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		<h1 class="catchCopy">最新，最良のリウマチ・膠原病診療をじっくり掘り下げて学べる1冊</h1>
		

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		<h1 class="title">分子標的／Bio時代のリウマチ・膠原病治療ストラテジー<span class="version"></span></h1>
		

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					ゲスト編集：松本　功（筑波大学准教授）
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					<span class="transparent">ゲスト編集</span>　保田晋助（北海道大学講師）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">リウマチ・膠原病を専門とする医師を読者対象として，実臨床で直面しうる種々の問題点を出発点に，初診時のアプローチ，患者背景に応じて標準治療を外れる場合のアレンジの仕方，その根拠を掘り下げた1冊．文献を豊富に掲載して，研究のクオリティー，臨床へのインパクトなどを勘案し，重要度を示した．臨床の奥深さを味わいながら，リウマチ・膠原病に関心を持つ皮膚科医，整形外科医などにもじっくりと読んでいただきたい．<br>☆図版75点，表組102点，モノクロ写真50点<br><br>▽シリーズ編集<br>　三森経世（京都大学教授）<br>　桑名正隆（日本医科大学教授）</section><section class="preface">序　文<br><br>　リウマチ・膠原病診療は新たなステージを迎えている．一昔前までは原因不明の難病と言われたリウマチ・膠原病も，診断法が確立し，次々と新しい治療法が臨床で使えるようになってきた．ゲノムワイド解析により様々な病因関連遺伝子が判明し，環境因子の同定，および細胞・蛋白レベルでの免疫学的解析が進み，病因論についても多くを語れる時代になった．また，昨今では病態の中枢である部位への分子標的薬・Bio製剤が誕生し，薬剤の有効性や副作用を詳しく検証することにより，患者さん個々のプロファイルが見え，ベストの治療ストラテジーを立てていくことも求められる時代でもある．<br>　本書は，このような新しい時代にリウマチ学を志す若手医師が直面するであろう臨床面での種々の問題点を出発点にして，基礎・臨床論文の隔てなく，豊富な文献考察をメインに深く掘り下げることを目的とした．ガイドラインやレコメンデーションの単なる引用ではなく，それらの根拠になった重要な研究論文を交えて論文ごとの重みづけを明確にし，図表を多く用いて執筆いただいた．特に重要な臨床の問題点に関してはClinical Questionも設けて，わかりやすく解説をいただいた．<br>　シリーズ編集の京都大学　三森経世先生，日本医科大学　桑名正隆先生のご指示のもと，ゲスト編集として北海道大学　保田晋助先生とともに，リウマチ・膠原病診療で臨床と研究の最前線で活躍されている先生方にご執筆をお願いし，現時点での最新の考え方を提示できるreference bookが出来上がったと考えている．リウマチ専門医はもちろん，リウマチ学を志す若手内科医，リウマチ膠原病に関心を持たれる他科（整形外科，皮膚科など）の先生方やプライマリケア医にも十分役立つ内容となった．<br>　最後に，本書のねらいや意図をご理解いただいて大変多忙の中ご執筆いただいた分担執筆者諸先生，および多大なご尽力をいただいた文光堂の皆様方に深謝いたします．<br>松本　　功</section><section class="indexes">1章　関節リウマチ<br>　1．病態・予後不良因子および疾患活動性評価に基づく治療アプローチ<br>　　Clinical Question 1<br>　　RAの経過中にみられる肺病変と治療方針<br>　　Clinical Question 2<br>　　RAに対して生物学的製剤をファーストラインとして使用することは，医療経済の面<br>　　から許容されるのか？<br>　　Clinical Question 3<br>　　慢性腎臓病を合併する関節リウマチ患者に対する治療は？<br>　2．早期関節リウマチの評価と治療戦略<br>　3．確立した関節リウマチの評価と治療戦略<br>　4．早期関節リウマチ初期治療不応例の対応<br>　5．確立した関節リウマチでの初期治療不応例への対応<br>　6．高齢関節リウマチ患者への対応<br>2章　関節リウマチ類縁疾患<br>　1．悪性関節リウマチとリウマトイド血管炎<br>　2．成人発症Still病<br>　　Clinical Question 1<br>　　成人発症Still病のsteroid-sparing にはどの薬剤が有効か？<br>　3．リウマチ性多発筋痛症，RS3PE症候群と回帰性リウマチ<br>　　Clinical Question 1<br>　　リウマチ性多発筋痛症のsteroid-tapering に有用な薬剤は？<br>3章　脊椎関節炎<br>　1．疫学・診断と分類による治療アプローチ<br>　　Clinical Question 1<br>　　5-ASAをすでに投与されている炎症性腸疾患への対応は？<br>　2．強直性脊椎炎<br>　　Clinical Question 1<br>　　NSAIDs 治療の実際は?<br>　3．乾癬性関節炎<br>　4．反応性関節炎<br>4章　全身性エリテマトーデス<br>　1．病態・臓器病変と疾患活動性評価に基づく治療アプローチ（概略）<br>　　Clinical Question 1<br>　　抗核抗体，特異抗体は陰性だが，それ以外の項目によってSLEの分類基準を満たす患者はSLEとして治療すべきか？<br>　2．皮疹・発熱・関節炎・漿膜炎；軽症〜中等症ループスへの対応<br>　3．ループス腎炎への対応<br>　　Clinical Question 1<br>　　ループス腎炎III型，IV型の寛解導入療法における，ステロイドパルス療法の位置づけは？<br>　　Clinical Question 2<br>　　ループス腎炎のⅤ型の初期治療はどうするか？ ステロイド療法を行う際に抗血<br>　　小板療法や抗凝固療法を行うべきか？<br>　　Clinical Question 3<br>　　免疫抑制薬の選択基準は？　IVCYプロトコールの選択は？<br>　4．NPSLEへの対応 <br>　5．血球減少へのアプローチ<br>　　Clinical Question 1<br>　　TMAの治療はどうするか？<br>　6．妊娠とSLE<br>5章　多発性筋炎・皮膚筋炎<br>　1．病態と分類に基づく治療アプローチ（概略）<br>　　Clinical Question 1<br>　　筋炎では，ステロイド初期投与量からの早めの減量を勧める文献もあるが，そのリスク・ベネフィットは？<br>　　Clinical Question 2<br>　　PSL単独治療に抵抗性の筋炎において，IVIGおよび免疫抑制薬のどちらが先に使用されるべきか？<br>　　Clinical Question 3<br>　　難治例・再発例に対する免疫抑制薬投与はどうすればよいか？<br>　2．特発性炎症性筋疾患（間質性肺炎非合併）例の治療<br>　3．間質性肺炎合併例の治療<br>　　Clinical Question 1<br>　　間質性肺炎の予後予測と治療は？<br>　　Clinical Question 2<br>　　気胸・縦隔気腫を診たら？<br>　　Clinical Question 3<br>　　CADMに関しての現状は？<br>　4．悪性腫瘍合併例の治療<br>6章　強皮症<br>　1．病態・病型に基づく治療アプローチ<br>　　Clinical Question 1<br>　　強皮症患者のレイノー現象，末梢循環不全の改善を目的とした血管拡張薬，ビタミンEなどの末梢循環改善薬は温暖な季節の時期には休薬としてもよいか？<br>　2．皮膚硬化に対する評価と治療<br>　　Clinical Question 1<br>　　急速に進行する皮膚硬化に対する治療はどうすればよいか？<br>　　Clinical Question 2<br>　　浮腫期の治療：副腎皮質ステロイドの初期投与量と減量のしかたは？<br>　3．間質性肺疾患の評価と治療<br>　4．肺高血圧症の診断，臨床分類と治療<br>　5．強皮症腎クリーゼの治療方針<br>　　Clinical Question 1<br>　　強皮症腎クリーゼの予防は可能か？　腎クリーゼを誘発するリスクはあるか？<br>　　Clinical Question 2<br>　　強皮症腎クリーゼにACEIとARBの効き目に差があるのか？<br>　　Clinical Question 3<br>　　正常血圧腎クリーゼ，TMA, ANCA関連血管炎の鑑別と治療は？<br>　6．強皮症の関節炎に良い治療は？<br>　7．大量の心囊液貯留に対する治療は？<br>　8．SSc とMCTD に伴う肺動脈性肺高血圧症の治療は同じか？<br>7章　混合性結合組織病<br>　1．病態・病型に基づく治療アプローチ（概略）<br>　　Clinical Question 1<br>　　混合性結合組織病における無菌性髄膜炎と三叉神経障害の発症頻度と治療は？<br>　　Clinical Question 2<br>　　肺高血圧症にはステロイドか肺血管拡張薬か？<br>8章　Sjögren症候群<br>　1．病態と治療アプローチ（概略）<br>　　Clinical Question 1<br>　　1．Sjögren 症候群のドライアイに対する点眼薬の使用法は？<br>　　2．ジクアホソルナトリウム点眼薬とレバミピド点眼薬の使い分けは？<br>　　3．ステロイド点眼薬を加えることの是非は？<br>　2．臓器合併症への対応<br>　　Clinical Question 1<br>　　リンパ球性間質性肺炎（LIP）に対する胸腔鏡下肺生検の適応は？<br>9章　抗リン脂質抗体症候群<br>　1．血栓症の予防と治療<br>　　Clinical Question 1<br>　　無症候性の抗リン脂質抗体陽性患者において，抗血小板薬などを血栓症の一次予防を目的として使用すべきか？<br>　　Clinical Question 2<br>　　抗リン脂質抗体はどのような患者に，どれを測定すべきか？　保険適応外の自己抗体は？<br>　　Clinical Question 3<br>　　抗凝固療法・抗血小板療法はどのように使うか？　中止は可能か？<br>　2．妊娠合併症への対処<br>　　Clinical Question 1<br>　　妊婦に対するヘパリン投与の時期は？　効果はモニターできるか？<br>10章　血管炎症候群<br>　1．病態・疾患活動性・臓器障害に基づく治療アプローチ<br>　　Clinical Question 1<br>　　側頭動脈生検・腓腹神経生検；実臨床での適応は？<br>　　Clinical Question 2<br>　　ステロイド＋CYで寛解導入できない症例への対応は？<br>　　Clinical Question 3<br>　　維持療法はどのように行うか？<br>　　Clinical Question 4<br>　　高齢者に対するステロイド・免疫抑制薬の用量調整は？<br>　　Clinical Question 5<br>　　感染症の予防はどのように行うか？<br>　　Clinical Question 6<br>　　IVCY後の再発例に対する治療はどうすればよいか？<br>　2．高安動脈炎・巨細胞性動脈炎<br>　　Clinical Question 1<br>　　高安動脈炎・側頭動脈炎の治療にはステロイドが中心だが，免疫抑制療法やbiologicsの併用効果は期待できるか？<br>　3．結節性多発動脈炎<br>　　Clinical Question 1<br>　　腓腹神経生検；実臨床での適応は？<br>　4．ANCA関連血管炎<br>　　Clinical Question 1<br>　　臓器障害がないまたは寛解しているが，ANCAが高値の場合はどう考えるべきか？<br>　　Clinical Question 2<br>　　多発単神経炎によるしびれに対する対症療法は？<br>　　Clinical Question 3<br>　　GPAにはIVCYかPOCYか？<br>　5．IgA血管炎（Henoch-Schönlein紫斑病）<br>11章　結晶誘発性関節炎<br>　1．痛　風<br>　2．偽痛風<br>12章　その他の疾患<br>　1．ベーチェット病<br>　2．再発性多発軟骨炎（Relapsing Polychondritis）<br>　3．IgG4関連疾患<br>　　Clinical Question 1<br>　　IgG4関連疾患のステロイド療法に，生命・機能予後を延長させる効果があるか？<br>　　Clinical Question 2<br>　　再発を繰り返すIgG4関連疾患に，PSL減量中の免疫抑制薬の適応と選択は？<br>索引</section></article>
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