前向き研究（prospective）による関節リウマチ手関節破壊の検討

Progression of Carpal Damage in Rheumatoid Arthritis Affected Wrist

　臨床上，関節リウマチ（RA）の進行を安定型と不安定型に区別ができれば，症例の治療選択がさらに適切となる．X線像を使用し，RAの手関節の破壊や手根骨の尺側，掌側の偏位による橈骨手根関節の不安定化をより早く知ることが可能であれば，早期にRAの破壊進行の病型を予測し，より早い時期に適切な治療方針を立てることができる．われわれは早期RA症例を前向きに観察し，carpal height ratioの経年変化率の計測が手関節の不安定型の予後予測に有用であり，関節破壊マーカーとして期待できる可能性を得た．

　Purpose：To explore the different patterns of disease manifestations and changes in the rate of progression of carpal damage in rheumatoid arthritis (RA).

　Methods：One hundred six hands in the early stage of RA were evaluated for 9.8 years by prospective analysis. Radiological misalignment was evaluated by measuring carpal height and compiling ulnar translation ratios annually. The modified Schulthess Classification of Rheumatoid Wrists by Simmen was used to classify the types of destruction.

　Results：Carpal collapse and ulnar translation showed progression with increasing duration of the disease. Early in the course of the disease, degradation was more rapid in the disintegrating and ankylosing types, than in the other types according to the Simmen classification.

　Conclusions：Evaluation of the time course of wrist damage by RA confirmed that the disintegrating and ankylosing types that were classified as unstable wrists became unstable, and ultimately became deformed.