慢性関節リウマチに合併した難治性胃潰瘍の1例―13年間の長期観察例

Refractory Gastric Ulcer with Rheumatoid Arthritis, Report of a Case

要旨　患者は59歳，女性．30歳時より慢性関節リウマチ（RA）に罹患し，非ステロイド系消炎鎮痛剤（NSAIDs）を長期間内服していた．46歳時に吐血，胃内視鏡にて幽門前庭部に潰瘍を認めた．NSAIDs内服を坐薬に変更し，抗潰瘍剤を投与したところ約4か月で瘢痕化した．しかし，48歳時に同部に胃潰瘍再発，H₂ブロッカーを中心とした抗潰瘍剤で治療し，3か月～2年間隔で胃内視鏡にて経過観察したが，下掘れ潰瘍を形成し11年を経過した現在も潰瘍は治癒していない．この間NSAIDsの経口および直腸内投与は継続されていた．本症例の胃潰瘍難治化の要因として，NSAIDsの投与，およびRAに伴う胃壁のmicroangitisによる胃粘膜防御因子の低下が考えられた．

　A 59-year-old woman with rheumatoid arthritis from the age of 30 vomited blood at the age of 46. She had been using non-steroidal anti-inflammatory drugs (NSAIDs) internally for a long time. Endoscopic examination revealed a gastric ulcer in the prepylorus. The ulcer was healed after 4 months under treatment with anti-ulcer drugs and by changing NSAIDs to a suppository type. But a gastric ulcer recurred in the same portion at the age of 48, and the ulcer has not healed after 11 years in spite of treatment with H₂ receptor antagonist. NSAIDs was used throughout the clinical course. The factors causing intractability of the gastric ulcer in this case were gastric mucosal damage due to NSAIDs and intramucosal microangitis with rheumatoid arthritis.