C6/7不整，C/5/6癒合あり．当初SAPHO症候群疑うが，皮膚症状．XP，MRIで両側の仙腸関節炎あり，Modified New York Criteriaを満たしておりASと診断した．NSAIDとSASPを投与したが，緩解増悪を繰り返えしていた．2014年1月より症状憎悪，PSL，MTX投与するも効果不十分で，Adalimumabの投与を開始した． |
| Author | 木村, 敦 原口, 和史 谷口, 秀将 川口, 雅之 |
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| References | 9) Van der Heijde, D., et al.: 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann. Rheum. Dis., 70: 905-908, 2011. 1) Braun, J., et al.: International ASAS consensus statement for the use of anti-tumor necrosis factor agent in patient with ankylosing spondylitis. Ann. Rheum. Dis., 62: 817-824, 2003. 10) Van der Linden, S., et al.: Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of New York criteria. Arthritis Rheum., 27: 361-368, 1984. 6) Rudwaleit, M., et al.: How to diagnose axial spondyloarthritis early. Ann. Rheum. Dis., 63: 535-543, 2004. 5) Rudwaleit, M., et al.: Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann. Rheum. Dis., 68: 1520-1527, 2009. 4) Rudwalei, M., et al.: The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann. Rheum. Dis., 70: 25-31, 2011. 2) 小林茂人：SAPHO症候群．リウマチ病学テキスト，p.169-171. 東京，診断と治療社，2010. 7) Sieper, J., et al.: The Assesment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann. Rheum. Dis., 68: ii1-ii44, 2008. 3) Rudwalei, M., et al.: The development of Assessment of SpondyloArthritis international Society classification creiteria for axial spondyloarthritis (part II): validation and final selection. Ann. Rheum. Dis., 68: 777-783, 2009. 8) Van der Heijde, D., et al.: Efficacy and Safety of Adalimumab in Patient with Ankylosing Spondylitis. Arthritis Rheum., 54: 2136-2146, 2006. |
| References_xml | – reference: 9) Van der Heijde, D., et al.: 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann. Rheum. Dis., 70: 905-908, 2011. – reference: 10) Van der Linden, S., et al.: Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of New York criteria. Arthritis Rheum., 27: 361-368, 1984. – reference: 2) 小林茂人：SAPHO症候群．リウマチ病学テキスト，p.169-171. 東京，診断と治療社，2010. – reference: 4) Rudwalei, M., et al.: The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann. Rheum. Dis., 70: 25-31, 2011. – reference: 5) Rudwaleit, M., et al.: Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann. Rheum. Dis., 68: 1520-1527, 2009. – reference: 1) Braun, J., et al.: International ASAS consensus statement for the use of anti-tumor necrosis factor agent in patient with ankylosing spondylitis. Ann. Rheum. Dis., 62: 817-824, 2003. – reference: 6) Rudwaleit, M., et al.: How to diagnose axial spondyloarthritis early. Ann. Rheum. Dis., 63: 535-543, 2004. – reference: 7) Sieper, J., et al.: The Assesment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann. Rheum. Dis., 68: ii1-ii44, 2008. – reference: 3) Rudwalei, M., et al.: The development of Assessment of SpondyloArthritis international Society classification creiteria for axial spondyloarthritis (part II): validation and final selection. Ann. Rheum. Dis., 68: 777-783, 2009. – reference: 8) Van der Heijde, D., et al.: Efficacy and Safety of Adalimumab in Patient with Ankylosing Spondylitis. Arthritis Rheum., 54: 2136-2146, 2006. |
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| Snippet | 診断・治療に迷ったSpondyloarthritisの1症例を報告した．症例56歳，女性．42歳時より安静時腰背部痛，48歳頃より両胸鎖関節部の腫脹疼痛あり．52歳時，頸肩部痛を主訴に... 診断・治療に迷ったSpondyloarthritisの1症例を報告した. 症例56歳, 女性. 42歳時より安静時腰背部痛, 48歳頃より両胸鎖関節部の腫脹疼痛あり. 52歳時, 頸肩部痛を主訴に... |
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| SubjectTerms | MRI アダリムマブ 強直性脊椎炎 脊椎関節炎 |
| Title | 診断・治療に迷ったSpondyloarthritisの1例 |
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