NSAID起因性小腸病変を来した関節リウマチの1例

Small Intestinal Ulcers Due to NSAID with Rheumatoid Arthritis, Report of a Case

要旨　患者は27歳，女性．関節リウマチ（RA）と診断されてから約6年間，Loxonin^®などを内服していた．下血を契機に消化管の検査を行った．初診時には，診断が困難であったが，約3年間の経過を追うことによって非ステロイド系消炎鎮痛剤（NSAID）起因性小腸病変と診断しえたRAの1例を経験した．小腸X線検査では回腸終末に地図状潰瘍とアフタ様病変が散在しており，ダブルバルーン小腸内視鏡検査では下掘れ潰瘍と露出血管を認めた．NSAIDの中止とsulfapyridine内服によって治療開始後約1年に小腸X線検査で治癒を確認した．

　The patient was a 27-year-old female, she had had rheumatoid arthritis (RA) for 6 years, and had been given loxoprofen. She underwent gastrointestinal endoscopy and colonoscopy because of melena. It took almost 3 years to diagnose her small intestinal ulcers due to nonsteroidal anti-inflammatory drugs (NSAID) with RA. Small intestinal barium study showed deep and wide ulcers and aphthoid ulcers in the ileum. Double-balloon enteroscopy showed deep ulcers with vessels. We recognized small intestinal ulcer scars by small intestinal barium study using double contrast methods, after removal of NSAID for one year. She was diagnosed as having small intestinal ulcers due to NSAID.