西野 譲

Case 1 was a 46-year-old man who developed neck pain in addition to pain and swelling in the limb joints in 1975. The patient was diagnosed with ankylosing spondylitis (AS) in 1983 based on detection of sacroillitis on X-ray as well as a positive result for HLA B-27. Following administration of non-steroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine (SSZ), methotrexate (MTX) was substituted at doses up to 17.5 mg/week in addition to concomitant prednisolone (PSL) (7.5 mg/day). However, no favorable response was obtained. As pain and inflammatory response improved following initiation of infliximab (IFX) in April 2005, PSL was discontinued and MTX was reduced to 10 mg/week. Case 2 was a 57-year-old man who experienced limitation of neck mobility in 1975. The patient was diagnosed with AS in 1989 based on detection of cervical ankylosis and sacroiliitis on X-ray and was given NSAIDs. After developing pain and swelling in the limb joints in 1994, the patient was given PSL (10 mg/day), bucillamine, MTX (8 mg/week), and leflunomide but did not improve. Arthritis in the limbs showed short-term improvement following initiation of IFX in May 2005. These findings demonstrate that IFX is a treatment option for AS refractory to conventional treatment. © 2009 The Japan Society for Clinical Immunology.

ANCA関連血管炎は血清に抗好中球細胞質抗体を認め, 血管壁に炎症が引き起こされる疾患群で多彩な臓器病変を呈する. 症例は61歳, 男性. 発熱, 四肢の感覚障害で発症し, ステロイドによる治療により, 炎症反応, MPO-ANCA値は改善したが, 血球貪食症候群, 肺胞出血, 肺胞蛋白症, 心筋梗塞など多彩な合併症を呈し死亡した. 血管炎患者では血管炎の非活動期でも様々な合併症に注意が必要である.