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。
手部退化性關節炎應適當休息及遵從醫囑，以免惡化。(奇美醫學中心提供)
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。
手部退化性關節炎應適當休息及遵從醫囑，以免惡化。(奇美醫學中心提供)
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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