関節リウマチ膝関節内注入療法の大規模実態調査―ヒアルロン酸とステロイドの効果について

Comparison between the Efficacy of Intra-articular Glucocorticoid and Hyaluronate Injections in the Treatment of Rheumatoid Knees. A Prospective Cohort Study

　関節リウマチ（RA）の注入療法の実態調査を行った報告はほとんどない．そこで，関節内注入療法の実態を検討する目的で，前向きの調査を行った．対象は4,998名のRA患者で，回答率は83％であった．関節内注入療法を受けた症例は，過去6カ月間で587名（14.1％）であり，CRP，血沈，HAQ，DAS28が高く，RAの疾患活動性の高い症例に注入される傾向を認めた．注入部位は，膝，肩の順であった．注入頻度は，3～6回が最も高い結果となった．使用薬剤はステロイド43％，ヒアルロン酸37.4％であり，薬剤別満足度は，ステロイドでは56.8であり，ヒアルロン酸は54.7という結果を得た．

　Intra-articular injections of corticosteroid and hyaluronate are useful tools for the treatment of osteoarthritis of the knee, and although the therapeutic efficacy of intra-articular corticosteroid injections has been established in rheumatoid arthritis, the most immediate form of evidence available for the clinical efficacy of intra-articular sodium hyaluronate is debatable. We therefore tried evaluating the clinical efficacy of intra-articular corticosteroid and hyaluronate injections by analyzing the patient database from a long-term, prospective, observational cohort study of IORRA. The cross-sectional analysis revealed a corticosteroid rate of 56.8 versus 54.7 for hyaluronate. No significant difference between the clinical efficacy of corticosteroid and hyaluronate injections was found in rheumatoid arthritis patients based on these data.