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104 4-25原來 ,這就是僵直性脊椎炎
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Transcript of 104 4-25原來 ,這就是僵直性脊椎炎
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原來 ,這就是僵直性脊椎炎 ! ?
台北榮總過敏免疫風濕科劉德鈴
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http://www.spondylitis.org/patient_resources/story18-tariq-gangari.aspx
“It was just as much embarrassing as it was painful “
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http://www.everydayhealth.com/custom/ankylosing-spondylitis-treatment-management/sanjay-gupta/life-guide/
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http://www.everydayhealth.com/custom/ankylosing-spondylitis-treatment-management/sanjay-gupta/life-guide/
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罹僵直性脊椎炎信大陸偏方 差點被村姑打死 日期:2014.12.21
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Ankylos : 沾黏僵直
Spondylos : 脊椎
-itis : 發炎
Ankylosing Spondylitis
僵直性脊椎炎
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主要症狀
• 下背痛蔓延至臀部 >3個月
• 早上起床背部僵硬
• 休息更痛
• 運動後症狀改善
• 疲倦
• 駝背
• 影響外觀
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薦腸骨關節
骶髂關節
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病程嚴重與控制不良者
– 脊椎可能黏合,使脊椎失去柔軟度和彎曲度,變得較易骨折,和行動不便。
– 更嚴重者,若壓迫到神經,也有些會出現下肢麻木和大小便失禁的狀況。
– 外觀上可能會造成駝背、畸形。
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僵直性脊椎炎與其他器官• 除了脊椎被侵犯之外,有些病人也會有關節以外的症狀。– 不對稱周邊關節炎
– 香腸指(Sausage digits)
– 著骨點病變(Enthesopathy)
– 25%的患者有急性前房虹彩炎/葡萄膜炎引致視力模糊
– 15% 患者會有腎功能異常。
– 心臟方面常見合併AR(主動脈瓣膜逆流),但通常沒有症狀。
– 胸廓活動度減少會造成肺活量減少,極少數較嚴重會產生肺纖維化。
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Uveitis 虹彩炎
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Common Features:
Heel Pain 足跟痛
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關節外病變:香腸指
• Sausage dactylitis
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腸胃道
• 發炎性腸炎
AbbVie Picture Library, access date 20Feb2013 http://abtmx1a03moss.oneabbott.com:5600/sites/ppdhome/rheumatology/SpaBrandLibrary/Pages/BrandMaterials.
aspx?category=SpA&folder=Picture+Library
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Figure 3 Hypothetical functional interactions between gene products associated with ankylosing spondylitis
Colbert, R. A. (2010) Classification of juvenile spondyloarthritis: enthesitis-related arthritis and beyondNat. Rev. Rheumatol. doi:10.1038/nrrheum.2010.103
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僵直性脊椎炎藥物治療
• 非類固醇消炎止痛藥– 新的證據顯示,每日服用消炎止痛藥(NSAID),不管有無症
狀,可以減少僵直性脊椎炎患者骨質的鈣化及黏合。原因可能是COX-2 與垂直骨刺(Syndesmophyte)的形成有關。
– 腸胃道不適症狀等
• 類固醇– 較少使用– 留在虹膜炎、或其他不易控制之關節外症狀治療時使用
• 疾病調節抗風濕藥物(免疫調節劑)– Sulfasalazine
– MTX: 可用於較嚴重病患
– Sulfasalazine 及Methotrexate 對週邊型僵直性脊椎炎較有效,
對軸心型病人療效較不明確。
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最新的疾病治療藥物- 生物製劑
會引起僵直性脊椎炎發炎的物質有很多,罪魁禍首則是一種叫做TNF-α (腫瘤壞死因子)的蛋白質。
研究發現,僵直性脊椎炎的病人有太多的TNF-α,阻斷TNF-α的藥物,可減輕發炎的疼痛症狀,大大改善活動度,提升生活品質。
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治療僵直性脊椎炎的生物製劑腫瘤壞死因子拮抗劑(Anti-TNF)
欣普尼 復邁 恩博
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生物製劑健保給付規範
.年齡18 歲以上。.HLA B27 陽性。. X 光(plain X Ray) 檢查需有薦腸關節炎:
雙側性二級以上,或單側性三級以上、附有報告影印或X 光影像光碟。
.臨床症狀及身體檢查,下列三條件至少須符合二項。.下背痛及晨間僵硬的症狀持續3 個月以上,這些症狀
無法因休息而緩解,但會隨運動改善。.腰椎活動受到限制,有確切體檢發現者。.胸部擴展受到限制,有確切體檢發現者。
.所有的病患都必須曾經使用過至少2 種非類固醇消炎止痛藥(NSAIDs) 充分的治療,但療效不彰。
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.充分治療的定義:
使用最高建議劑量或最高耐受劑量的NSAID 抗發炎藥物,在同一家醫院連續治療三個月以上,且每種NSAID 至少使用四週以上,除非出現毒性而停藥,需以附表二十一之二為根據記錄NSAID 之毒性送審。
.周邊關節炎患者必須曾經同時使用NSAIDs 和sulfasalazine 進行充分的治療,sulfasalazine 須以2 g/day 之標準治療4 個月或以上,除非有相關毒性發生而停藥,並有適當病歷記載者。
.療效不彰的定義:
活動性疾病持續四週以上。(需連續二次檢查BASDAI ≧ 6、ESR > 28mm/1 hr 且 CRP > 1 mg/dl,且二次檢查之間隔須經過至少4 周以上之充分治療)。
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巴斯僵直性脊椎炎疾病活動量表 BASDAI
姓名:_______ 病歷號:________ 日期:__年__月__日
1. 疲累的感覺完全沒有-------------------------非常嚴重
2. 脊椎(包含頸部、背部及髖關節)疼痛程度完全沒有-------------------------非常嚴重
3. 其他(頸部、背部及髖關節以外)關節疼痛程度完全沒有-------------------------非常嚴重
4. 身體任何部位有觸痛或壓痛的不適程度完全沒有-------------------------非常嚴重
5. 早上起床晨間僵硬程度完全沒有-------------------------非常嚴重
6. 從起床開始計算,您的晨間僵硬時間完全沒有-------------------------非常嚴重0 0.5 1 1.5 2 2.5小時
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預後與病程
• 僵直性脊椎炎的病程通常是慢性的。而且
會反反覆覆的發生。持續治療維持良好
的疾病治療與控制,病人仍然能夠擁有良好的生活品質。
• 僵直性脊椎炎由於初期症狀易與其他肌肉骨骼問題混淆,容易延遲診斷,若民眾出現疑似相關症狀,應至風濕免疫科就診。
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