関節リウマチリウマチ（RA ... - yoneda.or.jp

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2 RA RA 65 I 5 III 30 II 50% Emery Emery 3 MTP MCP or 30 3 MTP MCP or 30 RA ACR ACR 3 X 3 X 7 4 RA

3 RA RA MRI CCP RF MRI MRI CCP RF MRI MRI 3 5 Early RA CCP CCP RA 80 80~90% RF 50~70 80~90 RF 20% RA overlap ( ) RA 80 80~90% RF 50~70 80~90 RF 20% RA overlap ( )

4 MMP-3 -3 MMP-3 -3 MMP MMP-3 RA MMP MMP-3 RA MMP-3 CARF lgG-RF RF Modified Sharp Modified Sharp = Erosions : 0 = 1 = 5 = 50% 0-10 40 44 van der Heijde, MFM.

5 Bailliere s Clin Rheum. 1996;10:435 JSN :0= 1= 2= 50 3= 50 4= The Window of Opportunity The Window of Opportunity Quinn Emery RA The Window of Opportunity DMARDs DMARDs Gold Sodium Thiomalate Auranofine D-penicillamine Bucillamine Gold Sodium Thiomalate Auranofine D-penicillamine Bucillamine (GST: )(AU )(DPC )(BUC ) SSZ EN ATR MTX TAC: (GST: )(AU )(DPC )(BUC ) SSZ EN ATR MTX TAC.

6 DMARDs RA DMARDs RA 2004 MTX Anchor drugMTX Anchor drugRA MTX MTX MTX 1000 1000

7 5mg <10mg DMARDs, NSAIDs DMARDs DMARDs, NSAIDs QOL RA DMARDs 30 60mg Biologics( ) Biologics( )

8 RA NF- IL-6 IL-1 RA Smolen JS ;Nature Reviews Drug Discovery 2,2003 RA RA TNF- IL-6 IL-1 RANKL/ODF RA TNF- IL-6 IL-1 RANKL/ODF RA TNF (Tumor Necrosis Factor) 17kDa( 3 ) 26kDa( )

9 1. IL-1 IL-6 IL-8 2. 3. ICAM-1 VCAM-1 ) 4. B-1 TNFTNFTNFTNF TNFTNFTNFTNF Biologics Infliximab INF IFX Remicade TNF Etanercept ETA ETN Enbrel TNF receptorAdalimumab ADA Humira TNF Tocilizumab MRA Actemra IL-6 Anakinra Kinerret IL-1 Rituximab RTX Rituxan B CD20 Abatacept (ABA Orencia) CD80/86 6 6 CRP ESR 28mm/hr 6 X 6 6 CRP ESR 28mm/hr 6 X 65

10 70 65 70 Remicade : Infliximab Remicade : Infliximab TNF TNF