類風濕性關節炎病人因外傷誘發膝蓋疼痛之病例報告

Knee Pain Due to Traumatic Injury in a Patient with Rheumatoid Arthritis: A Case Report

10.7102/JTCIM.202406_22(1).0003

陳佳泓(Chia-Hung Chen)；林峻邦(Chun-Pang Lin)

類風濕性關節炎 ； 中醫藥 ； 疏經活血湯 ； 當歸拈痛湯 ； Rheumatoid Arthritis ； Traditional Chinese medicine ； Shu Jing Huo Xue Tang

中醫內科醫學雜誌

22卷1期（2024 / 06 / 01）

22 - 34

繁體中文;英文

類風濕性關節炎（Rheumatoid Arthritis, RA）屬於中醫學的「痺症」範疇。RA會使身體有多發性的骨關節炎，常影響手部的近端指間關節（PIPs）、掌指關節（MCPs），及腕、肩、膝、踝、蹠趾等關節，常見關節晨起僵硬、腫脹、疼痛等症狀。從中醫角度而言，本病的病因及病機和風、寒、濕、熱、瘀等有密切關係，臟腑則和腎、肝較相關。本案例為多年RA病史的患者，近年因年歲漸高而腎氣虛，使手指晨起緊繃僵硬復發，之後又因跌倒使右膝持續腫、熱、刺痛。本案例辨證以血瘀阻絡、濕熱痺阻為主，腎氣虛為次，治療思路上先活血化瘀、清熱除濕，待右膝狀況緩解再酌加補腎氣藥。經治療後，右膝腫、熱、刺痛已有緩解。

Rheumatoid arthritis (RA) is also regarded as the "bi-disease" in traditional Chinese medicine. The main problem of RA is multiple joint inflammation, including proximal interphalangeal joints (PIPs), metacarpophalangeal joints (MCPs), wrist joints, shoulder joints, knee joints, ankle joints, metatarsal joints, and so on. The main symptom of RA is stiffness in joints in the morning, swelling, and pain in joints. From a traditional Chinese medicine perspective, the cause and pathogenesis of RA is closely related to wind, cold, dampness, heat, and blood stasis. This case is a patient with a history of RA for many years. In recent years, due to the increasing age, this patient has suffered from kidney qi deficiency, which leads to the recurrence of tightness and stiffness in her finger joints in the morning. Later, due to a fall, the right knee of this patient continued to be swollen, hot, and a stabbing pain. The syndrome differentiation in this case is mainly blood stasis blocking the meridians, and syndrome of blockade of damp-heat, followed by kidney qi deficiency. The treatment of this patient is to activate blood circulation, remove blood stasis, clear away heat and remove dampness, and then increase kidney qi after the bulge and stabbing pain of the right knee are relieved.