Japanese

Title	早期の装具療法と作業療法が奏効したリウマチ性ボタン穴変形の1例
Subtitle	症例報告
Authors	鈴木玄一郎*1, 日比新*2, 笠原優人*2, 渡部晃平*2, 原真里*2, 森圭市郎*3
Authors (kana)
Organization	*1洛和会音羽病院整形外科, *2洛和会音羽病院リウマチ科, *3公立豊岡病院整形外科
Journal	The Japanese Journal of Rehabilitation Medicine
Volume	59
Number	12
Page	1259-1265
Year/Month	2022 / 12
Article	報告
Publisher	日本リハビリテーション医学会
Abstract	「はじめに」近年, 生物学的製剤などの薬物療法の進歩や早期からの治療によって関節リウマチ (rheumatoid arthritis : RA) の疾患活動性の改善が得られるようになり, その結果RA関連の手術, 特に人工股関節全置換術や人工膝関節全置換術は減少した. 一方で手指や足趾の手術は減少しておらず, RAの治療を考えるうえで手指などの小関節の機能維持にも配慮が必要であることが報告されている. 手指変形をきたしても疼痛は比較的少ないため治療がなされないことも多く, 変形や機能障害が不可逆的に進行してしまうため, 早期からの治療が肝要である. 今回, われわれは手術を希望しなかったRAのボタン穴変形に対して早期から装具および作業療法を行い症状が改善した1例を経験したので報告する.
Practice	医療技術
Keywords	ボタン穴変形 (boutonniere deformity), 関節リウマチ (rheumatoid arthritis), リハビリテーション (rehabilitation), 装具療法 (orthotic treatment), 作業療法 (occupational therapy)

English

Title	Early Orthotic Treatment and Occupational Therapy Improved Boutonniere Deformity in Rheumatoid Arthritis : A Case Report
Subtitle
Authors	Gen-ichiro Suzuki*1, Arata Hibi*2, Yuto Kasahara*2, Kohei Watanabe*2, Mari Hara*2, Keiichiro Mori*3
Authors (kana)
Organization	*1Department of Orthopaedic Surgery, Rakuwakai Otowa Hospital, *2Department of Rheumatology, Rakuwakai Otowa Hospital, *3Department of Orthopaedic Surgery, Toyooka Hospital
Journal	The Japanese Journal of Rehabilitation Medicine
Volume	59
Number	12
Page	1259-1265
Year/Month	2022 / 12
Article	Report
Publisher	The Japanese Association of Rehabilitation Medicine
Abstract	[Abstract] Since hand deformities in rheumatoid arthritis (RA) are relatively not very painful, the worsening of the deformities often goes unnoticed and the functional impairment progresses irreversibly. Herein, we report a case of boutonniere deformity of the left middle and ring fingers treated with rehabilitation since an early stage. The patient was a 58-year-old woman who was referred to our hospital due to joint pain in the fingers and feet, following which a diagnosis of RA as made ; however, she could not be administered methotrexate due to complications. PIP joint deformity of the left middle and ring fingers developed later. The middle finger was in -50-degree extension and difficult to correct passively, while the ring finger was in -35-degree extension and correctable. Surgery for the left middle finger was proposed based on the diagnosis of boutonniere deformity ; however, consent was not obtained. After a steroid injection in the painful middle finger, she was managed using a Capener splint and ROM exercises with finger stretching. The symptoms improved five months following the rehabilitation intervention. Nalebuff et al. classified the severity of the boutonniere deformity based on the limited PIP joint extension and recommended treatment accordingly. In this case, surgical treatment was believed to be required ; however, since the patient refused surgery, conservative treatment was chosen. Although the extension was severe, there was little joint destruction, due to which the symptoms improved with early and active intervention. Orthotic treatment and occupational therapy were effective in improving ADL.
Practice	Medical technology
Keywords	boutonniere deformity, rheumatoid arthritis, rehabilitation, orthotic treatment, occupational therapy

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