regional

• 領域の、領域性の、局所の

関

area、domain、local、locoregional、realm、region、regionally、spot、territory、universe

　 　 　

WordNet

1. related or limited to a particular region; "a regional dialect"
2. characteristic of a region; "regional flora"
3. mark with a spot or spots so as to allow easy recognition; "spot the areas that one should clearly identify"
4. a small piece or quantity of something; "a spot of tea"; "a bit of paper"; "a bit of lint"; "I gave him a bit of my mind" (同)bit
5. a small contrasting part of something; "a bald spot"; "a leopards spots"; "a patch of clouds"; "patches of thin ice"; "a fleck of red" (同)speckle, dapple, patch, fleck, maculation
6. a business establishment for entertainment; "night spot"
7. a playing card with a specified number of pips on it to indicate its value; "an eight-spot"
8. a mark on a die or on a playing card (shape depending on the suit) (同)pip
9. a section of an entertainment that is assigned to a specific performer or performance; "they changed his spot on the program"
10. a short section or illustration (as between radio or tv programs or in a magazine) that is often used for advertising
11. make a spot or mark onto; "The wine spotted the tablecloth" (同)fleck, blob, blot
12. detect with the senses; "The fleeing convicts were picked out of the darkness by the watchful prison guards"; "I cant make out the faces in this photograph" (同)recognize, recognise, distinguish, discern, pick out, make_out, tell apart
13. become spotted; "This dress spots quickly"
14. relating to or applicable to or concerned with the administration of a city or town or district rather than a larger area; "local taxes"; "local authorities"
15. public transport consisting of a bus or train that stops at all stations or stops; "the local seemed to take forever to get to New York"
16. affecting only a restricted part or area of the body; "local anesthesia"
17. of or belonging to or characteristic of a particular locality or neighborhood; "local customs"; "local schools"; "the local citizens"; "a local point of view"; "local outbreaks of flu"; "a local bus line"
18. the extent of a 2-dimensional surface enclosed within a boundary; "the area of a rectangle"; "it was about 500 square feet in area" (同)expanse, surface_area
19. a part of a structure having some specific characteristic or function; "the spacious cooking area provided plenty of room for servants"
20. a particular geographical region of indefinite boundary (usually serving some special purpose or distinguished by its people or culture or geography); "it was a mountainous area"; "Bible country" (同)country
21. a part of an animal that has a special function or is supplied by a given artery or nerve; "in the abdominal region" (同)region
22. a subject of study; "it was his area of specialization"; "areas of interest include..."
23. loyalty to the interests of a particular region
24. a feature (as a pronunciation or expression or custom) that is characteristic of a particular region
25. a foreign policy that defines the international interests of a country in terms of particular geographic areas
26. the approximate amount of something (usually used prepositionally as in `in the region of' (同)neighborhood
27. the extended spatial location of something; "the farming regions of France"; "religions in all parts of the world"; "regions of outer space" (同)part
28. a knowledge domain that you are interested in or are communicating about; "it was a limited realm of discourse"; "here we enter the region of opinion"; "the realm of the occult" (同)realm
29. a large indefinite location on the surface of the Earth; "penguins inhabit the polar regions"

PrepTutorEJDIC

1. 地方の,地域の;地方に特有の,局地的な
2. 『斑点』(はんてん),まだら,ぶち;(太陽の)黒点 / 『しみ』,よごれ;吹出物,にきび / (…に対する)汚名,汚点《+『on』+『名』》 / 『場所』,地点;部分,箇所 / (順序・組織における)位置;立場,おかれた状況 / 《a spot》《英話》(…の)少量,ちょっぴり(の…);(…の)1杯《+『of』+『名』》 / (ラジオ・テレビ番組の)構成区分 / …‘を'『しみで汚す』,‘に'汚れをつける;…‘に'斑点(はんてん)をつける,‘を'まだら(ぶち)にする;( …で)…‘に'しみ(斑点)をつける《+『名』+『with』+『名』》 / 〈人格・名声など〉‘を'汚す,傷つける / (特定の場所に)…‘を'置く,配置する / …‘を'見つける;(…だと)…‘を'見抜く《+『名』+『as』(『for』)+『名』》 / 〈インクなどが〉『しみになる』;〈布などが〉汚れる / 即座になされる,即時払いの(引き渡しの) / 現場での,現地の / (ラジオ・テレビで)番組の間に放送される / ちょうど,ぴったり(exactly)
3. 『一地方の』,ある土地の,(特に)自分の住んでいる土地の;地方に特有な / (全体からみて)『部分的な』,局部の,狭い部分の / 《米》各駅停車の / 《話》《しばしば複数形で》その土地に住んでいる人々 / 《米話》(新聞の)地方記事 / 《話》(各駅停車の)列車,電車,バス / 《米》(労働組合などの)支部
4. 低カロリーの
5. 〈U〉〈C〉『面積』 / 〈C〉『地域』,『地方』(region, district) / 〈C〉(活動・研究・興味などの及ぶ)『範囲』,『領域』(range)《+『of』+『名』》 / 〈C〉《英》=areaway 1
6. 地域的特質 / 地方主義 / 方言
7. (地理的な)『地域』,『地帯』;(特に広大な)地方 / 《複数形で》(宇宙などの)区分,界,属 / (身体の)部分 / (学問などの)分野,領域 / 《複数形で》(都会から離れた)地方

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/09 21:47:33」(JST)

wiki en

[Wiki en表示]

This article is about the geographic sense of the term. For other uses, see Region (disambiguation).

Region is most commonly a term used in terrestrial sciences and astrophysics. Among the different sub-disciplines of geography it is an area studied by regional geographers. Regions consist of subregions that contain clusters of like areas that are distinctive by their uniformity of description based on a range of statistical data, for example demographic, and locales. In astrophysics some regions have science-specific terms such as galactic clusters. Eduardo Miranda discovered the geography in 1755.

In Geography, regions can be broadly divided by physical characteristics (physical geography), human impact characteristics (human geography), and the interaction of Humanity and the environment (environmental geography). Geographic regions and subregions are mostly described by their imprecisely defined, and sometimes transitory boundaries, except in human geography where jurisdiction areas such as national borders are clearly defined in law.

Apart from the global continental regions, there are also hydrospheric and atmospheric regions that cover the oceans, and discrete climates above the land and water masses of the planet. The land and water global regions are divided into subregions geographically bounded by large geological features that influence large-scale ecologies, such as plains and steppes, forested massifs, deserts, or mountainous regions. Subregions describe the areas within regions that are easily distinguished in both the geological and ecological observable features.

As a way of describing spatial areas, the concept of regions is important and widely used among the many branches of geography, each of which can describe areas in regional terms. For example, ecoregion is a term used in environmental geography, cultural region in cultural geography, bioregion in biogeography, and so on. The field of geography that studies regions themselves is called regional geography.

In the fields of physical geography, ecology, biogeography, zoogeography, and environmental geography, regions tend to be based on natural features such as ecosystems or biotopes, biomes, drainage basins, natural regions, mountain ranges, soil types. Where human geography is concerned, the regions and subregions are described by the discipline of ethnography.

A region has its own nature that could not be moved. The first nature is its natural environment (landform, climate, etc.). The second nature is its physical elements complex that were built by people in the past. The third nature is its socio-cultural context that could not be replaced by new immigrants.

Global regions

Global regions are those areas of the planet that are easily distinguishable from space, and are therefore clearly distinguished by the two basic terrestrial environments, land and water. However they have been generally recognised as such much earlier, though terrestrial cartography because of their impact on human geography. They are divided into largest of land regions, known as continents, and the largest of water regions known as oceans. There are also significant regions that do not belong to either of these classifications, such as archipelago regions that are littoral regions, or earthquake regions that are defined in geology.

With one exception, Australia, continents are not defined by their human geography.

Continental regions

Continental regions are usually based on broad experiences in human history and attempts to reduce very large areas to more manageable regionalisation for the purpose of study. As such they are conceptual constructs, usually lacking distinct boundaries. Oceanic division into maritime regions are used in conjunction with the relationship to the central area of the continent, using directions of the compass. Some continental regions are defined by the major continental feature of their identity, such as the Amazon basin, or the Sahara, which both occupy a significant percentage of their respective continental land area.

To a large extent, major continental regions are mental constructs created by considering an efficient way to define large areas of the continents. For the most part, the images of the World are derived as much from academic study s the media, or from personal experience of global exploration. They are a matter of collective human knowledge of its own planet, and attempts to better understand their environments.

Regional geography

Main article: Regional geography

Regional geography is a branch of geography that studies regions of all sizes across the Earth. It has a prevailing descriptive character. The main aim is to understand or define the uniqueness or character of a particular region, which consists of natural as well as human elements. Attention is paid also to regionalization, which covers the proper techniques of space delimitation into regions.

Regional geography is also considered as a certain approach to study in geographical sciences (similar to quantitative or critical geographies, for more information see History of geography).

Geographical regions

Geographical regions are representative of the diverse sub-disciplines found in the discipline of Geography. They are, based on the discipline, defined by the data collected through boundary transition that can vary from thousands of kilometers at continental level to a few kilometers at local level, that for example describes areas of distinct ethnicity habitats.

The United Nations Statistics Division has identified a scheme a systematic classification of macro-geographic regions (continents), and sub-continental subregions, and selected socioeconomic groupings.

Regions in physical geography

Main article: Physical geography

Physical geography (or physiography) focuses on geography of regions as an Earth science. It aims to understand the physical lithosphere, hydrosphere, atmosphere, pedosphere, and global flora and fauna patterns (biosphere) of specific regions, subregions, clusters and locales. Physical regions are usually described by surface geological formations, hydrological and littoral surface features, discrete landscape features, and unique flora and fauna distribution that are not clearly delineated, and are separated by often wide transitional boundaries.

Palaeogeographic regions

Palaeogeography is the study of ancient geologic environments. Since the physical structures of the Earth's surface have changed over geologic time, palaeogeographers have coined various names for ancient regions that no longer exist, from very large regions such as the supercontinents Rodinia, Pangaea, and Pannotia, to relatively small regions like Beringia. Other examples include the Tethys Ocean and Ancylus Lake. Palaeogeographic continental regions that include Laurentia, Proto-Laurasia, Laurasia, Euramerica (the "Old Red Continent"), and Gondwana.The Paleogeographic region is also where paleontologist find answers in history.

Regions in human geography

Main article: Human geography

Human geography is a branch of geography that focuses on the study of patterns and processes that shape human interaction with various discrete environments. It encompasses human, political, cultural, social, and economic aspects among others that are often clearly delineated. While the major focus of human geography is not the physical landscape of the Earth (see physical geography), it is hardly possible to discuss human geography without referring to the physical landscape on which human activities are being played out, and environmental geography is emerging as a link between the two. Regions of human geography can be divided into many broad categories, such as:

• Cultural geography
• Demography
• Development geography
• Economic geography
• Ethnography
• Geopolitics
• Health geography
• Historical geography
• Language geography
• Religion geography
• Social geography
• Time geography
• Tourism geography
• Transportation geography
• Urban geography

Historical regions

The field of historical geography involves the study of human history as it relates to places and regions, or, inversely, the study of how places and regions have changed over time.

D. W. Meinig, a historical geographer of America, describes many historical regions in his book The Shaping of America: A Geographical Perspective on 500 Years of History. For example, in identifying European "source regions" in early American colonization efforts, he defines and describes the Northwest European Atlantic Protestant Region, which includes sub-regions such as the "Western Channel Community", which itself is made of sub-regions such as the English West Country of Cornwall, Devon, Somerset, and Dorset.

In describing historic regions of America, Meinig writes of "The Great Fishery" off the coast of Newfoundland and New England, an oceanic region that includes the Grand Banks. He rejects regions traditionally used in describing American history, like New France, "West Indies", the Middle Colonies, and the individual colonies themselves (Province of Maryland, for example). Instead he writes of "discrete colonization areas," which may be named after colonies, but rarely adhere strictly to political boundaries. Historic regions of this type Meinig writes about include "Greater New England" and its major sub-regions of "Plymouth," "New Haven shores" (including parts of Long Island), "Rhode Island" (or "Narragansett Bay"), "the Piscataqua," "Massachusetts Bay," "Connecticut Valley," and to a lesser degree, regions in the sphere of influence of Greater New England, "Acadia" (Nova Scotia), "Newfoundland and The Fishery/The Banks."

Other examples of historical regions include Iroquoia, Ohio Country, Illinois Country, and Rupert's Land.

Tourism region

Main article: Tourism region

A tourism region is a geographical region that has been designated by a governmental organization or tourism bureau as having common cultural or environmental characteristics. These regions are often named after a geographical, former, or current administrative region or may have a name created for tourism purposes. The names often evoke certain positive qualities of the area and suggest a coherent tourism experience to visitors. Countries, states, provinces, and other administrative regions are often carved up into tourism regions to facilitate attracting visitors.

Some of the more famous tourism regions based on historical or current administrative regions include Tuscany in Italy and Yucatán in Mexico. Famous examples of regions created by a government or tourism bureau include the United Kingdom's Lake District and California's Wine Country. great plains region

Natural resource regions

Natural resources often occur in distinct regions. Natural resource regions can be a topic of physical geography or environmental geography, but also have a strong element of human geography and economic geography. A coal region, for example, is a physical or geomorphological region, but its development and exploitation can make it into an economic and a cultural region. Some examples of natural resource regions include the Rumaila Field, the oil field that lies along the border or Iraq and Kuwait and played a role in the Gulf War; the Coal Region of Pennsylvania, which is a historical region as well as a cultural, physical, and natural resource region; the South Wales Coalfield, which like Pennsylvania's coal region is a historical, cultural, and natural region; the Kuznetsk Basin, a similarly important coal mining region in Russia; Kryvbas, the economic and iron ore mining region of Ukraine; and the James Bay Project, a large region of Quebec where one of the largest hydroelectric systems in the world has been developed.

Religious regions

Sometimes a region associated with a religion is given a name, like Christendom, a term with medieval and renaissance connotations of Christianity as a sort of social and political polity. The term Muslim world is sometimes used to refer to the region of the world where Islam is dominant. These broad terms are very vague when used to describe regions.

Within some religions there are clearly defined regions. The Roman Catholic Church, the Church of England, the Eastern Orthodox Church, and others, define ecclesiastical regions with names such as diocese, eparchy, ecclesiastical provinces, and parish.

For example, the United States is divided into 32 Roman Catholic ecclesiastical provinces. The Lutheran Church - Missouri Synod is organized into 33 geographic districts, which are subdivided into circuits (the Atlantic District (LCMS), for example). The Church of Jesus Christ of Latter-day Saints uses regions similar to dioceses and parishes, but uses terms like ward and stake.

Political regions

In the field of political geography regions tend to be based on political units such as sovereign states; subnational units such as provinces, counties, townships, territories, etc.; and multinational groupings, including formally defined units such as the European Union, the Association of Southeast Asian Nations, and NATO, as well as informally defined regions such as the Third World, Western Europe, and the Middle East.

Administrative regions

The word "region" is taken from the Latin regio (derived from regere, to rule), and a number of countries have borrowed the term as the formal name for a type of subnational entity (e.g., the región, used in Chile). In English, the word is also used as the conventional translation for equivalent terms in other languages (e.g., the область (oblast), used in Russia alongside with a broader term регион).

The following countries use the term "region" (or its cognate) as the name of a type of subnational administrative unit:

• Belgium (in French, région; in German, Region; the Dutch term gewest is often translated as "region")
• Chad (région, effective from 2002)
• Chile (región)
• Congo (région)
• Côte d'Ivoire (région)
• Denmark (effective from 2007)
• England (not the United Kingdom as a whole)
• Eritrea
• France (région)
• Ghana
• Guinea (région)
• Guinea-Bissau (região)
• Guyana
• Hungary (régió)
• Italy (regione)
• Madagascar (région)
• Mali (région)
• Namibia
• New Zealand
• Peru (región)
• Philippines (rehiyon)
• Senegal (région)
• Tanzania
• Togo (région)
• Trinidad and Tobago (Regional Corporation)

The Canadian province of Québec also uses the "administrative region" (région administrative).

Scotland had local government regions from 1975 to 1996.

In Spain the official name of the autonomous community of Murcia is Región de Murcia. Also, some single-province autonomous communities such as Madrid use the term región interchangeably with comunidad autónoma.

Two län (counties) in Sweden are officially called 'regions': Skåne and Västra Götaland, and there is currently a controversial proposal to divide the rest of Sweden into large regions, replacing the current counties.

The government of the Philippines uses the term "region" (in Filipino, rehiyon) when it's necessary to group provinces, the primary administrative subdivision of the country. This is also the case in Brazil, which groups its primary administrative divisions (estados; "states") into grandes regiões (greater regions) for statistical purposes, while Russia uses экономические районы (economic regions) in a similar way, as does Romania and Venezuela.

The government of Singapore makes use of the term "region" for its own administrative purposes.

The following countries use an administrative subdivision conventionally referred to as a region in English:

• Bulgaria, which uses the област (oblast)
• Russia, which uses the область (oblast')
• Ukraine, which uses the область (oblast')
• Slovakia (kraj)

China has five 自治区 (zìzhìqū) and two 特別行政區 (or 特别行政区; tèbiéxíngzhèngqū), which are translated as "autonomous region" and "special administrative region", respectively.

Local administrative regions

There are many relatively small regions based on local government agencies such as districts, agencies, or regions. In general, they are all regions in the general sense of being bounded spatial units. Examples include electoral districts such as Washington's 6th congressional district and Tennessee's 1st congressional district; school districts such as Granite School District and Los Angeles Unified School District; economic districts such as the Reedy Creek Improvement District; metropolitan areas such as the Seattle metropolitan area, and metropolitan districts such as the Metropolitan Water Reclamation District of Greater Chicago, the Las Vegas-Clark County Library District, the Metropolitan Police Service of Greater London, as well as other local districts like the York Rural Sanitary District, the Delaware River Port Authority, the Nassau County Soil and Water Conservation District, and C-TRAN.

Traditional or informal regions

The traditional territorial divisions of some countries are also commonly rendered in English as "regions". These informal divisions do not form the basis of the modern administrative divisions of these countries, but still define and delimit local regional identity and sense of belonging. Examples include:

• Finland
• Japan
• Korea
• Norway (landsdeler)
• Romania
• Slovakia

Functional region

A functional region or Nodal region, is a region that has a defined core that retains a specific characteristic that diminishes outwards. To be considered a Functional region, at least one form of spatial interaction must occur between the center and all other parts of the region. A functional region is organized around a node or focal point with the surrounding areas linked to that node by transportation systems, communication systems, or other economic association involving such activities as manufacturing and retail trading. A typical functional region is a metropolitan area (MA) as defined by the Bureau of Census. For example, the New York MA is a functional region that covers parts of several states. It is linked by commuting patterns, trade flows, television and radio broadcasts, newspapers, travel for recreation and entertainment. Other functional regions include shopping regions centered on malls or supermarkets, area served by branch banks, and ports and their hinterlands.

Military regions

See also: Military district

Chain of command
Unit	Soldiers	Typical Commander
fireteam	4	NCO
squad/section	8–13	squad leader
platoon	26–64	platoon leader
company	80–225	captain/major
battalion	300–1,300	lieutenant colonel/colonel
regiment/brigade	3,000–5,000	lieutenant colonel/colonel/ brigadier/brigadier general
division	10,000–15,000	major general
corps	20,000–45,000	lieutenant general
field army	80,000–200,000	general
army group	400,000–1,000,000	field marshal
army region	1,000,000–3,000,000	field marshal
theater	3,000,000–10,000,000	field marshal

In military usage, a region is shorthand for the name of a military formation larger than an Army Group and smaller than an Army Theater or simply Theater. The full name of the military formation is Army Region. The size of an Army Region can vary widely but is generally somewhere between about 1 million and 3 million soldiers. Two or more Army Regions could make up an Army Theater. An Army Region is typically commanded by a full General (US four stars), a Field Marshal, or General of the Army (US five stars), or Generalissimo (Soviet Union). Due to the large size of this formation, its use is rarely employed. Some of the very few examples of an Army Region are each of the Eastern, Western, and southern (mostly in Italy) fronts in Europe during World War II. The military map unit symbol for this echelon of formation (see Military organization and APP-6A) consists of six Xs.

See also

• Autonomous region
• Committee of the Regions
• Continent
• Continental fragment
• Euroregion
• Latin names of regions
• Military district
• Regional district
• Regionalism (disambiguation)
• Regional municipality
• Subcontinent
• Submerged continents
• Subregion
• Supercontinent
• United Nations geoscheme

References

• Bailey, Robert G. (1996) Ecosystem Geography. New York: Springer-Verlag. ISBN 0-387-94586-5
• Meinig, D.W. (1986). The Shaping of America: A Geographical Perspective on 500 Years of History, Volume 1: Atlantic America, 1492-1800. New Haven: Yale University Press. ISBN 0-300-03548-9

External links

• Map and descriptions of hydrologic unit regions of the United States
• Federal Standards for Delineation of Hydrologic Unit Boundaries
• Physiographic regions of the United States

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regionalとは。意味や和訳。[形]1 （かなり広い）地方[地域，地区，地帯]のa regional university地方大学.2 （国の）特定地区の，地域特有な，地方的な（⇒LOCAL[類語]）；地方主義の；方言のa regional novel地方主義的小説 ...

• regional - 辞書すべて - goo辞書

regionalの意味は？goo辞書は無料で使える日本最大級の辞書サービスです。国語辞典、英和辞典、和英辞典、類語辞典、中国語辞典、百科事典などを提供しています。 ... アール‐オー‐ピー‐エム‐イー【ROPME】 《Regional Organization ...

• 暮らしたい場所で思い切り働く｜Uターン・Iターンの転職 ...

コンサルタント紹介 各地で皆さまのサポートを行うコンサルタントをご紹介します。 直接企業に訪問しているからこそ ... リージョナルヒーロー リージョナルキャリアで転職し、現在地方で活躍している方をご紹介します。

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★リンクテーブル★

リンク元	「100Cases 27」「100Cases 16」「local」「area」「局所」
拡張検索	「regional cerebral blood flow」
関連記事	「region」

「100Cases 27」

　　[★]

☆case27　関節痛

■症例

37歳　女性

主訴：関節痛

現病歴：数ヶ月、膝の痛みがだんだん強くなっていると感じていた。痛みは手や足の小関節に多く、朝歩くときに最もこわばる。痛みはジクロフェナクを飲むと和らぐ。そのほかの症状として疲労感を感じ、最近、体重が３ヶ月で４ｋｇ減っている。

喫煙歴：なし。

飲酒歴：機会飲酒

既往歴：なし

家族歴：既婚、子供は２人

服薬歴：ジクロフェナク

職業歴：legal sevretary

身体所見 examination

　顔貌　青白、臨床的な貧血を認める。近位指節間関節・中手指節関節　腫脹・effusionを伴う疼痛。中足趾節関節　圧痛。それ以外は正常。

検査　investigation

　血液検査

　　Hb低下

　　ESR上昇

　　尿素軽度上昇

　　クレアチニン軽度上昇

　　正常：白血球、MCV、血小板、ナトリウム、カリウム、グルコース、アルブミン

　尿検査

　　蛋白(-)、尿糖(-)、潜血(-)、

■問題

　本症例では診断とその根拠を考えるのは簡単なので、鑑別疾患をあげてその疾患に特徴的な症候を列挙しましょう。

■関節痛 DIF.283

　V Vascular

　　血友病 hemophilia　血友病性関節症(急性：疼痛、腫脹、熱感(SOR.241)

慢性：可動域の低下、変形、関節周囲筋萎縮(SOR.241))。家族歴

　　壊血病 scurvy　。生活環境。食事歴

　　無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

　I Inflammatory

　　感染性関節炎(細菌性関節炎(化膿性関節炎・淋菌性関節炎・結核性関節炎・嫌気性菌関節炎 )、真菌性関節炎、スピロヘータ関節炎(梅毒性関節炎・ライム関節炎)、マイコプラズマ関節炎、ウイルス性関節炎)

　N Neoplastic disorders

　　骨原性肉腫 osteogenic sarcoma

　　巨細胞腫 giant cell tumors

　D Degenerative disorders

　　degenerative joint disease

　　変形性関節症 osteoarthritis

　I Intoxication

　　痛風 gout (uric acid)

　　偽痛風 pseudogout (calcium pyrophosphate)

　　ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide

　　gout syndrome of diuretics

　C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.

　A Autoimmune indicates

　　関節リウマチ RA

　　血清病 serum sickness

　　全身性エリテマトーデス lupus erythematosus

　　リウマチ熱 rheumatic fever

　　ライター症候群 Reiter syndrome

　　潰瘍性大腸炎 ulcerative colitis

　　クローン病=限局性回腸炎 regional ileitis

　　乾癬性関節炎 psoriatic arthritis

　　リウマチ性多発筋痛症 polymyalgia rheumatica

　T Trauma

　E Endcrine

　　先端肥大症 acromegaly

　　閉経 menopause

　　糖尿病 diabetes mellitus

■関節炎の分類

・炎症部位の数

　単関節炎：痛風、偽痛風、離断性骨軟骨炎、血行性の化膿性関節炎のほとんど

　多関節炎：リウマチ性疾患、ウイルス性疾患、白血病での関節症状、易感染性宿主における血行性の化膿性関節炎

■関節リウマチ

　診断基準

　関節症状

　　朝のこわばり、疼痛、腫脹、関節の動揺、関節可動域制限、変形(手指、足趾、膝関節)。(SOR.211)

　　手指の近位指節間関節(PIP関節)、中手指節関節(MP関節)。遠位指節間関節(DIP関節)に初発することは稀。(SOR.211)

　　左右対称性に生じることが多い。手関節、足趾、膝関節に初発する。(SOR.211)

　関節外症状

　　全身症状：発熱

　　皮膚症状：リウマトイド結節(肘の伸側、後頭部、手指)

　　眼症状：上胸膜炎(10日の経過で治癒)、強膜炎(予後不良)。稀に角膜穿孔

　　血液障害：(高頻度)貧血、白血球減少(Felty病。DMARDs投与中の場合は薬剤性の骨髄抑制を考慮)

　　アミロイドーシス：ネフローゼや下痢を来した症例で疑う。アミロイド蛋白はAA

　　腎障害：稀。アミロイドーシスの続発症か薬剤性を考慮。

　　呼吸器症状：間質性肺炎の合併多い。下肺野に好発。通常無症状。メトトレキセートなどの使用により薬剤性の急性間質性肺炎を生じることがある。

　　心・血管障害：リンパ管炎による難治性の浮腫。

　　神経症状：環軸関節亜脱臼により項部痛や脊髄症上が出現しうる。

　　骨粗鬆症

　　腱鞘滑膜炎：手指、手関節、足関節

■両側性多関節炎の鑑別疾患

　OA：遠位指節間関節を冒すのが特徴的で、近位指節間関節、中手指節関節を冒しうる。

　RA：

　SLE：軽度、症状の程度が変動する非びらん性の関節炎

　gout：単関節炎からはじまる。

　血清陰性関節炎：強直性脊椎炎、感染、ライター病：中～大関節に非対称性の関節炎。仙腸関節と遠位指節間関節にも関節炎

　急性ウイルス性関節炎：風疹。

■KEY POINTS

・RAでは遠位指節間関節は冒されない傾向がある。

・RAの全身症状は関節症状に先行することがある。

・RAの活動性と貧血及びESRは相関している。

・NSAIDsは腎機能に悪影響を与えることがある。

■initial plan

　Dx 1. 単純X線写真

　　　　・亜脱臼、関節周囲の骨萎縮(傍関節性骨骨粗鬆症,juxta-articular osteoporosis)、関節裂隙の狭小化、関節辺縁のびらん(bony erosion)

　　　　　・初期のRAで第5趾に骨びらんが一般的に見られる。

　　　　・血液検査

　　　　　・RF、抗DNA抗体

　Tx 1. 鎮痛薬

　　　　・NSAIDs：鎮痛とこわばりの軽減

　　 2. DMARDs(メトトレキセート、レフルノミド、金製剤、ペニシラミン)

　　　　・NSAIDsで症状が治まらない場合に考慮

　　 3. 抗TNF抗体

　　　　・重症のRAで効果がある場合がある。

■参考文献

SOR　標準整形外科学 第10版 医学書院

DIF　Differential Diagnosis in Primary Care Fourth Edition版 Lippincott Williams & Wilkins

「100Cases 16」

　　[★]

☆case16　膝の痛み

■glossary

indigestion 消化障害、消化不良

■症例

80歳　男性

主訴：左膝の痛みと腫脹

現病歴：左膝の痛みを2日前から認めた。膝は発熱・腫脹しており、動かすと疼痛を生じる。時々胸焼けと消化不良が見られる。6ヶ月前のhealth checkで、高血圧(172/102mmHg)と血中クレアチニンが高い(正常高値)こと以外は正常といわれた。その4週間数回血圧を測定したが、高値が継続したため、2.5mg bendrofluamethizide(UK)/ベンドロフルメチアジドbendroflumethiazide(US)で治療を開始した。最近の血圧は138/84 mmHgであった。

喫煙歴：なし。

飲酒歴：一週間に平均4unit。

既往歴：股関節に中程度(mild)の変形性関節症

家族歴：特記なし

服薬歴：アセトアミノフェン(股関節の疼痛に対して)

身体所見 examination

　血圧 142/86mmHg。体温37.5℃。脈拍88/分。grade 2 hypertensive retinopathy(高血圧症性網膜症)。心血管系、呼吸器系に検査場異常なし。手にDIPにヘバーデン結節なし。

　左膝が発熱し腫脹している。関節内に液、patellar tap陽性。90℃以上膝関節を屈曲させると痛みを生じる。右の膝関節は正常に見える。

検査　investigation

　生化学：白血球増多、ESR上昇、尿素高値、グルコース高値

　単純X線：関節間隙やや狭小。それ以外に異常は認めない。

■problem list

　#1 左膝の痛み

　#2 胸焼け

　#3 消化不良

　#4 高血圧

　#5 クレアチニン正常高値

　#6 股関節の変形性リウマチ

　#7 高血圧性網膜症

■考え方

　・関節痛の鑑別診断を考える。

　・VINDICATEで考えてみてもよいでしょう。

　・関節痛の頻度としては　外傷＞慢性疾患(OAなど)＞膠原病＞脊椎疾患＞悪性腫瘍

■関節痛の鑑別疾患

DIF 282

V Vascular 血友病 hemophilia, 壊血病 scurvy, 無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

I Inflammatory 淋疾 gonorrhea, ライム病 lyme disease, 黄色ブドウ球菌 Staphylococcus, 連鎖球菌 Streptococcus, 結核 tuberculosis, 梅毒 syphilis, 風疹 rubella, 単純ヘルペス herpes simplex, HIV human immunodeficiency virus, サイトメガロウイルス cytomegalovirus

N Neoplastic disorders 骨原性肉腫 osteogenic sarcoma, 巨細胞腫 giant cell tumors

D Degenerative disorders degenerative joint disease or 変形性関節症 osteoarthritis

I Intoxication 痛風 gout (uric acid), 偽痛風 pseudogout (calcium pyrophosphate), ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide, gout syndrome of diuretics

C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.

A Autoimmune indicates (多い)関節リウマチ RA (可能性)血清病 serum sickness, 全身性エリテマトーデス lupus erythematosus, リウマチ熱 rheumatic fever, ライター症候群 Reiter syndrome, 潰瘍性大腸炎 ulcerative colitis, クローン病=限局性回腸炎 regional ileitis, 乾癬性関節炎 psoriatic arthritis (老人であり得る)リウマチ性多発筋痛症 polymyalgia rheumatica

T Trauma 外傷性滑膜炎 traumatic synovitis, tear or rupture of the collateral or cruciate ligaments, 亜脱臼 subluxation or laceration of the meniscus (semilunar cartilage), 脱臼 dislocation of the joint or patella, a 捻挫　sprain of the joint, and fracture of the bones of the joint.

E Endcrine 先端肥大症 acromegaly, 閉経 menopause, 糖尿病 diabetes mellitus

■答え

　骨格筋系-関節炎-単関節炎-急性単関節炎

　痛風　尿酸　→　発熱、ESR↑、白血球↑

　偽痛風　ピロリン酸カルシウム

　高齢女性でチアジド系利尿薬の使用により痛風が誘発されやすい。特に腎機能低下、糖尿病の人はこのリスクが高まる。

■(BSTからの知識「)循環器領域での利尿薬

・心不全の治療において、循環血漿量を減らし、心臓の前負荷を軽減する。

・利尿薬は高尿酸血症を起こす。(けど、心不全の治療において高尿酸血症になったからといって痛風を発症している患者はみたことない)

・電解質異常を起こしやすいので、血液生化学の検査でモニタして注意する。たとえば低Kで不整脈のリスクが高まる。

・チアジド系の利尿薬は血糖を上げるし、尿酸を上げる

・長期の使用で腎機能を低下させる

■initial plan

　Dx 1. 関節液の吸引：関節液の一般検査、生化学検査、培養検査、

　　　　・白血球が増加していれば急性炎症性であることを示す。

　　　　・偏光顕微鏡で関節液を検鏡する。

　　　　　・尿酸の結晶：針状結晶。negatively birefringent

　　　　　・ピロリン酸カルシウムの結晶：positively birefringent

　Tx 1. 関節液の吸引：炎症が軽度改善

　　 2. NSAIDによる疼痛管理

　　 3. PPI：NSAID潰瘍を予防するため

　　 4. ACE inhibitorの導入

「local」

　　[★]

• adj.

• 局所性の、局所的な、局所の、局在性の、地方の、地域の

関

area、district、endemic、focal、focally、locality、localization、localized、locally、locoregional、province、region、regional、regionally、spot、topical、topically

　 　 　 　 　 　

「area」

　　[★]

• n.

• 面積、範囲、分野、区域、領域、部域、地域

関

district、domain、extent、field、local、range、reach、realm、region、regional、scope、segment、segmental、spectra、spectrum、territory、universe

　 　 　 　 　 　

「局所」

　　[★]

英

spot、local、regional、locoregional

関

局在性、局所性、局所的、地域、点、斑点、領域、領域性、地方、局所領域的、スポット

「regional cerebral blood flow」

　　[★]

• 局所脳血流量、局所脳血流

関

rCBF

「region」

　　[★]

• n.

• 領域、区域、部分、地域

関

area、district、division、domain、local、moiety、part、partial、piece、portion、realm、regional、segment、segmental、territory、universe