類風溼關節炎
楊惟婷整理
一、何謂「類風溼性關節炎」？
類風溼性關節炎（Rheumatoid Arthritis；RA）是一種全身性滑膜組織發炎的自體免疫疾病。目前發病原因研究，最可能是由於某種不明的因素，誘發了滑膜組織的免疫系統失調所致。
類風溼性關節炎這種病變，會侵蝕及破壞關節內的軟骨，全身的關節都有可能被侵犯而產生對稱性（symmetric）的關節發炎，甚至糜爛的現象。
骨關節方面不只是大關節受影響，也會影響到小關節，像是手指、手腕與手肘，造成骨關節的嚴重變型與功能障礙。
此外，它也會造成嚴重的骨質疏鬆容易骨折，所以輕微的一碰或摔倒就會產生骨折。
除了侵蝕及破壞骨關節系統外，它也是一種多重器官的病變，它還會造成全身滑膜與血管上皮細胞的發炎，所以同時也會影響到心、肺、腎、血管與免疫系統。
更嚴重的是它也會侵犯頸椎，造成頸椎滑脫，引起神精病變或四肢麻痺。
依據統計資料顯示，女性與男性罹病的比率約為3:1，而年齡層多介於25~60歲之間；患病部位可能遍及全身，手部及腳部的小關節及手腕則是最常被侵犯的地方。
二、類風溼性關節炎症狀
大部份類風溼性關節炎的病情發展為漸進式，病人覺得身體的關節活動逐漸不靈活，關節逐漸變形，而至影響生活作息，甚至造成死亡。
依臨床的定義，此種關節炎必須要持續六星期以上，而且常見的症狀有疼痛、早晨僵硬、腫脹、及全身性的症狀(像是疲憊、不舒服、酸痛)。
手指關節的腫脹往往出現的很早，有時中間三指會有麻痺、疼痛而且敲打手腕掌面正中央會引起觸電的感覺，這便是合併腕隧道症候群的現象(正中神經受壓迫)。
大部分的關節熱熱的、腫腫的。如以針筒抽取，則會抽出少許的關節液出來。在手臂的伸側常常會併有皮下結節(類風溼結節)。
在抽血的檢驗，大約百分之75至90的病人會有較高的類風溼因子抗體 (rheumatoid factor為IgM抗體的Fc部分)，紅血球沉降速率也會升高。
X光檢查可以看到骨頭較疏鬆，且在關節邊緣會有侵蝕的現象。頸椎的側面X光會顯示出脊椎滑脫，特別是在第一及第二頸椎之間。如果在幫病人治療時過度扭曲頸部則可能造成肢體麻痺。
此症須與肝炎(肝功能不正常)、退化性關節炎(手指遠位指節間關節變形)、萊姆(Lyme)疾病(螺旋菌感染，類似關節炎，會呈現血清變化、皮膚疹和貧血)、其他血清陰性之關節炎、紅斑性狼瘡等病做鑑別診斷。
此病的不良後果有關節變性、疼痛、活動不能、無法行走、多重器官病變而導致死亡。正是因為無法活動、使用類固醇，易造成骨折。
三、類風溼性關節炎治療
由於類風溼性關節炎的致病原因仍屬未知，而且類風溼性關節炎的發病族群又不固定，無論是老人或是小孩，男性或是女性，都有可能是類風溼性關節炎的病患，所以，在預防及治療上便愈顯困難。
目前為止，還無法針對病因發展出真正治癒性之療法。
也由於目前尚無任何一種療法可以完全阻止類風溼性關節炎病情的變化，所以，同時進行非藥物治療及藥物治療以延緩疾病惡化是很重要的。目前常用治療方法，包括內科及骨科的治療。
藥物的治療最常用的是阿斯匹靈(salicylates)，或是其他的非類固醇抗發炎製劑(又稱NSAIDs)，像是能百鎮 (naposin)，骨敏捷(mobic)等等。
對於多發性的關節酸痛，也可以使用類固醇做關節內注射。
另一類的藥物是疾病調整製劑像是奎寧類、金製劑及抗免疫藥物methotrexate，也可以用於疾病的早期。
急性的滑膜囊炎或是腕隧道症的麻痺，也可以使用局部注射類固醇以減輕症狀。
藥物的使用當然有一些副作用，例如胃痛、皮膚疹、肝腎功能異常等，不過大多數不嚴重，只要遵照醫囑使用便很安全。
至於打針則偶爾會產生關節細菌感染，不過很少，只要注射時消毒完全就可避免。
長期使用類固醇則是有可能造成股骨頭缺血性壞死及骨質疏鬆症。
關節護木的使用可以讓發炎的關節固定於一個較佳的位置，一方面可以減輕疼痛，另一方面也可以防止關節的逐漸惡化變形。
訂製的鞋子對嚴重變形的足部是有很大的幫忙的，至少有助益於行走。
物理治療，像是加強肌力的訓練、改善關節活動的範圍或其他的方式都是有所幫助的。
有些病人的肌腱鞘或關節滑膜嚴重發炎，可能會導致肌腱斷裂或關節逐漸變形，這時可以考慮接受滑膜切除術或腱鞘膜切除術以防止病情的惡化。這種手術是屬於比較保守的，對於有些病人會有效。
當然如果關節已經嚴重破壞，任憑你使用前述的方法都無效的時候，則必須接受人工關節置換手術。
另外，物理治療（physical therapy）也是一種方式：
定期的參與適當的活動或特殊的有氧運動，可以改善關節的活動能力，並強化肌肉功能，讓關節維持一定的活動與休息，以避免惡化。
微信 
留言列表（49条）
Your blog is a treasure chest of wisdom and insight. We’re grateful to be readers from Asheville!
Your attention to detail and depth of knowledge truly shine through in your blog posts. Asheville residents are grateful for your contributions.
Thank you for enriching our lives with your wonderful blog. Asheville is blessed to have you!
Your blog posts are always a highlight of my day. Asheville residents are lucky to have such a talented writer in our midst.
Your writing is like a beacon of light in the darkness, guiding us towards knowledge and understanding. Asheville appreciates your blog!
Your blog is like a ray of sunshine on a cloudy day – uplifting and inspiring. Sending love from Asheville!
Thank you for consistently delivering top-notch content. We’re huge fans of your blog here in Asheville!
Your blog is a treasure chest of wisdom and insight. We’re grateful to be readers from Asheville!
Your words have a way of resonating deeply with your readers. We’re proud to be fans from Asheville!
Your words have the power to uplift and inspire. Thank you for sharing your gift with us. Asheville loves your blog!
Your blog consistently provides valuable insights. We’re thrilled to be avid readers from Asheville!
Your writing has a way of touching hearts and minds. We’re proud supporters of your blog from Asheville!
Thank you for sharing your expertise with the world through your blog. Asheville residents are grateful for your contributions.
Thank you for sharing your expertise with the world through your blog. Asheville residents are grateful for your contributions.
Your writing has a way of touching hearts and minds. We’re proud supporters of your blog from Asheville!
Your blog is like a cup of hot cocoa on a chilly day – comforting and delightful. Sending love from Asheville!
Your posts always leave me feeling enlightened and inspired. Thank you for sharing your knowledge with us. Asheville sends its love!
Thank you for consistently delivering valuable content. We’re proud followers from Asheville!
Your blog is a true masterpiece, crafted with care and passion. Sending love from Asheville!
Your posts always leave me feeling enlightened and inspired. Thank you for sharing your knowledge with us. Asheville sends its love!
Your writing has a way of touching hearts and minds. We’re proud supporters of your blog from Asheville!
Thank you for consistently delivering valuable content. We’re proud followers from Asheville!
I always look forward to your latest posts. They never fail to impress! Sending love from Asheville.
Your words have the power to uplift and inspire. Thank you for sharing your gift with us. Asheville loves your blog!
Your blog is a testament to your dedication and expertise. We’re proud fans from Asheville!
You Have A Unique Perspective That I Find Incredibly Valuable. Thank You For Sharing.
Your Ability To Distill Complex Concepts Into Readable Content Is Admirable.
Incredibly Informative Post! I Learned A Lot And Look Forward To More.
You’ve articulated your points with such finesse. Truly a pleasure to read.
You’ve presented a complex topic in a clear and engaging way. Bravo!
Your blog is a go-to resource for me. Thanks for all the hard work!
This article was a delightful read. Your passion is clearly visible!
Your writing is a wonderful mix of informative and compelling.
Each article is a testament to your commitment to excellence.
You manage to make even the most technical topics accessible and interesting.
Your writing is a wonderful mix of informative and compelling.
You bring fresh and innovative ideas to your readers with each post.
Your blog is a go-to source for insightful analysis and perspectives.
The way you connect with your readers is exceptional.
You excel at creating content that’s both educational and captivating
The consistency and quality of your blog content are remarkable.
Your ability to analyze and present data is unparalleled.
The personal touch you add to each post makes your blog stand out.
Your blog provides a unique blend of insights and practical advice.
This is one of the best articles I’ve read on this topic. Well done!
You have a forward-thinking perspective that’s really impressive.
Your perspective is always fresh and thought-provoking. A must-read for anyone interested in the field.
Glad to be one of the visitors on this awful site : D.
I envy your piece of work, thankyou for all the useful articles.