| 特集名 | 関節リウマチと骨代謝 | |
|---|---|---|
| 題名 | 生物学的製剤時代の関節リウマチに対する手術の変遷と今後の展開 | |
| 発刊年月 | 2010年 10月 | |
| 著者 | 桃原 茂樹 | 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 |
| 【 要旨 】 | 関節リウマチに対してさまざまな新規薬剤の登場により，手術療法の適応と選択が変わりつつある．以前は薬物によりコントロールできなかった炎症性滑膜に対しては外科的に滑膜切除を行ってきたが，現在ではその適応はかなり限られてきている．一方，関節機能を回復する人工関節に関しては，変形性関節症による手術件数の増加傾向に比べては増えてはいないものの，その適応は依然としてある．また一方で，病勢が安定化することで，さらに高いレベルでのquality of lifeが求められ，新しい外科的治療の時代が築かれる可能性が期待されている．手の外科や足の外科のように機能のみならず整容までも求められるようになってきており，生物学的製剤時代の手術適応や術式の変遷に関しては，まだ暫くその推移を見守る必要がある． | |
| Theme | Bone metabolism in rheumatoid arthritis | |
|---|---|---|
| Title | Changes and developing of surgeries for rheumatoid arthritis in new era of biological agent | |
| Author | Shigeki Momohara | Institute of Rheumatology, Tokyo Women's Medical University |
| [ Summary ] | Studies from various countries show that the rate of orthopaedic surgery for rheumatoid arthritis (RA) has decreased in recent years. In Sweden, there was a decrease in RA-related lower limb surgical procedures, and in RA-related upper limb surgery between 1998 and 2004. Denmark has reported a decrease in the incidence of total hip arthroplasties due to RA. The number of total joint replacement (TJR) surgeries and synovectomies has decreased in the Norwegian population. These changes may reflect trends in disease severity, management and health outcomes in each country. However, the total number of TJRs per year in our institute remained relatively constant over that five year period. Therefore, it is thought that it may be some time before we begin to observe a decrease in the number of TJRs. We recently investigated whether or not the number of orthopaedic surgeries, including TJRs, had decreased in a large observational cohort of RA patients. The most popular orthopaedic interventions were TJRs, such as total knee joint replacement and total hip joint replacement. The number of TJRs peaked in October, 2002 and has gradually decreased since then. The total number of operations, including synovectomies, has also decreased. The reason for these decreases may be due to the use of methotrexate (MTX) and anti-tumor necrosis factor α therapy. The use of MTX for the treatment of RA was approved by the Japanese Ministry of Health, Labour and Welfare in 1999. Moreover, the use of infliximab was approved in 2003, and etanercept in 2005. In addition, the use and dosage of MTX and the ratio of the use of biologics have increased every year. Conversely, the Disease Activity Score in 28 joints has decreased. Medical journals have reported that improvements in pharmaceutical treatment may partly explain the reductions in orthopaedic joint surgery, suggesting a worldwide trend towards better long-term outcomes. The declining use of orthopaedic surgery in Japan also appears to be primarily influenced by treatment with MTX and biologics. However, further studies, including analyses of RA databases which collect long-term data on a variety of surgical interventions, are necessary. |
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