{"id":778,"date":"2010-06-23T11:13:58","date_gmt":"2010-06-23T02:13:58","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=778"},"modified":"2015-08-07T11:15:14","modified_gmt":"2015-08-07T02:15:14","slug":"%ef%bd%9e%e9%96%a2%e7%af%80%e3%83%aa%e3%82%a6%e3%83%9e%e3%83%81%e3%81%ae%e6%97%a9%e6%9c%9f%e8%a8%ba%e7%99%82%ef%bd%9e","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=778","title":{"rendered":"\uff5e\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u65e9\u671f\u8a3a\u7642\uff5e"},"content":{"rendered":"

\u3010\u6587\u732e\u540d\u3011
\n\uff08\uff11\uff09\u3000Patients with suspected rheumatoid arthritis should be referred early to rheumatology. BMJ 2008;336:215, doi: 10.1136\/bmj.39381.597454.AE, (Published 26 January 2008)
\n\uff08\uff12\uff09\u3000\u30ec\u30b8\u30c7\u30f3\u30c8\u30ce\u30fc\u30c8\uff082010\u5e744\u6708\u53f7 vol.12-No1\u30012010\u5e745\u6708\u53f7 vol.12-No3\uff09<\/p>\n

\u3010\u8981\u7d04\u3011<\/p>\n

The clinical problem
\n\u3000\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306f\u6210\u4eba\u306e1\uff05\u306b\u5b58\u5728\u3057\u3001\u9032\u884c\u6027\u306e\u95a2\u7bc0\u969c\u5bb3\u3092\u304d\u305f\u3059\u3002
\n\u3000 DMARDs\u306b\u3088\u308b\u6cbb\u7642\u306f\u95a2\u7bc0\u969c\u5bb3\u3084\u9577\u671f\u7684\u306a\u6a5f\u80fd\u306b\u5bfe\u3057\u3066\u660e\u78ba\u306b\u6709\u52b9\u3067\u3042\u308b\u3053\u3068\u304c\u793a\u3055\u308c\u3066\u304a\u308a\u3001\u8fd1\u5e74\u3001\u53ef\u80fd\u306a\u9650\u308a\u65e9\u671f\u306eDMARDs\u306b\u3088\u308b\u6cbb\u7642\u304c\u8a00\u308f\u308c\u3066 \u3044\u308b\u3002\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u3082\u75c7\u72b6\u51fa\u73fe\u304b\u30896\u9031\u9593\u4ee5\u5185\u306e\u8a3a\u65ad\u300112\u9031\u9593\u4ee5\u5185\u306eDMARDs\u306b\u3088\u308b\u6cbb\u7642\u958b\u59cb\u3059\u308b\u3053\u3068\u304c\u63a8\u5968\u3055\u308c\u3066\u3044\u308b\u3002
\n\u3000\u3057\u304b\u3057\u3001\u5b9f\u969b\u306e\u81e8\u5e8a\u3067\u306f50\uff05\u7a0b\u5ea6\u306e\u60a3\u8005\u3057\u304b\u305d\u306e\u671f\u9593\u306b\u6cbb\u7642\u958b\u59cb\u3068\u306a\u3063\u3066\u3044\u306a\u3044\u3002<\/p>\n

Evidence for change
\n\uff1c\u65e9\u671f\u6cbb\u7642\u306e\u5229\u70b9\uff1e\u3000
\n\u3000 \u3042\u308b12\u306e\u30e1\u30bf\u5206\u6790\uff086\u3064\u306eRCT\u30016\u3064\u306e\u30b3\u30db\u30fc\u30c8\u7814\u7a76\uff09\u3067\u306f\u3001DMARDs\u306e\u6cbb\u7642\u306e\u9045\u308c\u3068\u65e9\u671f\u30ea\u30a6\u30de\u30c1\u60a3\u8005\uff082\u5e74\u4ee5\u5185\uff09\u306e\u30ec\u30f3\u30c8\u30b2\u30f3\u6240\u898b\u306e\u9032\u884c\u6027\u306b\u95a2\u9023 \u6027\u3092\u307f\u3068\u3081\u305f\u3002\u3000\u65e9\u671f\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u306b\u5bfe\u3057\u3001\u65e9\u671f\u6cbb\u7642\u7fa4\u3068\u305d\u308c\u4ee5\u4e0a\u6cbb\u7642\u307e\u3067\u6642\u9593\u306e\u304b\u304b\u3063\u305f\u5bfe\u7167\u7fa4\uff08\u5e73\u57479\u30ab\u6708\u306e\u6cbb\u7642\u306e\u9045\u308c\uff09\u3067\u306f\u3001\u305d\u306e3\u5e74\u5f8c\u306b\u306f\u65e9\u671f\u6cbb\u7642\u7fa4 \u306f\u6cbb\u7642\u307e\u3067\u6642\u9593\u306e\u304b\u304b\u3063\u305f\u5bfe\u7167\u7fa4\u3088\u308a\u308233\uff05\u9032\u884c\u304c\u6291\u5236\u3055\u308c\u3066\u3044\u305f\u3002\u3000\u307e\u305f\u3001\u3042\u308b\u30e1\u30bf\u5206\u6790\uff0814\u306eRCT\uff09\u3067\u306f\u3001\u6700\u3082DMARDs\u306b\u53cd\u5fdc\u6027\u304c\u9ad8\u3044\u306e\u306f\u75c7\u72b6 \u51fa\u73fe\u304b\u30891\u5e74\u4ee5\u5185\u306e\u60a3\u8005\u3067\u3042\u308b\u3068\u793a\u3055\u308c\u305f\u3002
\n\uff1c\u3069\u308c\u304f\u3089\u3044\u307e\u3067\u306e\u671f\u9593\u304c\u65e9\u671f\u304b\uff1e
\n\u3000\u75c7\u72b6\u51fa\u73fe\u5f8c12\u9031\u304c\u514d\u75ab\u7d44\u7e54\u5b66\u7684\u306b\u533a\u5225\u3055\u308c\u308b\u305f\u3081\u3001\u305d\u306e\u671f \u9593\u307e\u3067\u304cDMARDS\u958b\u59cb\u671f\u9593\u3068\u3057\u3066\u63a8\u5968\u3055\u308c\u308b\u3002\u3000DMARDs\u306b\u3088\u308b\u6cbb\u7642\u3092\u958b\u59cb\u3057\u305f\u3042\u308b\u30b3\u30db\u30fc\u30c8\u7814\u7a76\u3067\u306f\u30013\u30ab\u6708\u4ee5\u5185\u306b\u6cbb\u7642\u3092\u958b\u59cb\u3057\u305f\u7fa420\u75c7\u4f8b\u306812 \u30ab\u6708\u4ee5\u5185\u306b\u6cbb\u7642\u3092\u958b\u59cb\u3057\u305f\u7fa420\u75c7\u4f8b\u3067\u306f\u30013\u304b\u6708\u4ee5\u5185\u306b\u6cbb\u7642\u3092\u958b\u59cb\u3057\u305f\u7fa4\u306e\u65b9\u304c3\u5e74\u9593\u306e\u8ffd\u8de1\u3067\u8457\u660e\u306b\u81e8\u5e8a\u75c7\u72b6\u3001\u30ec\u30f3\u30c8\u30b2\u30f3\u6240\u898b\u3067\u52b9\u679c\u304c\u3042\u3063\u305f\u3002\u3053\u308c\u3089\u306e\u767a \u898b\u306f\u3068\u3066\u3082\u671f\u5f85\u3067\u304d\u308b\u7d50\u679c\u3067\u3042\u3063\u305f\u304c\u3001\u4eca\u5f8c\u3057\u3063\u304b\u308a\u3068\u3057\u305f\u5927\u898f\u6a21RCT\u304c\u671b\u307e\u308c\u308b\u3002<\/p>\n

Barriers to change
\n\u3000\u30ea\u30a6\u30de\u30c1 \u60a3\u8005\u306e\u3046\u3061\u30013\u304b\u6708\u4ee5\u5185\u306b\u30ea\u30a6\u30de\u30c1\u5c02\u9580\u533b\u3092\u53d7\u8a3a\u3059\u308b\u5272\u5408\u306f\u7d04\u534a\u5206\u3067\u3042\u308a\u3001\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u660e\u78ba\u306a\u8a3a\u65ad\u30af\u30e9\u30a4\u30c6\u30ea\u30a2\u304c\u306a\u3044\u305f\u3081\u3001\u65e9\u671f\u8a3a\u65ad\u306f\u3059\u3079\u3066\u306e\u533b\u8005\u306b\u3068\u3063 \u3066\u30c1\u30e3\u30ec\u30f3\u30b8\u30f3\u30b0\u306a\u3082\u306e\u3067\u3042\u308b\u3002\u591a\u304f\u306e\u60a3\u8005\u306e\u95a2\u7bc0\u75db\u304c\u9593\u6b20\u75db\u3067\u3042\u3063\u305f\u308a\u3001\u4ed6\u65b9\u3067\u306fNSAIDS\u306b\u3088\u3063\u3066\u30de\u30b9\u30af\u3055\u308c\u3066\u3044\u308b\u3002\u3057\u304b\u3057\u3001\u8fd1\u5e74\u6297CCP\u6297\u4f53\u306a\u3069\u306e \u3088\u3046\u306b\u591a\u304f\u306e\u81e8\u5e8a\u75c7\u72b6\u304c\u51fa\u73fe\u3059\u308b\u524d\u306b\u6709\u52b9\u306a\u691c\u67fb\u304c\u958b\u767a\u3055\u308c\u3066\u3044\u308b\u3002<\/p>\n

Hou should we change our practice?
\n\u708e\u75c7\u6027\u95a2\u7bc0\u75be\u60a3\u304c\u7591\u308f\u308c\u305f\u308a\u3001\u7dca\u6025\u3067\u30ea\u30a6\u30de\u30c1\u5c02\u9580\u533b\u3078\u306e\u7d39\u4ecb\u304c\u8003\u3048\u3089\u308c\u308b\u60a3\u8005\u306b\u304a\u3044\u3066\u306f\u3001\u708e\u75c7\u6027\u95a2\u7bc0\u75be\u60a3\u304c\u3042\u308b\u304b\u3069\u3046\u304b\u3092\u660e\u78ba\u306b\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002\u3053\u308c\u306f\u3001\u30ea\u30a6\u30de\u30c1\u56e0\u5b50\u3084\u30ec\u30f3\u30c8\u30b2\u30f3\u5199\u771f\u3067\u3057\u3070\u3057\u3070\u6b63\u5e38\u306e\u5834\u5408\u304c\u3042\u308b\u305f\u3081\u3001\u3053\u308c\u3089\u306e\u7d50\u679c\u3092\u5f85\u305f\u305a\u306b\u884c\u308f\u308c\u308b\u3079\u304d\u3067\u3042\u308b\u3002<\/p>\n

\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u8a3a\u65ad\uff082009 ACR\/EULAR\u5171\u540c\u63d0\u6848\uff09<\/p>\n

\"100623\"<\/a><\/p>\n

\u3010\u958b\u50ac\u65e5\u3011
\n\uff12\uff10\uff11\uff10\u5e74\uff16\u6708\uff12\uff13\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u3010\u6587\u732e\u540d\u3011 \uff08\uff11\uff09\u3000Patients with suspected rheumatoid arthritis should be referred early to rheumatology. BMJ 2008;336: … \u7d9a\u304d\u3092\u8aad\u3080 \uff5e\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u65e9\u671f\u8a3a\u7642\uff5e<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-778","post","type-post","status-publish","format-standard","hentry","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/778","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=778"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/778\/revisions"}],"predecessor-version":[{"id":780,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/778\/revisions\/780"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=778"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=778"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=778"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}