誰正走向類風濕關節炎？淺談未分化關節炎與臨床可疑關節痛

10.6666/ClinMed.201810_82(4).0113

黎子豪；陳明翰；蔡長祐

類風濕關節炎(rheumatoid arthritis, RA) ； 未分化關節炎(undifferentiated arthritis, UA) ； 臨床可疑關節痛(clinically suspect arthralgia, CSA)

臨床醫學月刊

82卷4期（2018 / 10 / 26）

613 - 621

繁體中文

類風濕關節炎(rheumatoid arthritis)因為病程遷延且疾病活動度容易變化，發病又常出現在社經貢獻度最高的中壯年族群，同時可能致殘並與其他共病症有關聯，所以被視為令人困擾的重大疾病。近年來，由於機轉更被了解，藥物治療也有更新的發展，且診斷標準修訂後，期許臨床醫師能更早期診斷與治療；然而，確診之後開始介入，似乎對改善病程的效果不盡理想，也讓此病蒙上無法真正治癒的陰影。近十年來研究著眼於早期關節炎與尚未達確診階段的未分化關節炎(undifferentiated arthritis, UA)，試圖從中鑑別高風險的類風濕關節炎前期病人，盡早評估與即時治療，希望能遏阻病程持續進展，達到完全治癒的理想；因此歐洲抗風濕病聯盟推出針對這一族群的診療原則，包括：早期轉介給風濕科醫師、仔細評估危險因子、充分與病患討論治療模式、給予以methotrexate為主軸的治療、非類固醇消炎止痛藥與類固醇以低劑量短時間使用、定期監測疾病活動度與疾病修飾抗風濕病藥物(disease-modifying anti-rheumatic drugs, DMARDs)副作用、衛教活動及戒菸、體重、疫苗等方面的全人療護等。最近更有研究聚焦於臨床可疑關節痛(clinically suspect arthralgia, CSA)，希冀能在臨床可見關節炎出現之前，就及早發現與治療，讓關節免於破壞一途，而使類風濕性關節炎能有機會被治癒，甚至完全被預防。

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