関節リウマチ(RA)に対する TNF 阻害薬使用ガイドライン

1 1 (RA) TNF (2019 6 29 ) TNF RA 5 RA RA 1 2008 recommendation 2 2010 3 20144 RA MTX TNF 2012 2012 ACR recommendations 5 Treat to Target : T2T 6 (EULAR recommendation) 7 (BS) 8-10 BS 11,12 TNF TNF 1.

2 (DMARD) ) 3 RA 3 6 2 6 CRP ESR 28mm/hr DAS28-ESR (moderate disease activity) 2. 6 DAS28-ESR (high disease activity) RF CCP MTX 3. 3 4000/mm3 1000/mm3 D- 1) BS MTX 16mg/ BS MTX 2) 1. 1kg 3mg 2 ) 2 6 8 6 10mg/kg 4 6mg/kg 2.

3 10-25mg 1 1 2 25-50mg 1 1 1 3. 40mg 1 1 2 1 1 80mg 80mg 4. 50mg 1 1 4 1 1 100mg 100mg 1 1 4 1 3 5. 1 400 mg 2 4 1 200 mg 2 1 400 mg 4 BS kg mg kg 10mg mg BS 10 25mg 1 1 2 25 50mg 1 1 1 2)

4 BS MTX BS MTX 1. TNF 2. NYHA III II NYHA(New York Heart Association) 1964 ) I : II : III : IV : 3. 4 1. TNF X - T-SPOT X CT X ( 5 ) - TNF TNF TNF 3 (INH) ( 300mg/ 5mg/kg/ )

5 6 9 TNF TNF 13,14 -D KL-6 RA TNF TNF 8) stage III 9) class III 10) 65 / * stage III 65 / / * class III *: / / 5 TNF 15 ST 16 TNF 2.

6 B (HBV) B B 17 C (HCV) TNF 3. , BS Infusion reaction( ) ( ) : 2 Infusion reaction( ) 4. TNF TNF 18,19 20-22 2014 4 SSI , SSI , RA , , SSI.

7 SSI 6 RA TNF 2014 , , (ACR) 2 (BSR) 3-5 23 (CRI) , BS 1-2 3-4 8 2-3 4-6 24 5.

8 TNF )3 3 25,26 6. TNF ( ) 7. BCG , TNF , 27 8. -D- - T-SPOT KL-6 CT INH ST INH Kekkaku Vol.

9 88, No. 5 : 497_512, 2013 19 8 1 7 0801001 ST 24 2 1 0201 2 1.. 2. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 2008;59:762-84. 3. Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010;69:964-75.

10 4.. 5. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012;64:625-39. 6. Smolen JS, Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010;69:631-7. 7. Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016;75:3-15. 8. Matsuno H, Tomomitsu M, Hagino A, Shin S, Lee J, Song YW.