慢性關節炎治療　生物製劑惠氏恩博新選擇

舉凡類風濕性關節炎、僵直性脊椎炎、乾癬性關節炎等，皆為免疫風濕科常見之自體免疫慢性關節炎疾病,其中尤以類風濕性關節炎最具破壞性，能於發病二至五年內即導致關節侵蝕與變形，堪稱為關節炎之王，早期知名作家劉俠(筆名杏林子)一生便為此疾及其所導致之併發症所苦。

目前治療風濕病的用藥而言，除作用時間仍較緩慢外，其他副作用的問題大多已透過藥物的改良與劑量的調整獲得改善，只要耐心配合,將近七成患者可得到滿意的治療成果，面對仍無法改善的患者，近幾年頗夯的生物製劑如惠氏恩博Enbrel等，提供了更為快速、有效與安全的治療選擇。

　　所謂自體免疫性疾病乃指自身免疫系統失調,製造出過多會反其道而行攻擊破壞自己組織器官的抗體(如：類風濕因子、Anti-CCP抗體、免疫球蛋白A等)，常會導致自身關節發炎甚至內臟器官發炎受損(如：眼睛、肺部、腎臟......等)，其疾病本質就如同其他常見的慢性病如:糖尿病、高血壓、高血脂症、腦中風......，是需要長期控制治療的疾病，差別常在於目前使用上已有豐富臨床經驗的免疫調節劑如：Plaquenil(必賴克慺)、Salazopyrin(斯樂)、M.T.X、Arava，及免疫抑制劑如：Cyclosporine(新體睦)等，皆須服用到約兩個月時間才漸漸達到治療目的，加上為控制發炎常需配合使用類固醇或者非類固醇抗發炎藥物。

　　對多數患者而言,往往對於藥物副作用的擔心(如：胃腸道不適、肝腎功能受損......)遠勝過對於疾病治療的信心，因此,總是間斷地自行停止或減少藥物的劑量，但當病情加劇時又到處求助他科醫師：骨科、神經科、復健科、中醫、民俗療法、偏方等，最終的結果常使得疾病本身並無得到更適當的控制而使得關節逐漸侵蝕、變形、失能,反倒是使用過多重複性質"症狀治療"為主的藥物如止痛劑、消炎藥物、麻醉藥劑、肌肉鬆弛劑等,副作用常不減反增，最近殞逝的巨星麥克傑克遜應是警醒大家最好的例子。

　　其實，面對慢性又無法根治之疾病，最重要的常是醫病間的溝通與患者的配合，以目前治療風濕病的用藥而言，除作用時間仍較緩慢外，其他副作用的問題大多已透過藥物的改良與劑量的調整獲得改善，只要耐心配合,將近七成患者可得到滿意的治療成果，面對仍無法改善的患者，近幾年最夯的生物製劑如：Enbrel(恩博)、Humira(復邁)、Mabthera(莫需瘤)等，亦提供了更為快速、有效與安全的治療選擇，雖然其價格非常昂貴，健保局目前已有藥物申請使用的準則，至今已嘉惠不少疾病程度較為嚴重的患者重拾關節功能，改善生活品質進而回到工作崗位。

　　因此，對付難纏的風濕病已因生物製劑的開發，又有突破性的發展,患者不要失去治療的信心與勇氣，不要失去耐心病急亂投醫，好好追蹤並與醫護人員溝通治療的作用與副作用，切忌隨意停止藥物或許多科別藥物混合使用，必能期待疾病得到最佳控制。

資料來源:中時健康網

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