特発性に左中指伸筋腱断裂を呈したJaccoud関節炎を伴った全身性エリテマトーデスの一例に対する作業療法

Occupational therapy for spontaneous repair of the extensor digit tendons in left middle finger with Jaccoud arthropathy due to systematic lupus erythematosus: A case study

要旨：全身性エリテマトーデスは関節や多臓器に病変をきたす全身性の自己免疫疾患である．本報告は，誘因なくJaccoud関節炎（JA)を伴った左中指の伸筋腱断裂と環指と小指の伸筋腱脱臼を呈した事例の経過から，段階的スプリント療法と関節保護に対する患者指導の重要性について検討することを目的とした．事例は70歳代女性，段階的にスプリント療法を行い，介入終了まで把握動作に対し患者指導を実施した．その結果，尺側偏位と中指の自動伸展角度の改善と安全な手の使用行動が獲得された．JAを伴った伸筋腱断裂では疼痛，腫脹や骨関節病変がなく腱の炎症性変化が出現するため，行動変容につながるまで関節保護指導を徹底する必要性が示唆された．

　Systematic lupus erythematosus is an autoimmune disease that causes systemic multi-organ malfunction. The purpose of this study was to demonstrate that splinting and education of joint protection are effective in changing hand behavior after a case of non-induced extensor tendon rupture of the left middle finger accompanied by Jaccoud arthritis. The case involved a seventy-year-old woman who has been affected since she was thirty years old. Jaccoud arthropathy caused middle and extensor tendon dislocation and a ruptured synovial tendon sheath. After tendon reconstruction, we intervened with rest and dynamic splinting for three weeks, which resulted in preventing ulnar deviation. After six weeks, we educated the patient in joint protection during cooking and washing, which resulted in improving ulnar deviation and increasing the automatic extensor angle in the middle finger. In addition, behavioral change toward the hand was promoted, and safe use of the hand in daily life was acquired. Jaccoud arthroplasty may cause rupture of the synovial tendon sheath, affecting the extensor digits. It is important to change behavior toward the hand as soon as possible to protect the joint.