译者:梁娜娜 校对:杨艳丽 审核:张莉芸
Abstract:Polymyalgia rheumatica (PMR) is a common inflammatory condition that often affects people over the age of 50 years. Characteristic symptoms are shoulder and hip girdle pain and prolonged morning stiffness. Markers of inflammation are often elevated. Clinicians are often faced with the challenge of distinguishing PMR from other conditions, particularly rheumatoid arthritis and spondyloarthropathy that can mimic symptoms of PMR in older people. Additionally, there is an association between PMR and giant cell arteritis, a common large-vessel vasculitis which also affects people over the age of 50 years. Imaging of the large vessels in asymptomatic patients with PMR often reveals findings of subclinical vasculitis. Presently, there are no tests that are specific for the diagnosis of PMR and clinicians rely on a combination of history, physical examination, laboratory tests and imaging studies to make a diagnosis. A recent undertaking by the European League Against Rheumatism/American College of Rheumatology has led to the publication of provisional classification criteria of PMR. Ultrasonography, which is being increasingly used by rheumatologists, can greatly aid in the diagnosis of PMR and often shows changes of synovitis and tenosynovitis. Treatment consists of low doses of glucocorticoids which are associated with morbidity. Evaluation of newer biologic therapies targeting inflammatory cytokines is underway. Despite treatment, relapses are common.
摘要:风湿性多肌痛( PMR )是好发于50岁以上老年人的一种常见的炎症病变。典型症状是肩胛带及臀区肌肉疼痛和长时间的晨僵。炎症标志物通常较高。临床医师往往要对PMR和具有类似临床表现的类风湿关节炎及脊柱关节病进行鉴别诊断,此外,巨细胞动脉炎也好发于老年人,也需要鉴别。临床上没有症状的PMR患者大血管成像示:亚临床血管炎,目前,PMR无特异的诊断标准,临床医师只能依据病史,体格检查,实验室检查和影像学检查进行诊断,我们通常采用的是欧洲抗风湿协会/美国风湿病学院公布的关于PMR的临时分类标准,超声检查被广泛应用于风湿病,不仅有助于诊断风湿性多肌痛,而且还可以显示出滑膜炎和腱鞘炎的改变,治疗上包括低剂量的糖皮质激素,这与疾病相关,旨在降低炎性因子的新的生物治疗方法评估正在进行。治疗好转后,容易复发。
引自:Kermani TA1, Warrington KJ2. Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. Ther Adv Musculoskelet Dis. 2014 Feb; 6(1): 8-1.