手部退化性關節炎不可逆 6成病人是家族遺傳
2022-06-07 記者莊兆暉/台南報導
54歲葉女士長期從事美髮業,她的雙手第2至第5手指末端兩個關節疼痛多年,尤其在冬天及下雨前疼痛更劇烈,相當困擾,且關節二側外觀特別突起,摸起來有堅硬感,她前往奇美醫學中心風濕免疫科求診,經手部X光檢查後確定為手部退化性關節炎,醫師判斷與家族遺傳、工作相關,開立非類固醇消炎藥解除疼痛,加上衛教關節的保養、運動、熱敷等輔助治療後,症狀已大幅改善。
退化性關節炎影響全球3億以上人口,為全世界最常見的關節炎,最好發的部位是手部,其次是膝關節及髖關節。奇美醫學中心風濕免疫科主治醫師陳昭宇表示,民眾年紀漸長,關節退化無可避免,手部退化性關節炎為不可逆的疾病,嚴重的話將侵蝕關節,若能早期發現,配合藥物及非藥物的治療,加上調整生活型態及運動,就能得到控制與改善。
陳昭宇指出,手部退化性關節炎發生率約0.1至1.1%,而且女性的比率大於男性,停經前後是發生率最高的時期,另外約有6成的病人有家族遺傳,其他則與需要使用手部工作的型態有關,像是按摩、美髮、手工業等,而慣用手更容易產生退化性關節炎。
姆指的腕掌關節炎是最常好發部位,其次是遠端指間關節、拇指指間關節以及近端指間關節,這個過程進展緩慢,會引起局部關節疼痛、僵硬、關節活動角度受限、握力以及捏力減少。如果產生發炎反應,局部的關節會出現紅腫熱痛的狀況,嚴重後就會演變為侵蝕性退化性關節炎,發生部位在指間關節的以女性為多,而發生在姆指的腕掌關節炎的則以男性為多,局部關節也會合併發生滑膜炎、肌腱腱鞘炎。
陳昭宇指出,教導病人自我管理是治療上最核心的部分,包含保護關節、合適活動、重量調整等。藥物部分主要為使用口服止痛藥,可使用關節內注射類固醇、局部使用的止痛藥、軟骨素等,其他如口服雙磷酸鹽、葡萄糖胺、免疫抑制劑及局部離子導入法等則較不建議。
陳昭宇也提到,疫情期間民眾需要重複清潔環境,包括扭毛巾、拖地等動作,都會造成關節勞損,應善用工具協助,並適當休息及伸展筋骨。
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