類風濕性關節炎合併小兒麻痺症、全身性紅斑狼瘡及兩側全膝關節置換術－病例報告及文獻回顧

Rheumatoid Arthritis with Systemic Lupus Erythematosus Poliomyelitis and Bilateral Total Knee Replacement-A Case report and Literature Review

林時維(Shie-Wei Lin) ； 周正亮(Chen-Liang Chou) ； 劉作仁(Tcho-Jen Liu) ； 徐道昌(Tao-Chang Hsu) ； 陳省章(Sheeng-Jung Chen)

《中華民國復健醫學會雜誌》 21期 (1993/12) Pp. 149-153

摘要

這是一位三十歲女性，類風濕性關節炎患者，合併有小兒麻痺症及全身性紅斑狼瘡，在接受兩側全膝關節置換術後，幾乎完全臥床且多處關節疼痛，兩側下肢肌力最佳僅達普通(fair)程度，在整體性的復健治療中，除了給予methotrexate口服治療以降低關節發炎及疼痛等病況外，並強調關節保護的重要性及日常生活的調適，製作固定支架保護已受損之關節，再加上心理晤談及職業諮詢，減輕患者心理上及日後就業上的壓力。另外在避兔引發後小兒麻痺症候群的前提下，施予適當之肌力及耐力訓練並重新訓練其步行的能力。兩個月後，病患的下肢肌力恢復至將近正常(normal)程度並可持前臂著力(支撐)之助行器自由行走。對於類風濕性關節炎患者的復健，最重要的部份就在積極藥物治療，控制疾病之進展性，各項復健的專業治療人員更能對此疾病所造成身心，日常生活及職業的問題，有莫大的幫助。

關鍵字

類風濕性關節炎 ； 全膝關節置換術

並列摘要

This is a case of 30-year-old female patient who suffered from Rheumatoid Arthritis for 8 years. She also has the problems of Systemic Lupus Erythematosus and the sequsela of Poliomyelitis. After bilateral total knee replacement, she was almost bed ridden with multiple joints pain. The best muscle power of both lower limbs was only fair then. She received oral methotrexate therapy and got moderate improvement, such as decrease in unmber of joint pain. Resting splints and anterior direct molding ankle-foot orthosis were made for her. And the education of joint protection was emphasized once again. Psychological and vocational consultations helped her to cope with depression and to make proper work adjustment. After two months of training for muscle power and endurance, she could walk by herself with a forearm support walker. The muscle power of lower limbs returned to nearly normal.
The most important part of the rehabiliation for the rheumatoid arthritis patient is aggressive usage of medications. All the staffs in the rehabilitation trams can to great help to what the patient has suffered physically or mentally.