関節リウマチ患者における長期血漿交換療法のQOLへの影響(<特集>アフェレシスにおけるセイフティーマネジメント)  [in Japanese] The Influence of Long-Term Plasmapheresis on Quality of Life for Patients with Rheumatoid Arthritis  [in Japanese]

近年, 医療の面においてquality of life(以下QOL)が重要視されている.特に関節リウマチ(rheumatoid arthritis : RA)は, 慢性かつ進行性で激しい疼痛と肢体機能低下を伴う難治性の疾患であり, 関節の痛みだけでなく著しく関節の機能が障害されるため, 長期間の療養を必要とし患者のQOLは著しく低下しており, QOLの向上を目指した治療が最も重要視されている.現在, RAの治療は非ステロイド抗炎症剤, 抗リウマチ剤, 免疫抑制剤, ステロイド剤, また最近では生物学的製剤など複数の薬剤が組み合わせて使用されている.これら薬物療法に抵抗性を示す患者に対しては血漿交換療法(plasmapheresis : PP)も行われている.今回我々は, RAの治療法の一つであるPPがQOLに及ぼす影響について検討した.薬物療法に抵抗性であり1年以上継続的にPPを施行しているRA患者11名とし, Health Assessment Questionnaire(以下HAQ), Arthritis Impact Measurement Scale, ver.2(以下AIMS 2), 厚生省リウマチ調査研究事業のQOL研究班の評価案(NIH案)を参考に作成した調査票を用いて行った.今回の調査で長期間継続したPPによりRA患者のactivity of daily life (ADL), 快適度, 満足度だけでなく精神及び社会面などにおいても改善が認められた.長期間継続したPPはRA患者のQOLを高められると考えられた.

In recent years, quality of life (QOL) has become emphasized in healthcare. In particular, rheumatoid arthritis (RA) is a chronic, progressive disease accompanied by sharp pain and reduced limb function, which not only causes joint pain, but also impedes joint function. As a result, the QOL of patients requiring long-term medical treatment is significantly reduced, so that treatment aiming at QOL improvement is emphasized. Current RA treatments include nonsteroidal anti-inflammation analgesics, anti-rheumatic drugs, immunosuppressive agents, and steroids. Recently, multiple agents including biological preparations have been applied in combination. Patients exhibiting resistance to these drugs may receive plasmapheresis (PP). This study examined the effect of PP on patient QOL. Eleven RA patients resistant to pharmacotherapy, and receiving PP continuously for at least 1 year were studied. The study questionnaire was prepared using the "Health Assessment Questionnaire, Arthritis Impact Measurement Scale, version 2", developed by the QOL study group of the Ministry of Health and Welfare RA survey activities, as a reference. Results indicated improvement not only in the activity of daily life (ADL), comfort and satisfaction of the RA patients, but also in the mind and sociability of the patients. As a result of this study, it was determined that the QOL of RA patients can be improved with continuous long-term PP.