最新リウマチ情報
08/18 Rheumatism/arthritis can affect lungs, kidneys, brain, others ? Expert
08/24 Mother 'put children in wheelchairs for benefits' | World
07/17 Inflammatory rheumatism: Types, symptoms, and treatments
08/23 Potential Predictors of Successful Biologic or Targeted Synthetic DMARD Discontinuation
08/17 White paradise of Pamukkale a perfect offbeat summer destination
08/19 The Last Laugh: This column is alive with the sound of music
08/18 Feature: Chinese medical team works to benefit Moroccan patients
09/12 Palindromic rheumatism: What it is, symptoms, and outlook
08/18 Feature: Chinese medical team provides free treatment in rural Cameroon
08/21 Eternal vigil at the nation's 'eastern gate'
08/09 Tributes paid to doctor dedicated to saving lives in Tibet
05/20 A Sand Bath in Merzouga
08/24 $7 an Hour, 72 Hours a Week: Why Laundry Workers Have Had Enough
06/12 Disease remission associated with 80% reduction in risk of cardiovascular outcomes
06/11 Centrexion Therapeutics to Announce CNTX-4975 Trial Results at the European League Against Rheumatism's (EULAR) 2019 Annual European Congress of Rheumatology
06/14 Vagus nerve stimulation study shows significant reduction in rheumatoid arthritis symptoms
08/23 Healing, soothing effects of cloves | The Post
05/15 Rituximab Effectively Treats ‘Forerunner’ of RA
02/08 Surprise rheumatoid arthritis discovery points to new treatment for joint inflammation
03/07 Rheumatology Conference: South Carolina Rheumatism Society 2019 Annual Meeting
04/24 Controversy persists for palindromic rheumatism: RA precursor or distinct entity?
06/19 More than 1 in 10 patients with rheumatic diseases report suicidal thoughts linked to pain
06/06 New option for treating active rheumatoid arthritis
08/23 The Ghanaian man fixing sexual health problems with traditional aphrodisiac
06/20 Tanezumab Eases Severe Osteoarthritis Pain
04/03 Palm trees can help cure headaches, rheumatism
10/10 Rheumatoid arthritis sufferers can now live a "normal" life
07/09 UK Hospital Reports Slightly Uneven Results of Rituximab Switch
03/18 PTSD in Rheumatoid Arthritis
06/19 News to Know from the 20th European Congress of Rheumatology
06/12 Cyclosporine benefits patients through more rapid remission of proteinuria in lupus nephritis
04/17 Non-invasive vagus nerve stimulation shows promise for treatment of rheumatoid arthritis
06/14 Biosimilar Adalimumab, Hulio, Is Safe Long-Term, Causes Less Injection-Site Pain Than Humira
08/16 AbbVie Receives FDA Approval of RINVOQ™ (upadacitinib), an Oral JAK Inhibitor For The Treatment of Moderate to Severe Rheumatoid Arthritis
07/03 EULAR 2019: highlights from the annual conference
05/17 Rheum in Review: Tocilizumab and Malignancy, Vitamin B and Hip Fracture Risk, Rituximab for RA Prevention, and More
11/07 Why an English Museum Has a Collection of Magic Potatoes
03/27 Exercise helps prevent cartilage damage caused by arthritis
03/14 No Rise in Cancer Risk for RA Patients on Actemra
05/22 Aging HIV population face complicated rheumatologic care
03/03 Cancer drugs shed light on rheumatism
05/21 Lung Disease in RA: Which Factors are Linked With Mortality?
08/20 He Walked On Water From Cincinnati To New Orleans
06/13 No link between cancer and tumor necrosis factor inhibitor (TNFi) use in psoriatic arthritis
06/12 Ixekizumab May Be Superior to Adalimumab in bDMARD-Naïve Patients With PsA
06/17 Switching Among Multiple Infliximab Biosimilars Does Not Cause Immunogenicity, Study Finds
03/12 What makes joints pop and crack and is it a sign of disease?
02/13 Celery Seed Benefits Rheumatism, Arthritis, and Gout
06/13 Study supports bisphosphonate use prior to denosumab to prevent loss of bone mineral density in post-menopausal women
06/13 Studies Disagree on the Role of Education, Nocebo Effect in Biosimilar Switching
06/12 Secukinumab Improves Axial Manifestations in Psoriatic Arthritis
06/13 Verinurad with febuxostat significantly reduces albuminuria and hyperuricaemia in patients with type 2 diabetes
04/01 The Prescription for Rheumatism Used to Be to Sit Inside a Rotting Whale for 30 Hours
06/17 Korean biosimilars take on original drugs in Europe
06/13 Celltrion unveils P3 trial results for rheumatoid biosimilar in Europe
02/12 Could PTSD Worsen Rheumatoid Arthritis? | Medpage Today
09/07 New Recommendations for Hand Osteoarthritis Released
09/17 Rheumatoid arthritis and pregnancy: Advice, effects, and planning
03/21 For RA With COPD, Abatacept is Safe
11/23 Tiger Bone Wine
07/04 Eye on Pharma: Bio-Thera's Adalimumab Biosimilar Meets Primary End Point in Phase 3 Study
06/10 Kezar Life Sciences to Host Conference Call and Webcast at the EULAR 2019 Annual Meeting to Discuss Results of First in Patient Study with KZR-616
04/04 EULAR Updates SLE Management Guidelines
12/27 Cancer Treatment and Arthritis: A Growing Complaint
06/16 Methotrexate Withdrawal: Feasible in Stable RA? | Medpage Today
04/17 Disseminated subcutaneous nodules and destructive polyarthritis
09/04 What is autoimmune arthritis? Symptoms and treatment
12/16 Alabukun's untold story of a successful Nigerian business
06/15 Gum disease may be a key initiator of rheumatoid arthritis related autoimmunity: Significantly higher prevalence of gum disease found in individuals at risk of rheumatoid arthritis compared to healthy controls
07/09 International award for physio's research identifying targets for reducing premature death in older people with osteoarthritis
04/19 5 Common Types of Arthritis
12/14 Worth the sting: Cuba's scorpion pain remedy
12/05 Rheumatism treatment effective even when the use of biological agents is slightly delayed
06/14 Rheumatoid arthritis in pregnancy associated with low birth weight and premature birth
11/02 Risk for Peripheral Neuropathy Assessed in Patients With Rheumatic Diseases
01/20 Epigenetics explains rheumatism? Genes and their regulatory 'tags' conspire to promote rheumatoid arthritis
06/26 Does RA Have a Prodrome? | Medpage Today
12/19 The Marvelous Mrs. Maisel Season 2 Episode 9 Recap
10/29 Symbol of the state: Empress Michiko's concern for the public
01/12 EULAR Guidelines Updated for Early Arthritis
12/09 Midge shows just how far she's come when she gets her first TV gig in The Marvelous Mrs. Maisel
06/14 Clinical advances in systemic lupus erythematosus
03/31 Australians bathed inside rotting whales to 'cure' rheumatism
07/30 Who Narrates 'Counting Tigers: A Survival Special'? There's A Genuine British Treasure Involved
03/08 Rheumatoid arthritis sufferers likely to die earlier
12/28 Acupuncture Found Effective For Rheumatoid Arthritis Relief
06/13 Patients with rheumatoid arthritis have an increased risk of certain types of malignancy
12/13 Future
10/08 British soldiers' WW1 trench battles with STDs, rheumatism and wasp stings
01/01 Rheumatoid Arthritis
03/28 Drug compound shows promise against rheumatoid arthritis
09/05 Updated Recommendations for the Management of Hand Osteoarthritis Released by EULAR
01/11 Major Improvements in Psoriatic Arthritis Disease Activity Achieved With Methotrexate
03/02 Rheumatoid arthritis: New treatment option for difficult-to-treat patients
03/30 Bizarre whale treatment for rheumatism revealed
09/11 Undifferentiated Arthritis: Identifying Candidates for Early Treatment to Prevent Progression to RA
06/19 New oral treatment option for rheumatoid arthritis
04/17 Study reveals enormous advances for rheumatoid arthritis patients
03/02 New treatment option for difficult-to-treat rheumatoid arthritis patients
06/20 Tocilizumab Triumphs in Methotrexate Combo for RA
08/24 Mother 'put children in wheelchairs for benefits' | World
07/17 Inflammatory rheumatism: Types, symptoms, and treatments
08/23 Potential Predictors of Successful Biologic or Targeted Synthetic DMARD Discontinuation
08/17 White paradise of Pamukkale a perfect offbeat summer destination
08/19 The Last Laugh: This column is alive with the sound of music
08/18 Feature: Chinese medical team works to benefit Moroccan patients
09/12 Palindromic rheumatism: What it is, symptoms, and outlook
08/18 Feature: Chinese medical team provides free treatment in rural Cameroon
08/21 Eternal vigil at the nation's 'eastern gate'
08/09 Tributes paid to doctor dedicated to saving lives in Tibet
05/20 A Sand Bath in Merzouga
08/24 $7 an Hour, 72 Hours a Week: Why Laundry Workers Have Had Enough
06/12 Disease remission associated with 80% reduction in risk of cardiovascular outcomes
06/11 Centrexion Therapeutics to Announce CNTX-4975 Trial Results at the European League Against Rheumatism's (EULAR) 2019 Annual European Congress of Rheumatology
06/14 Vagus nerve stimulation study shows significant reduction in rheumatoid arthritis symptoms
08/23 Healing, soothing effects of cloves | The Post
05/15 Rituximab Effectively Treats ‘Forerunner’ of RA
02/08 Surprise rheumatoid arthritis discovery points to new treatment for joint inflammation
03/07 Rheumatology Conference: South Carolina Rheumatism Society 2019 Annual Meeting
04/24 Controversy persists for palindromic rheumatism: RA precursor or distinct entity?
06/19 More than 1 in 10 patients with rheumatic diseases report suicidal thoughts linked to pain
06/06 New option for treating active rheumatoid arthritis
08/23 The Ghanaian man fixing sexual health problems with traditional aphrodisiac
06/20 Tanezumab Eases Severe Osteoarthritis Pain
04/03 Palm trees can help cure headaches, rheumatism
10/10 Rheumatoid arthritis sufferers can now live a "normal" life
07/09 UK Hospital Reports Slightly Uneven Results of Rituximab Switch
03/18 PTSD in Rheumatoid Arthritis
06/19 News to Know from the 20th European Congress of Rheumatology
06/12 Cyclosporine benefits patients through more rapid remission of proteinuria in lupus nephritis
04/17 Non-invasive vagus nerve stimulation shows promise for treatment of rheumatoid arthritis
06/14 Biosimilar Adalimumab, Hulio, Is Safe Long-Term, Causes Less Injection-Site Pain Than Humira
08/16 AbbVie Receives FDA Approval of RINVOQ™ (upadacitinib), an Oral JAK Inhibitor For The Treatment of Moderate to Severe Rheumatoid Arthritis
07/03 EULAR 2019: highlights from the annual conference
05/17 Rheum in Review: Tocilizumab and Malignancy, Vitamin B and Hip Fracture Risk, Rituximab for RA Prevention, and More
11/07 Why an English Museum Has a Collection of Magic Potatoes
03/27 Exercise helps prevent cartilage damage caused by arthritis
03/14 No Rise in Cancer Risk for RA Patients on Actemra
05/22 Aging HIV population face complicated rheumatologic care
03/03 Cancer drugs shed light on rheumatism
05/21 Lung Disease in RA: Which Factors are Linked With Mortality?
08/20 He Walked On Water From Cincinnati To New Orleans
06/13 No link between cancer and tumor necrosis factor inhibitor (TNFi) use in psoriatic arthritis
06/12 Ixekizumab May Be Superior to Adalimumab in bDMARD-Naïve Patients With PsA
06/17 Switching Among Multiple Infliximab Biosimilars Does Not Cause Immunogenicity, Study Finds
03/12 What makes joints pop and crack and is it a sign of disease?
02/13 Celery Seed Benefits Rheumatism, Arthritis, and Gout
06/13 Study supports bisphosphonate use prior to denosumab to prevent loss of bone mineral density in post-menopausal women
06/13 Studies Disagree on the Role of Education, Nocebo Effect in Biosimilar Switching
06/12 Secukinumab Improves Axial Manifestations in Psoriatic Arthritis
06/13 Verinurad with febuxostat significantly reduces albuminuria and hyperuricaemia in patients with type 2 diabetes
04/01 The Prescription for Rheumatism Used to Be to Sit Inside a Rotting Whale for 30 Hours
06/17 Korean biosimilars take on original drugs in Europe
06/13 Celltrion unveils P3 trial results for rheumatoid biosimilar in Europe
02/12 Could PTSD Worsen Rheumatoid Arthritis? | Medpage Today
09/07 New Recommendations for Hand Osteoarthritis Released
09/17 Rheumatoid arthritis and pregnancy: Advice, effects, and planning
03/21 For RA With COPD, Abatacept is Safe
11/23 Tiger Bone Wine
07/04 Eye on Pharma: Bio-Thera's Adalimumab Biosimilar Meets Primary End Point in Phase 3 Study
06/10 Kezar Life Sciences to Host Conference Call and Webcast at the EULAR 2019 Annual Meeting to Discuss Results of First in Patient Study with KZR-616
04/04 EULAR Updates SLE Management Guidelines
12/27 Cancer Treatment and Arthritis: A Growing Complaint
06/16 Methotrexate Withdrawal: Feasible in Stable RA? | Medpage Today
04/17 Disseminated subcutaneous nodules and destructive polyarthritis
09/04 What is autoimmune arthritis? Symptoms and treatment
12/16 Alabukun's untold story of a successful Nigerian business
06/15 Gum disease may be a key initiator of rheumatoid arthritis related autoimmunity: Significantly higher prevalence of gum disease found in individuals at risk of rheumatoid arthritis compared to healthy controls
07/09 International award for physio's research identifying targets for reducing premature death in older people with osteoarthritis
04/19 5 Common Types of Arthritis
12/14 Worth the sting: Cuba's scorpion pain remedy
12/05 Rheumatism treatment effective even when the use of biological agents is slightly delayed
06/14 Rheumatoid arthritis in pregnancy associated with low birth weight and premature birth
11/02 Risk for Peripheral Neuropathy Assessed in Patients With Rheumatic Diseases
01/20 Epigenetics explains rheumatism? Genes and their regulatory 'tags' conspire to promote rheumatoid arthritis
06/26 Does RA Have a Prodrome? | Medpage Today
12/19 The Marvelous Mrs. Maisel Season 2 Episode 9 Recap
10/29 Symbol of the state: Empress Michiko's concern for the public
01/12 EULAR Guidelines Updated for Early Arthritis
12/09 Midge shows just how far she's come when she gets her first TV gig in The Marvelous Mrs. Maisel
06/14 Clinical advances in systemic lupus erythematosus
03/31 Australians bathed inside rotting whales to 'cure' rheumatism
07/30 Who Narrates 'Counting Tigers: A Survival Special'? There's A Genuine British Treasure Involved
03/08 Rheumatoid arthritis sufferers likely to die earlier
12/28 Acupuncture Found Effective For Rheumatoid Arthritis Relief
06/13 Patients with rheumatoid arthritis have an increased risk of certain types of malignancy
12/13 Future
10/08 British soldiers' WW1 trench battles with STDs, rheumatism and wasp stings
01/01 Rheumatoid Arthritis
03/28 Drug compound shows promise against rheumatoid arthritis
09/05 Updated Recommendations for the Management of Hand Osteoarthritis Released by EULAR
01/11 Major Improvements in Psoriatic Arthritis Disease Activity Achieved With Methotrexate
03/02 Rheumatoid arthritis: New treatment option for difficult-to-treat patients
03/30 Bizarre whale treatment for rheumatism revealed
09/11 Undifferentiated Arthritis: Identifying Candidates for Early Treatment to Prevent Progression to RA
06/19 New oral treatment option for rheumatoid arthritis
04/17 Study reveals enormous advances for rheumatoid arthritis patients
03/02 New treatment option for difficult-to-treat rheumatoid arthritis patients
06/20 Tocilizumab Triumphs in Methotrexate Combo for RA
リウマチとは
リウマチとは
- 「リウマチ」、「リューマチ」、「リュウマチ」、「ロイマチ」とよばれます。
- 英語では、"Rheumatism", "Rheuma" と表記します。
- からだのあちこちの関節に炎症が起こり、関節が腫れて痛む病気です。
- 進行すると関節の変形や機能障害（使えなくなること）が起こります。
- おもに、下の２つが代表的な疾患とされます。
- 関節リウマチ と、
- リウマチ熱
日本全国でリウマチに悩む人は１００万人ともいわれ、その数は社会の高齢化にともない、年々増加しています。
リウマチ専門医・病院・クリニック検索
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病院
関節リウマチ ( Rheumatoid Arthritis, RA )
関節リウマチ ( Rheumatoid Arthritis, RA )
関節リウマチ(Rheumatoid Arthritis：RA）は、自己の免疫が主に手足の関節を侵し、これにより関節痛、関節の変形が生じる代表的な膠原病の一つで、炎症性自己免疫疾患です。しばしば血管、心臓、肺、皮膚、筋肉といった全身臓器にも障害が及びます。
関節リウマチの原因
関節リウマチの原因
- 完全には病気の原因は究明されていません。
- 自己の免疫系（細菌などから体を防御するシステム）に異常があることが知られています。
- 免疫細胞が攻撃を始める根本原因は不明です。
- 遺伝的なもの（遺伝子が関係する）
- 感染した微生物（ウイルスや細菌）の影響
- 妊娠や出産など女性ホルモンの変化
関節リウマチの診断・早期診断(関節リウマチが疑われる症状)
リウマチの診断
多くの病院では、1987年米国リウマチ学会によって提唱された分類基準を参考にして、関節リウマチかどうかの診断します。（1994年に日本リウマチ学会が提唱した「早期関節リウマチの診断基準」を使う病院もあります。）
- 朝のこわばりが、少なくとも1時間以上にわたってみられる
- 3つ以上の関節に炎症による腫れがみられる
- 手首や手指のつけ根の関節、手指の第2関節に炎症による腫れがみられる
- 左右対称の関節に炎症による腫れがみられる
- 皮下結節（リウマトイド結節）がひじやひざなどにみられる
- 血液検査でリウマトイド因子が陽性である
- X線検査で手の関節に骨の萎縮などの変化がみられる
上記の7項目のうち、4項目以上にあてはまる場合を関節リウマチとする、とされています。
早期診断・リウマチが疑われる症状
早期のリウマチ患者では上記の基準に当てはまらないことも多くあります。以下は、リウマチを疑ったほうがよいとされる症状です。
- 関節の痛み、腫れがある
- 特に朝に、関節がこわばる
- 多くの関節に症状がある（3か所〜程度）
- 左右対称に症状がある（例：右手指と左手指）
関節リウマチの症状
関節リウマチの症状
- 関節炎
- 初期の症状「朝のこわばり(morning stiffness)」
朝起きてから、手をにぎることが困難であり、文字通りこわばります。
5-10分程度のこわばりは他の疾患でも診られますが、1時間以上も続くこわばりであれば関節リウマチまたは他のリウマチ性疾患の可能性が高い様です。
- そのうち、関節痛がおこるようになり、手指や足指の関節がおかされ、次第に手首、肘、膝など体の中心に近い大きな関節の痛みを感じるようになります。
- 関節痛は、手を動かすなど活動すると増強します。
- 関節炎が進行すると、関節そのものが変性し、最終的には関節が破壊し尽くされ、骨と骨が直接接した強直という状態になります。
- 手足の関節の他では、胸・腰の背骨はおかされないが首の背骨（頚椎）はおかされやすいようです。
- 頚部痛を生じたり、脊髄損傷、また、鎖骨に関節痛が起こる事もあります。
- 初期の症状「朝のこわばり(morning stiffness)」
- 血管
血管病変を合併する場合には、全身にくまなく留意しなければなりません。
心臓では狭心症・心筋梗塞、肺では肺高血圧症、腎臓では糸球体硬化症、脳では脳梗塞が起こりえます。
- 眼
関節リウマチ患者には、ドライアイもよく見られ、目の内側にリウマトイド結節が生じることもあります。
- 呼吸器
間質性肺炎、気道病変、胸膜病変、リウマチ結節、血管病変、睡眠時無呼吸症候群（顎関節病変、輪状披裂関節病変）などを合併することがあります。
- 心臓
心膜炎やリウマトイド結節を生じることもあります。
- 神経
関節リウマチに伴い血管炎が生ずれば、それに伴い多発単神経炎が起こる事があります。
- 皮膚
圧のかかる部位に、リウマチ結節と呼ばれる病変や、皮下出血などもみられることがあります。
- 血液
重症の関節リウマチ患者においては、脾腫、白血球（好中球のみ）減少をきたします。
関節リウマチの治療
関節リウマチの治療
現在の治療指針では関節リウマチの診断がついたら、出来るだけ早期に抗リウマチ薬(DMARDs), 生物学的製剤を用いることが推奨されています。痛みに対する対症療法として非ステロイド系消炎鎮痛剤（NSAIDs）などを用います。
- DMARDs（抗リウマチ薬）
関節リウマチの病気の勢いそのものを弱める薬として、メトトレキサート（リウマトレックス®）、スルファサラジン（アザルフィジン®）、 ブシラミン（リマチル®）、レフルノミド（アラバ®）、ミゾリビン、タクロリムス（プログラフ®）が使用されます。
欧米では抗マラリア薬であるヒドロキシクロロキンも使用され、免疫抑制薬であるアザチオプリン（イムラン®）、シクロスポリン（ネオーラル®）も効果が示されています。
- ステロイド
臨床試験の結果、ステロイドもDMARDsと同様に、病気の進行を遅らせる効果を示すことがわかり、DMARDsのみよりもDMARDsにステロイドを加えたほうが 病気の進行をさらに遅らせるという研究結果も報告されています。
- 抗サイトカイン療法
インフリキシマブ（レミケード®）、アダリムマブ(ヒュミラ®)、トシリズマブ(アクテムラ®)、エタネルセプト（エンブレル®）、アバタセプト(オレンシア®)は新しく開発されています。
これらはリウマチに対してきわめて強力な治療効果を示していますが、これらの薬剤は免疫応答に対する抑制効果が強く、しばしば感染症を引き起こすことがあり、 抗菌薬の併用などによる十分な予防を行う必要があります。
- その他の研究段階の新しい治療法
悪性リンパ腫に効果のあるリツキシマブ（リツキサン®）、抗生剤であるテトラサイクリン、高脂血症治療薬であるスタチン、多発性骨髄腫治療薬であるサリドマイドの効果や、 造血幹細胞移植の効果も検討されています。
- ビオチン治療法
各ビタミンの相互作用により、血中ビオチン値の上昇を目的とし、脾臓細胞における、免疫不全症の改善治癒を行うための治療方法です。
今までは、免疫不全症の原因が不明であることから、対処療法薬の投与をおこなう寛解維持療法がおこなわれていましたが、昨今の研究で、免疫不全症の一部の原因が初めて特定され、 これにより、ビオチン治療が確立しました。