アブストラクト
| Title | 2. csDMARDs, ステロイドの使い方のポイント |
|---|---|
| Subtitle | 特集 関節リウマチ治療をめぐる話題 |
| Authors | 野崎祐史* |
| Authors (kana) | |
| Organization | *近畿大学大学院医学研究科内科学教室血液・膠原病内科部門 |
| Journal | PROGRESS IN MEDICINE |
| Volume | 41 |
| Number | 1 |
| Page | 17-22 |
| Year/Month | 2021 / 1 |
| Article | 報告 |
| Publisher | ライフ・サイエンス |
| Abstract | 「はじめに」生物学的製剤の登場により関節リウマチ(RA)治療は著しい進歩を遂げ, RAは治せない病気から治せる病気へと認識は変化した. よく引用される1例として, 医学教育の父と称されるWilliam Oslerは「RA患者が前のドアから入ってきたら, 医師は後ろのドアから逃げ出す」との表現がある. この表現は現在の若手医師にはあまり理解できないと考えるが, 生物学的製剤の登場より以前, 少なくともメトトレキサート(MTX)がRA治療において使用可能となる以前では, RA患者を担当する医師において共通認識であった. それが一変して, 分子標的療法によるめざましい治療効果が日常臨床においても実感できる現在ではある. しかし, 様々な事情からすべての患者に生物学的製剤やヤヌスキナーゼ(JAK)阻害薬が投与できることは不可能であり, 現在までに構築されたリウマチ専門医として基本である疾患修飾性抗リウマチ薬(DMARDs)の中でも, 従来型合成リウマチ薬(conventional DMARDs:csDMARDs), また副腎皮質ステロイドについて理解することは重要である. |
| Practice | 医学総合 |
| Keywords |
- 全文ダウンロード： 従量制、基本料金制の方共に968円(税込) です。
参考文献
- 1) 西岡久寿樹, 東 威, 岩崎由雄:慢性関節リウマチに対するサラゾスルファピリジン腸溶錠(PJ-306)の二重盲検比較試験. リウマチ 1991;31:327-345.
- 2) Capell HA, Madhok R, Porter DR, et al:Combination therapy with sulfasalazine and methotrexate is more effective than either drug alone in patients with rheu-matoid arthritis with a suboptimal response to sulfas-alazine:results from the double-blind placebo-con-trolled MASCOT study. Ann Rheum Dis 2007;66:235-241.
- 3) Haagsma CJ, van Riel PL, de Jong AJ, et al:Combina-tion of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double-blind, 52 week clinical trial. Br J Rheumatol 1997;36:1082-1088.
- 4) Dougados M, Combe B, Cantagrel A, et al:Combina-tion therapy in early rheumatoid arthritis: a ran-domised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components. Ann Rheum Dis 1999;58:220-225.
- 5) Mizushina K, Hirata A, Hayashi N, et al:Possible pre-ventive effect of salazosulfapyridine against develop-ment of Pneumocystis pneumonia in methotrexate-receiving patients with rheumatoid arthritis. Mod Rheumatol 2016;26:976-978.
残りの18件を表示する
- 6) Matsuno H, Sugiyama E, Muraguchi A, et al:Pharma-cological effects of SA96(bucillamine)and its metabo-lites as immunomodulating drugs-the disulfide struc-ture of SA-96 metabolites plays a critical role in the pharmacological action of the drug. Int J Immuno-pharmacol 1998;20:295-304.
- 7) Ichikawa Y, Saito T, Yamanaka H, et al:Therapeutic effects of the combination of methotrexate and bucil-lamine in early rheumatoid arthritis: a multicenter, double-blind, randomized controlled study. Mod Rheumatol 2005;15:323-328.
- 8) Kurasawa T, Nagasawa H, Kishimoto M, et al:Addi-tion of another disease-modifying anti-rheumatic drug to methotrexate reduces the flare rate within 2 years after infliximab discontinuation in patients with rheumatoid arthritis:an open, randomized, controlled trial. Mod Rheumatol 2014;24:561-566.
- 9) Gan K, Yang L, Xu L, et al:Iguratimod(T-614)sup-presses RANKL-induced osteoclast differentiation and migration in RAW264.7 cells via NF-κB and MAPK pathways. Int Immunopharmacol 2016;35:294-300.
- 10) Nozaki Y, Inoue A, Kinoshita K, et al:Efficacy of igu-ratimod versus salazosulfapyridine as the first-line csDMARD for rheumatoid arthritis. Modern Rheuma-tol 2020;30:249-258.
- 11) Hara M, Ishiguro N, Katayama K, et al:Safety and efficacy of combination therapy of iguratimod with methotrexate for patients with active rheumatoid ar-thritis with an inadequate response to methotrexate:an open-label extension of a randomized, double-blind, placebo-controlled trial. Mod Rheumatol 2014;24:410-418.
- 12) Yoshikawa A, Yoshida S, Kimura Y, et al:Add-on iguratimod as a therapeutic strategy to achieve re-mission in patients with rheumatoid arthritis inade-quately responding to biological DMARDs: A retro-spective study. Mod Rheumatol 2018;28:227-234.
- 13) Yocum DE, Furst DE, Kaine JL, et al:Efficacy and safety of tacrolimus in patients with rheumatoid ar-thritis: a double-blind trial. Arthritis Rheum 2003;48:3328-3337.
- 14) Kremer JM, Habros JS, Kolba KS, et al:Tacrolimus in rheumatoid arthritis patients receiving concomitant methotrexate: a six-month, open-label study. Arthri-tis Rheum 2003;48:2763-2768.
- 15) Takahashi N, Fujibayashi T, Kida D, et al:Concomi-tant methotrexate and tacrolimus augment the clini-cal response to abatacept in patients with rheumatoid arthritis with a prior history of biological DMARD use. Rheumatol Int 2015;35:1707-1716.
- 16) van Vollenhoven RF, Geborek P, Forslind K, et al:Conventional combination treatment versus biological treatment in methotrexate-refractory early rheuma-toid arthritis: 2 year follow-up of the randomised, non-blinded, parallel-group Swefot trial. Lancet 2012;379:1712-1720.
- 17) Matsuno H, Okada M, Sakai Y, et al:The usefulness of a new triple combination treatment utilizing meth-otrexate, salazosulfapyridine, and bucillamine in rheu-matoid arthritis. Mod Rheumatol 2016;26:51-56.
- 18) Smolen JS, Landewe RBM, Bijlsma JWJ, et al:EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modify-ing antirheumatic drugs:2019 update. Ann Rheum Dis 2020;79:685-699.
- 19) Graudal N, Jurgens G:Similar effects of disease-mod-ifying antirheumatic drugs, glucocorticoids, and bio-logic agents on radiographic progression in rheuma-toid arthritis:meta-analysis of 70 randomized placebo-controlled or drug-controlled studies, includ-ing 112 comparisons. Arthritis Rheum 2010;62:2852-2863.
- 20) Montecucco C, Todoerti M, Sakellariou G, et al:Low-dose oral prednisone improves clinical and ultrasono-graphic remission rates in early rheumatoid arthritis:results of a 12-month open-label randomised study. Arthritis Res Ther 2012;14:R112.
- 21) Strangfeld A, Eveslage M, Schneider M, et al:Treat-ment benefit or survival of the fittest:what drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient? Ann Rheum Dis 2011;70:1914-1920.
- 22) Mikuls TR, Johnson SR, Fraenkel L, et al:American College of Rheumatology guidance for the manage-ment of rheumatic disease in adult patients during the COVID-19 pandemic:Version 1. Arthritis Rheu-matol 2020;72:1241-1251.
- 23) Mikuls TR, Johnson SR, Fraenkel L, et al:American College of Rheumatology guidance for the manage-ment of rheumatic disease in adult patients during the COVID-19 pandemic:Version 2. Arthritis Rheu-matol 2020;72:e1-e12.
