GlANT CELL ARTERlTlS DIAGNOSED FOLLOWING ARM CLAUDICATION

A patient is described whose initial symptoms, though suggestive of polymyalgia rheumatica, were attributed to psoriatic arthritis, and whose subsequent development of claudication of the left arm led to the biopsy proven diagnosis of giant cell arteritis. Attention is drawn to widespread arterial involvement by giant cell arteritis which, though uncommon, must be considered in all patients with ischemic limb pain. In addition, the consequences of overlooking polymyalgia rheumatica as an early manifestation of giant cell arteritis are outlined.     

风湿性多肌痛住院患者38例临床诊治分析

目的 为探讨风湿性多肌痛的临床特点,并分析误诊病例,从而提高对风湿性多肌痛的诊治水平.方法 回顾性分析38例住院风湿性多肌痛患者的临床表现、治疗反应和首诊误诊疾病谱.结果 (1)患病性别多为女性,男:女=1∶2.8,平均发病年龄(68.2±10.4)岁.(2)临床表现有累及颈肩痛者22例(57.9％),仅有肩胛带肌和骨盆带肌痛者16例(42.1％),其中伴随膝、髋关节疼痛者18例(47.3％),伴有晨僵17例(44.7％),发热20例(52.6％),合并巨细胞动脉炎11例(28.9％).(3)所有患者均红细胞沉降率增快,平均为(85.8±30.2) mm/h.(4)首诊误诊病例24例占全部病例的63.1％,其中以误诊为呼吸道感染性疾病和类风湿性关节炎居多.(5)全部病例均使用激素治疗,单用激素18例(47.3％),联合甲氨蝶呤15例(39.4％),联合雷公藤占5例(13.1％).结论 风湿性多肌痛是以四肢近端肌肉僵痛为主要特征,在老年人群中发生的一种免疫性疾病,可伴有发热,关节痛和红细胞沉降率显著增快,激素治疗有效.随着我国老年人口数量增加,患病数也随之增加,应提高对此疾病诊治水平,避免误诊、漏诊.     

2012年风湿性多肌痛暂行分类标准发布

风湿性多肌痛（polymyalgiarheumatica,PMR）是一种老年人常见的炎性疾病,缺乏标准化的分类标准已成为阻碍PMR规范化治疗的重要原因,2012年美国风湿病学会（AmericanCollegeofRheumatology,ACR）,欧洲抗风湿病联盟（EuropeanLeagueAgainstRheumatism,EULAR）联合发表PMR暂行分类标准,大大提高了诊断的敏感性和特异性,具有一定的权威性和先进性。     

诊断年龄对风湿性多肌痛临床特征的影响: 68例患者的单中心回顾性队列研究

目的 比较不同诊断年龄(>60岁和≤60岁)风湿性多肌痛(polymyalgia rheumatica, PMR)患者的临床特征。方法 回顾性分析2013年1月至2019年12月我院诊治的风湿性多肌痛患者68例,依据诊断年龄,分为PMR≤60岁组(24例)和PMR>60岁组(44例),比较两组临床资料(一般资料、临床表现、实验室指标、治疗反应)。结果 两组病程、是否吸烟差异均无统计学意义(P>0.05),与PMR≤60岁组相比,PMR>60岁组女性占比更高(P<0.05);两组在体重减轻、发热、肩胛带肌痛、骨盆带肌痛、颈痛、腰痛、晨僵方面比较,差异均无统计学意义(P>0.05);两组乳酸脱氢酶(LDH)水平差异无统计学意义(P>0.05),与PMR≤60岁组相比,PMR>60岁组血沉(ESR)、 C反应蛋白(CRP)水平较高,血红蛋白(Hb)水平较低(均 P<0.05);所有的患者均接受一线糖皮质激素治疗,两组单独使用糖皮质激素占比、糖皮质激素累积剂量差异均无统计学意义(P>0.05),与PMR>60岁组相比,PMR≤60岁组复发占比较少(P<0.05)。结论 与诊断年龄>60岁的PMR患者相比,诊断年龄≤60岁的患者复发风险较低,更积极的糖皮质激素治疗是不合理的。     

Whole-body fluorodeoxyglucose positron emission tomography/computed tomography in patients with active polymyalgia rheumatica: evidence for distinctive bursitis and large-vessel vasculitis

Abstract

Objectives To investigate fluorodeoxyglucose (FDG) accumulation in large joints, bursas, and large vessels in patients with polymyalgia rheumatica (PMR) using 18-FDG positron emission tomography/computed tomography (PET/CT) and to differentiate PMR from similar diseases.

Methods Fourteen untreated patients with active PMR and 17 control patients with rheumatoid arthritis (n = 11) or other active rheumatic diseases (n = 6) underwent 18-FDG PET/CT. FDG uptake in large joints, bursas and vertebral spinous processes was evaluated by calculating maximum standardised uptake values and by visual scoring (scale 0–4). PET scan images were scored in seven vascular regions, and total vascular scores (range 0–21) were calculated.

Results Polymyalgia rheumatica patients showed increased FDG uptake in ischial tuberosities, greater trochanters, and lumbar spinous processes. Positive results at two or more of these sites showed high sensitivity (85.7%) and specificity (88.2%) for the diagnosis of PMR, and shoulder or hip-joint involvement showed low disease specificity. High FDG accumulations were found in the aortas and subclavian arteries of two PMR patients who were asymptomatic for temporal arteritis and scanty synovium and perisynovium, based on FDG uptake. PET/CT images of the 12 PMR patients without apparent vascular involvement showed synovitis and/or perisynovitis.

Conclusions Fluorodeoxyglucose-PET/CT may be useful for the detection of PMR lesions, which are difficult to identify using other methods.     

The association of other autoimmune diseases in patients with Graves' disease (with or without ophthalmopathy): Review of the literature and report of a large series

Graves' disease (GD) and autoimmune thyroiditis (AT) are the two main clinical presentations of AITD, and their clinical hallmarks are thyrotoxicosis and hypothyroidism, respectively. GD, and AT, can be associated with other organ specific, or systemic autoimmune diseases in the same patient. However discordant results have been reported in the literature about the possible associations. Here, we review the association of GD and other autoimmune syndromes. Furthermore, we report the results of our prospective study that investigated the prevalence of other autoimmune disorders in 3209 GD patients (984 with Graves' ophthalmopathy), with respect to 1069 healthy controls, or 1069 patients with AT, or 1069 with multinodular goiter (matched by age, gender, coming from the same area, with a similar iodine intake).On the whole, 16.7% of GD patients had another associated autoimmune disease; and the most frequently observed were: vitiligo (2.6%), chronic autoimmune gastritis (2.4%), rheumatoid arthritis (1.9%), polymyalgia rheumatica (1.3%), multiple sclerosis (0.3%), celiac disease (1.1%), diabetes (type 1) (0.9%), systemic lupus erythematosus and sarcoidosis (<0.1%), Sjogren disease (0.8%). Moreover, 1.5% patients with GD had three associated autoimmune disorders. Interestingly, patients with Graves' ophthalmopathy (GO) had another autoimmmune disorder more frequently (18.9%), with respect to GD patients without GO (15.6%). However the pattern of the associated autoimmune disorders in GD was not significantly different from that observed in AT patients.In conclusion, we suggest GD patients who are still sick, or who develop new unspecific symptoms (even if during an appropriate treatment of hyperthyroidism) should be appropriately screened for the presence of other autoimmune disorders.     

风湿性多肌痛45例临床分析

目的:分析风湿性多肌痛的临床特点及治疗反应,提高对风湿性多肌痛的认识。方法:回顾分析皖南医学院附属弋矶山医院风湿免疫科2007～2011年住院及门诊确诊为风湿性多肌痛的45例患者的临床表现和治疗反应。结果:①女性多见,男女比为1∶5.43,女性发病年龄低于男性,病程长于男性。②临床以累及肩胛带肌和骨盆带肌痛多见,其次为发热和关节痛,乏力及体质量下降相对少见。③所有患者均有血沉(ESR)和C反应蛋白(CRP)升高。轻中度贫血31例(68.89%),免疫球蛋白升高18例(40%),肝功能异常8例(17.78%),血小板异常5例(11.11%)。④41例(91.11%)患者需要泼尼松或泼尼松联合甲氨蝶呤治疗,单纯非甾体抗炎药治疗4例(8.89%)。结论:PMR多见于50岁以上老年患者,以肩胛带及骨盆带肌肉疼痛和晨僵多见,ESR≥50 mm/1 h伴CRP升高,小剂量激素治疗显效。