加味独活寄生汤配合糖皮质激素治疗风湿性多肌痛疗效观察

目的:观察加味独活寄生汤治疗风湿性多肌痛的疗效,研究加味独活寄生汤在减少糖皮质激素的剂量及减低糖皮质激素的毒副反应方面的作用。方法:风湿性多肌痛患者64例,随机分为2组,试验组(加味独活寄生汤加泼尼松组)34例,对照组(单用泼尼松组)31例。两组均给予泼尼松15mg/d,2周后根据病情酌情减量,试验组加服加味独活寄生汤煎剂,每次200m l,每日2次,共治疗12周。结果:试验组34例,临床缓解11例(32.34%),显效15例(44.12%),有效7例(20.59%),无效1例(2.94%),总有效率97.06%;对照组31例分别为5例(16.13%),8例(25.81%),13例(41.94%),5例(16.13%),及83.87%。两组比较,差异有显著性(P<0.05);试验组血沉比对照组下降快(P<0.05),试验组泼尼松用量比对照组用量小(P<0.05),不良反应(P<0.01)结论:加味独活寄生汤有利于减少糖皮质激素的剂量,减低糖皮质激素的副作用,提高疗效。     

抗角蛋白抗体在风湿性多肌痛与老年类风湿关节炎鉴别诊断中的意义

目的:探讨抗角蛋白抗体在风湿性多肌痛与老年发病类风湿关节炎鉴别诊断中的意义。方法:以W istar大鼠中1/3食管组织冰冻切片为底物,采用间接免疫荧光法检测50例老年类风湿性关节炎及30例风湿性多肌痛患者的血清抗角蛋白抗体。结果:50例老年类风湿性关节炎患者中,29例血清抗角蛋白抗体阳性,而在30例风湿性多肌痛患者中,仅7例患者的血清抗角蛋白抗体阳性,两者比较有统计学意义。随访观观察8个月至3.5年,7例血清抗角蛋白抗体阳性的患者中,有5例修正诊断为老年类风湿性关节炎,而在23例血清抗角蛋白抗体阴性的患者中,仅1例修正诊断为老年类风湿性关节炎,两者比较有统计学意义。结论:血清抗角蛋白抗体可能是一种诊断老年类风湿性关节炎特异性抗体;血清抗角蛋白抗体阳性且具风湿性多肌痛症状的患者也许是早期老年类风湿性关节炎患者。     

Behavior of prealbumin in the acute phase of polymyalgia rheumatica treated with 6-methylprednisolone

Summary Serum levels of prealbumin, fibronectin, fibrinogen, α₁-acid glycoprotein, C-reactive protein, immunoglobulins, and white blood cell count were prospectively studied in 33 patients affected by polymyalgia rheumatica during the first 45 days of treatment with 6-methylprednisolone. Almost all parameters considered, except for fibronectin and IgM, settled within the normal range fairly quickly, while prealbumin showed a specular course compared with the other reactants. This behavior reflected the improvement of clinical symptoms registered in all patients after steroid treatment. Finally, the genesis of the low baseline prealbumin levels found in polymyalgia rheumatica/giant cell arteritis and their behavior during treatment are discussed.     

Immunsuppressive Therapiemodalitäten bei chronischen Polyarthritiden

Zum Thema Die rheumatoide Arthritis (RA) ist eine systemische Autoimmunerkrankung mit symmetrischer Gelenkentzündung zumeist peripherer Gelenke. Die ?tiologie der RA ist ungekl?rt, den T-Zellen scheint aber dabei eine wichtige Rolle zuzukommen. Dagegen tritt die Psoriasis Arthritis (PsA) als asymmetrische Oligo- oder Polyarthritis auf, bei der distale Interphalangeal- und Wirbels?ulengelenke einbezogen sind. H?ufig gehen Psoriasis-typische Hautl?sionen voraus. Auch die ?tiologie der PsA ist weitgehend unbekannt. Genetische Faktoren dürften ebenso wie bei der RA von Bedeutung sein. Beiden Arthritisformen gemeinsam ist der meist chronisch-aggressive Verlauf mit Knorpel-, Knochen- und Gelenkdestruktion sowie die erh?hte Mortalit?t. über die schwierige Differentialtherapie wird in dieser übersicht referiert. Im Gegensatz zu früheren Therapiestrategien wird derzeit erfolgreich eine wesentlich früher einsetzende aggressive Behandlung mit immunsuppressiven und/oder -modulierenden Medikamenten begonnen.     

Plasma levels of fibronectin in polymyalgia rheumatica giant cell arteritis

Summary In order to verify whether measurement of plasma fibronectin (Fn) could represent a useful tool in acute-phase-response assessment, Fn was measured in 16 previously untreated patients (group A) affected by polymyalgia rheumatica giant cell arteritis (PMR-GCA), both before, during, and after 45 days of steroid therapy, and its course was compared with the behavior of some acute-phase reactants such as erythrocyte sedimentation rate (ESR), fibrinogen (Fng), and prealbumin (Preal). No difference was detected between the baseline Fn levels found in patients and those registered in a control group composed of 15 sex- and age-matched healthy subjects; no correlation was found with the other acute-phase parameters considered, and no significant variation of plasma Fn levels was registered as a result of the steroid therapy administered. On the contrary, all the other parameters revealed a good degree of correlation and tended progressively and homogeneously towards normalization as a result of the therapy administered.Plasma Fn was also measured in another group of 16 PMR-GCA patients (group B), all of whom had pathological retinal fluoroangiographic findings, and its levels were compared with those of the von Willebrand factor antigen (vWfAg), a biochemical index of vascular damage. While the levels of Fn continued to be the same as those detected in the control group, the values of vWfAg registered in group B proved to be significantly different from those found in another homogeneous control group of 25 healthy subjects. Finally, no correlation could be detected between Fn and vWfAg, and neither of them showed any significant correlation with the ESR. These results indicate that plasma Fn may not be considered to be an acute-phase reactant in PMR-GCA, and that it is not useful for revealing the vascular involvement in PMR-GCA.     

Fast track clinic for early diagnosis of polymyalgia rheumatica: Impact on symptom duration and prednisolone initiation

ObjectivesTo evaluate the efficacy of a fast track clinic (FTC) for patients suspected of polymyalgia rheumatica (PMR) regarding symptom duration, prednisolone initiation before rheumatological assessment, number of hospital contacts before diagnosis, and cancer diagnosis.MethodsIt is a retrospective cohort study with a one year follow-up period. Patients referred to the FTC (1st August 2016 to 25th June 2019) were compared to a historical cohort of PMR patients (1st August 2014 to 1st August 2016). Referral criteria are: age over 50, symptoms of PMR but not cranial GCA, and increased C-reactive protein. Data were obtained from patient journals.ResultsNinety-seven PMR patients in the historical cohort and 113 FTC patients, of whom 83 patients had PMR, were included. The median (interquartile range) number of days from symptom onset until PMR diagnosis were 53 (31–83) days in the FTC versus 80 (58–132) days in the historical cohort (P < 0.001). Prednisolone was prescribed before rheumatological assessment to 11% in the FTC versus 42% in the historical cohort (P < 0.001). Patients in the FTC had significantly fewer contacts with the hospital before the diagnosis compared with the historical cohort. Four patients in the FTC were diagnosed with a cancer, all of which were found by imaging.ConclusionThe FTC reduced the time from symptom onset until diagnosis, lowered prednisolone initiation before rheumatological assessment, and resulted in fewer hospital visits. The frequency of cancers was low in patients suspected of PMR and cancers were discovered by imaging.     

Specific IgE positivity against inhalant allergens and development of autoimmune disease

Abstract

Background: Allergic and autoimmune diseases have been suggested to be inversely associated. We investigated the association between atopy and development of any and specific types of autoimmune disease. Methods: We included a total of 14?849 individuals from five population-based studies with measurements of atopy defined as specific IgE positivity against inhalant allergens. We followed the participants by linkage to the Danish National Patient Register (median follow-up time 11.2 years). Hazard ratio (HR) and 95% confidence interval (CI) of autoimmune disease were estimated by Cox regression. Results: The risk for atopics versus non-atopics was: for any autoimmune disease (HR?=?0.99, 95% CI: 0.83, 1.18), thyrotoxicosis (HR?=?0.69, 95% CI: 0.34, 1.37), type 1 diabetes (HR?=?1.16, 95% CI: 0.84, 1.60), multiple sclerosis (HR?=?1.97, 95% CI: 0.95, 4.11), iridocyclitis (HR?=?0.82, 95% CI: 0.38, 1.74), Crohn’s disease (HR?=?1.03, 95% CI: 0.47, 2.25), ulcerative colitis (HR?=?0.93, 95% CI: 0.52, 1.69), psoriasis vulgaris (HR?=?1.50, 95% CI: 0.86, 2.62), seropositive rheumatoid arthritis (HR?=?0.74, 95% CI: 0.48, 1.14) and polymyalgia rheumatica (HR?=?0.79, 95% CI: 0.44, 1.44). Conclusions: We found no statistically significant associations between atopy and autoimmune disease, but we cannot exclude relatively small to moderate effects - protective or promotive - of atopy on autoimmune disease.     

Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) syndrome in an elderly Spanish patient: Ruling-out polymyalgia rheumatica and management

BackgroundThe Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) syndrome is a rare rheumatological disorder of the elderly with pitting edema and tenosynovitis of the hands as notable features.Aim of the workThis case report presents an elderly male patient with RS3PE without arthritis after ruling out polymylagia rheumatica (PMR) or any associated malignancy.Case presentationA 73-year-old white man presented to the Hospital of Navarra, Spain with pain and weakness in both upper extremities, predominantly in wrists, associated with symmetrical swelling of dorsum of both hands of two months duration. The patient was febrile (37.5 °C) had pitting edema in both hands, with no signs of arthritis, associated with shoulder girdle muscles weakness without pelvic involvement. The lower limbs and feet were not involved. The differential diagnosis of PMR was raised adding to the clinical diagnostic dilemma. Erythrocyte sedimentation rate was 66 mm/1st hour and C-reactive protein 126.4 mg/L. Extended diagnostic work showed negative autoimmune biomarkers with normal complement. No joint erosion was found on plain x-ray radiography of the affected joints. Thoracic and abdominal CT scan was performed with no evidence of a neoplastic disease. The patient was finally diagnosed with RS3PE showing a rapid response to low doses of prednisone (20 mg/day) and without any further flares on follow up.ConclusionRS3PE could be diagnosed even without polyarthritis and successfully treated by low dose steroids after excluding any related malignancy. Excluding PMR is important to avoid exposing the patient to unwanted higher steroid doses.     

Lack of association of high body mass index with risk for developing polymyalgia rheumatica

Background: High body mass index (BMI) may have modulatory effects on the immune system. Objectives: To determine the association between BMI and polymyalgia rheumatica (PMR) as well as the influence of BMI on glucocorticoid treatment duration and development of giant‐cell arteritis (GCA) in patients with PMR. Methods: The BMI of 364 patients with PMR from a population‐based incidence cohort was compared to the BMI of non‐PMR subjects from the same population. High and low BMI were defined as ≥ 25 and < 18.5 kg/m², respectively. The association between BMI and case status was determined. The association between BMI and the duration of glucocorticoid therapy, as well as the development of GCA after accounting for relevant variables, were also examined. Results: The mean BMI at index was similar in both groups (PMR: 26 ± 5.4 kg/m²; non‐PMR: 25.9 ± 4.0 kg/m², P = 0.83). There was no association between BMI and the duration of glucocorticoid therapy. No significant association was found between BMI and the development of GCA in patients with PMR. Conclusion: Patients with high BMI (≥ 25 kg/m²) are not more likely to develop PMR. BMI did not influence the duration of glucocorticoid therapy or the occurrence of GCA in patients with PMR.