译者:李变变 校对:侯睿宏 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)是一种常见的炎症性疾病,常常累及50岁以上的老人。典型症状为肩部、臀周的疼痛和晨僵。炎症指标通常升高。临床医生常常面临较大的难题是如何鉴别风湿性多肌痛和与其有相似症状的也同样发生在老年人的其它风湿疾病,尤其是类风湿关节炎和脊柱关节病。另外,PMR和巨细胞动脉炎具有相关性,而巨细胞动脉炎是一种普遍发生在大血管的炎症,也常累及50岁以上的老人。在无症状PMR的患者中,大血管的影像学检查可发现亚临床血管炎。目前,诊断PMR缺乏确切的检查手段。临床医生依据病史、体格检查,实验室检测和影像学资料来明确诊断。欧洲风湿病联盟/美国风湿病学会最近制定了PMR的临时分类标准。超声这一技术广泛地应用于风湿科,它能够有助于诊断风湿性多肌痛,并且能显示滑膜炎和腱鞘炎的变化。治疗上可以使用小剂量的糖皮质激素,并取决于疾病活动度。针对炎症细胞因子的新的生物治疗仍在研究中。尽管有明确的治疗方法,但复发是常见的。
引自:Kermani TA,Warrington KJ. Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. Ther Adv Musculoskelet Dis. Feb 2014; 6(1): 8–19.