僵直性脊椎炎中西醫治療綜述

Review a Treatment of Chinese and Western Medicine on Ankylosing Spondylitis

10.29613/JICWM.200412.0006

魏正宗(James Cheng-Chung Wei)

僵直性脊椎炎 ； 傳統中醫 ； 治療 ； Ankylosing spondylitis ； Traditional Chinese Medicine ； Treatment

中西整合醫學雜誌

6卷1期（2004 / 12 / 01）

59 - 67

繁體中文

僵直性脊椎炎，是一種與寒因有關的自體免疫疾病，主要侵犯脊椎與週逢大關節的滑膜、肌腱接骨點及附近軟組識。僵直性脊椎炎的治療，是根據疾病的臨床活性以及侵犯的器官程度而定，主要有復健及運動治療、非類固醇類消炎止痛藥、免疫調節劑、類固醇局部注射、抗腫瘤壞死因子療法等等。沙利竇邁，近年來被發現有抗發炎、免疫調理及抑制血管增生的作用，對80%的嚴重僵直性脊椎炎病人有效。西藥的副作用、藥物順從性及價格，使得僵直性脊椎炎的治療效果，仍未能令人滿意。 僵直性脊椎炎屬於傳統中醫骨疾範疇，治療原則是辨證施治，以滋補肝腎為本，兼顧清熱、活血、祛寒、止痛。綜合文獻及專家意見，獨活、黃耆、白芍、桂枝、狗脊、葛根、雷公藤、薏苡仁、青風藤、大棗、當歸、羌活等中藥為組成的方劑曾有初步報告有效。這些過去的研究顯示，中藥治療僵直性脊椎炎，可能有其可取之處。但共同的缺點是研究設計不夠嚴謹，療效評估等未有統一的標準，數據有誇大之嫌，以至尚無在國際期刊發表，中醫藥治療僵直性脊椎炎仍極有空間。

Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by sacroiliitis, spondylitis, enthesitis, and occasionally, peripheral arthritis. Therapies for AS are sometimes unsatisfactory. Non-steroid anti-inflammatory drugs (NSAIDs), as well as the COX-2 inhibitor are the major therapy for most AS patients. Sulfasalazine may benefit AS patients with peripheral arthritis, uveitis, inflammatory bowel diseases or psoriasis. Management of refractory AS is often difficult. Pamidronate, a bisphosphonate, was shown promising results for refractory AS patients. Anti-tumor necrosis factor (TNF α) therapies, such as eternacept and infliximab are the major breakthrough for refractory AS patients in these years. Recently, thalidomide was found to be beneficial for refractory AS patients. Among these therapies, cost and side effects are the major disadvantages. For Traditional Chinese Medicine, there were no scientific evidences so far, although some small trials had demonstrated positive response. Further well-designed clinical trials need to be done in the future. Two clinical trials using Traditional Chinese Medicine Formulas were ongoing in our institute now.