橋本 あゆみ¹, 岡野 匡志², 杉岡 優子², 真本 建司², 多田 昌弘², 武田 節子¹, 髭野 泰博¹, 小池 達也³

Ayumi HASHIMOTO¹, Tadashi OKANO², Yuko SUGIOKA², Kenji MAMOTO², Masahiro TADA², Setsuko TAKEDA¹, Yasuhiro HIGENO¹, Tatsuya KOIKE³

¹大阪市立大学医学部付属病院中央臨床検査部, ²大阪市立大学医学部付属病院整形外科, ³大阪市立大学医学部付属病院リウマチ外科

¹Central Clinical Laboratory, Osaka City University Medical School, ²Department of Orthopaedic Surgery, Osaka City University Medical School, ³Department of Rheumatosurgery, Osaka City University Medical School

キーワード : musculoskeletal ultrasonography, power Doppler, rheumatoid arthritis, biologics, clinical remission

関節リウマチ（RA）治療に生物学的製剤が導入され，治療の目標である臨床的寛解状態を達成できる患者が増えてきている．さらに，臨床的寛解状態が維持された後に生物学的製剤を休薬することが可能な症例も出てきている．今回我々は抗腫瘍壊死因子抗体製剤であるアダリムマブ（ADA）投与患者において，臨床的寛解の後にADAが休薬可能であった症例と休薬後にRAの活動性が再燃した症例を1例ずつ経験し，その休薬前後での関節超音波検査所見を比較検討したので報告する．症例1は41歳の男性で，メトトレキサート（MTX）とADAの併用療法によって12ヵ月以上臨床的寛解状態が維持された後にADAを休薬した．休薬前の超音波検査では両手指・両手関節にパワードプラ（PD）シグナルは陰性であった．ADA休薬後も3ヵ月にわたって臨床的寛解状態が維持できている．症例2は33歳の女性でMTXとADAの併用療法によって症例1と同じく12ヵ月間臨床的寛解状態が維持された後にADAを休薬した．休薬前超音波検査では右手関節にPDシグナル陽性所見が認められた．ADA休薬後1ヵ月で全身の関節に疼痛と腫脹が再燃した．炎症反応の上昇も認められ，高疾患活動性となった．このことから，臨床的寛解状態においても関節超音波検査においてPD陽性滑膜が認められる場合は，生物学的製剤の休薬後にRAの活動性が再燃する可能性が示唆された．

Since the introduction of biologics for the treatment of rheumatoid arthritis (RA), many patients have been able to achieve a state of clinical remission, which is the goal of treatment. It has also been possible to withdraw biologics in some cases after achievement of clinical remission. We experienced one case in which clinical remission could be maintained after withdrawal of adalimumab (ADA), and another case in which the activity of RA was recurred after ADA withdrawal. We report a study comparing the ultrasonographic assessment in those cases. Case 1: The patient was a 41-year-old man in whom clinical remission was maintained for more than 12 months by combination therapy of methotrexate (MTX) and ADA. Power Doppler (PD) ultrasound examination was negative at all fingers and both wrists before withdrawal of ADA. After withdrawal of ADA, clinical remission was maintained for over three months. Case 2: The patient was a 33-year-old woman in whom clinical remission was maintained for 12 months by combination therapy of MTX and ADA. PD ultrasound examination was positive at both wrists before withdrawal of ADA. After withdrawal of ADA, pain and swelling in many joints of the body recurred within one month. From these two cases, it may be suggested that if PD-positive synovial tissue is observed on ultrasonography even during clinical remission, the activity of RA may recur after withdrawal of biologics.