老年风湿性多肌痛诊治现状

<正>风湿性多肌痛(PMR)临床特征主要表现为近端肌群(肩胛带、骨盆带肌)及颈肌疼痛和僵硬,化验检查示经细胞沉降率(ESR)显著增快,伴有非特异性全身症状,治疗上常需要长期进行糖皮质激素,部分患者可合并巨细胞动脉炎(GCA)〔1〕。该病需与其他一些自身免疫性、感染性、内分泌性及恶性疾病等鉴别〔1,2〕。本文将对老年PMR的诊断和治疗现况进行综述。1发病率PMR好发于老年人和老年前期人群,发病呈急性或亚急     

风湿性多肌痛和巨细胞动脉炎

风湿性多肌痛(polymyalgiarheumatica,PMR)是一种以全身疼痛和僵硬伴血沉明显增快为特征的特殊的风湿状态,首发在颈部、肩部、臀部和骨盆带的近端肌群。巨细胞动脉炎(gaintcellarteritis,GCA)或颞动脉炎(temporalarteritis,TA)是一种大中血管的血管炎,常累及起源于主动脉弓的颅支。随着年龄的增长,老年人的非特异性骨骼肌肉疼痛和疲劳常与PMR/GCA相关。一、流行病学在高纬度地区发病率高,不同种族发病有差异。PMR发病年龄在50岁以上,发病率约为600/10万,70～80岁是发病高峰,男女比率为1:1.8。GCA/TA的发病率较PMR低,50岁以上发病…     

风湿性多肌痛1例

1病历摘要 患者，男，28岁。因腰、双侧臀部、双腿疼痛、晨僵1个月伴发热1周于2006年4月15日转入我院。患者1个月前无明显诱因出现腰部、双臀部及双腿疼痛，以右侧髋关节疼痛为甚，跛行，严重时行走困难，甚至不能行走，晨起时双腿僵硬，不能屈曲及伸直，活动后疼痛加重，休息时稍缓解，     

风湿性多肌痛诊治进展

195 7年Ｂａｒｂｅｒ等首先报道了风湿性多肌痛 (ＰＭＲ) ,ＰＭＲ是以老年人发病为主的一组临床综合征 ,女性是男性的 2～ 2 5倍。流行病学调查报道美国和意大利 5 0岁以上的ＰＭＲ发病率分别为 5 3 7·10 - 5和 2 0 4·10 - 5[1,2 ] ,70岁以上的发病率高达 112 2·10 - 5,5 0岁以下发病少见 ,我国至今尚无流行病学的调查资料。随着人口老龄化 ,ＰＭＲ患病率将逐年上升。ＰＭＲ主要症状为四肢及躯干肌肉疼痛和晨僵 ,尤以肩胛带和骨盆带疼痛较重 ,可伴有全身反应如发热、贫血等 ,临床上易误诊。ＰＭＲ可和其他病变合并存在 ,最常见的是巨…     

风湿性多肌痛的临床诊断：（附20例报告）

对１９９０年￣１９９６年间明确诊断的风湿性多肌痛（ＰＭＲ）２０例临床资料进行回顾性分析。主伙风年龄≥５０岁、出现里僵（８０％）、四肢肢带肌僵痛（８０％）、乏力９７０％）、发热（２０％）及体重减轻（〉５ｋｇ）、血沉沉５０ｍｍ／１ｈ者，可拟诊为原发性ＰＭＲ，即投予小剂量强的松（１０ｍｇ／ｄ）。若在数日内临床症状明显改善或缓解者，更有利于诊断，但需注意排除颞动脉炎、多发性肌炎及肿瘤等所致的继发性ＰＭＲ。     

风湿性多肌痛5例临床分析及治疗评价

风湿性多肌痛(PMR)是以老年人发病为主的一组临床综合征,在欧美国家的发病率较高,我国至今尚无PMR的流行病学资料[1] 。现将我院近年来诊治的5例PMR报道如下。1　临床资料1.1　一般资料　5例PMR患者均为我院住院病人,女3例,男2例。病程1～2 4月,平均(6 4±9 9)月。发病年龄47～     

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。     

风湿性多肌痛的临床诊断(附20例报告)

对1990年～1996年间明确诊断的风湿性多肌痛(PMR)20例临床资料进行了回顾性分析。认为凡年龄≥50岁、出现晨僵(80％)、四肢肢带肌僵痛(80％)、乏力(70％)、发热(20％)及体重减轻(>5kg)、血沉≥50mm/1h者,可拟诊为原发性PMR,即投予小剂量强的松(10mg/d)。若在数日内临床症状明显改善或缓解者,更有利于诊断,但需注意排除颞动脉炎、多发性肌炎及肿瘤等所致的继发性PMR。     

慢性肾功能衰竭并风湿性多肌痛1例

1病例资料 患者，男，57岁。因“腰酸乏力7年，发热，肩胛、双侧臀部、双腿疼痛10天”于2008年4月10日入院。患者6年前开始出现腰酸乏力，头晕，无眼睑及双下肢水肿等，在我院就诊，查尿常规PRO（3＋），ERY（2＋）；     

风湿性多肌痛诊治指南(草案)

风湿性多肌痛(polymyalgia rheumatica，PMR)多发生于老年人。以近端肌群(肩胛带肌、骨盆带肌)和颈肌疼痛和僵硬为主要特征，伴血沉显著增快和非特异性全身症状。本病病因不明。一般为良性过程且与年龄密切相关，随年龄增长发病渐增多，50岁之前患本病者甚少．女性较男性多2～3倍。有家族聚集发病现象。该病可与巨细胞动脉炎(GCA)见于同一患者．提示两者关系密切．但二者之间的确切关系尚不十分清楚。我国PMR并不少见．     

Steroid-reversible parkinsonism as presentation of polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory disorder typically affecting elderly people, characterized by pain and stiffness in the neck and in the shoulder and pelvic girdless with prompt clinical response to low doses of corticosteroids. PMR is closely related to giant cell arteritis (GCA), likely sustained by a “subclinical vasculitis”. Whereas in GCA both the central and peripheral nervous systems may be involved, only a PMR case of global, steroid-reversible dementia has been hitherto described. We report two elderly patients who abruptly developed, as PMR presenting symptom, an akinetic-rigid parkinsonian syndrome that promptly and completely resolved after corticosteroid treatment.     

Cytidine deaminase in polymyalgia rheumatica and elderly onset rheumatoid arthritis

Serum cytidine deaminase (CD) as a marker of inflammatory disease was assessed in 44 patients and 47 controls to differentiate polymyalgia rheumatica (PMR) from elderly onset rheumatoid arthritis (EORA). The patients were divided into four groups: PMR with and without synovitis and seropositive and seronegative EORA. No statistically significant differences were found when serum CD levels of seropositive EORA patients were compared with serum CD of PMR patients without synovitis, neither when serum CD levels of all PMR patients were compared with a seronegative EORA group, nor when serum CD levels of PMR patients with synovitis were compared with those with EORA. Nevertheless, statistically significant differences were detected between EORAs serum CD levels and the control group (p=0.023). This difference was 10% when comparing CD levels of PMR patients with the control group (p=0.070). We did not demonstrate that serum CD levels could be a useful tool to differentiate PMR from EORA, but these findings could nevertheless reflect the presence of an inflammatory disease.     

Rapid development of renal failure secondary to AA-type amyloidosis in a patient with polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is a common chronic inflammatory disorder affecting patients over the age of 50. Renal involvement in PMR is extremely rare and very few cases of AA amyloidosis secondary to PMR have been described in literature. We present a case of a patient with history PMR who developed nephrotic range proteinuria and rapidly deteriorating renal function secondary to AA amyloidosis within 18 months of the onset of symptoms of PMR. This case reinforces the association of PMR with secondary AA amyloidosis and highlights the importance of monitoring renal function in patients with PMR.     

MRI findings of the shoulder and hip joint in patients with polymyalgia rheumatica

Abstract

Objectives. The purpose of this study is to evaluate magnetic resonance imaging (MRI) findings of the shoulder and hip joint in patients with polymyalgia rheumatica (PMR).

Methods. MR images of a total of 25 PMR patients (23 shoulders and 6 hips), 43 rheumatoid arthritis (RA) patients (22 shoulders and 22 hips), and 50 control patients (25 shoulders and 25 hips) were examined. The following MRI findings were evaluated: In the shoulder, thickness and abnormalities of the supraspinatus tendon, effusion around the glenohumeral joint, subacromial-subdeltoid bursa, and the biceps tendon; In the hip, effusion around the acetabulofemoral joint, iliopsoas bursa, and trochanteric bursa. Periarticular soft-tissue edema and bone findings were also analyzed.

Results. The supraspinatus tendon was significantly thicker in PMR patients than in RA patients and control patients (p < 0.05). Severe rotator cuff tendinopathy was frequently observed in PMR patients (p = 0.002). The scores for the amount of effusions (joint, bursa, and tendon sheath in the shoulder and bursa in the hip) were much higher in PMR patients (p < 0.05). Periarticular soft tissue edema was detected more frequently in PMR patients than in RA patients and control patients (p < 0.05).

Conclusions. Thick supraspinatus tendon, severe rotator cuff tendinopathy, effusion around the joints, and periarticular soft tissue edema can be good indicators for the diagnosis of PMR.     

Tocilizumab for polymyalgia rheumatica: Report of two cases and review of the literature

Background

Glucocorticoids (GC) are the mainstay of treatment of polymyalgia rheumatica (PMR). However GC-related adverse events occur frequently, particularly in patients with relapsing disease. Several studies have demonstrated that IL-6 is a key player in the pathogenesis of PMR.

Objectives

To report 2 patients with PMR treated with the anti-IL-6 receptor monoclonal antibody tocilizumab (TCZ) and to review the published evidence on the efficacy and safety of TCZ in patients with PMR.

Methods

We treated 2 GC-naive patients with newly diagnosed pure PMR with monthly TCZ infusions (8 mg/kg body weight) for 6 months. Disease activity and drug tolerability were assessed clinically, by laboratory tests, and bilateral shoulder ultrasonography before starting the treatment and subsequently every month during TCZ therapy. We performed a systematic literature search (PubMed until July 2012) using the terms “tocilizumab,” “anti-IL-6-receptor,” “polymyalgia rheumatica,” “giant cell arteritis”, and “large-vessel vasculitis” to identify published reports of patients with PMR treated with TCZ.

Results

One of our patients responded well to TCZ, while the other patient required GC therapy after the 2nd TCZ infusion because of lack of appreciable clinical response. Both patients tolerated TCZ well. The review of the literature revealed 4 reports with a total of 9 patients who received TCZ for PMR. In 7 of these 9 patients, PMR was associated with giant cell arteritis. Including our patients, 5 patients received TCZ alone and 6 TCZ plus GC. A good response to TCZ treatment was observed in all patients reported in the literature without any major adverse events.

Conclusions

TCZ both as monotherapy and in association with GC appears to be mostly effective and safe to treat patients with PMR. However, larger controlled studies are required to confirm these favorable data.     

巨细胞动脉炎与风湿性多肌痛临床特征的对比分析

目的:通过比较风湿性多肌痛（PMR）和巨细胞动脉炎（GCA）的临床差异,总结GCA患者的临床特点。方法:收集皖南医学院附属弋矶山医院风湿免疫科2010年8月至2019年9月住院的12例巨细胞动脉炎患者临床资料,并选择同期住院的,与GCA组患者进行2∶1年龄、性别相匹配的PMR患者形成对照组,比较2组患者的临床表现、实验...     

Fast recovery with etanercept in patients affected by polymyalgia rheumatica and decompensated diabetes: a case-series study

We enrolled nine consecutive patients affected by newly diagnosed polymyalgia rheumatica and decompensated diabetes mellitus. All patients were treated with etanercept (25 mg twice weekly) and prednisone and were followed up to 1 year. At the sixth-month follow-up, etanercept and prednisone were withdrawn. Patients were seen at regular intervals (days 0, 30, 60, 90, 150, 180) and the following variables determined: erythrocytes sedimentation rate, C-reactive protein, fasting serum glucose, pain measured by visual analog scale, and the Health Assessment Questionnaire. Our results indicate that etanercept might have some steroid-sparing effects, but controlled investigations are needed to support etanercept use in clinical practice for this kind of patients.     

Concomitant gastric adenocarcinoma and stromal tumor in a woman with polymyalgia rheumatica

Gastrointestinal stromal tumors （GISTs） are rare neoplasms （1%） of the gastrointestinal tract and to our knowledge only rare cases of synchronous presentation of gastric carcinomas and GISTs are reported in the literature. A 72-year-old female with a simultaneous presentation of gastric adenocarcinoma and GIST is presented. Moreover, due to polymyalgia rheumatica the patient received corticosteroids as treatment for the last 3 years. The concomitant occurrence of these neoplasms may involve common carcinogenic factors and there could be an association with polymyalgia rheumatica either as a paraneoplastic presentation or due to its treatment with corticosteroids.     

Elderly onset rheumatoid arthritis and polymyalgia rheumatica: ultrasonographic study of the glenohumeral joints

The glenohumeral joints of 32 patients (aged 60 or above) were examined using ultrasonography. Thirteen patients were suffering from characteristic polymyalgia rheumatica (PMR) symptoms. In contrast 19 other patients initially had similar complaints, but were diagnosed as having elderly onset rheumatoid arthritis (EORA) upon development of typical symptoms. Ultrasound examination revealed glenohumeral joint inflammation in 61% (8 out of 13) of the patients with PMR and 63.2% (12 out of 19) of the patients with EORA. These findings suggest that a subgroup of patients with PMR and EORA suffers from shoulder joint inflammation and this synovitis/bursitis/intraarticular effusion might play an important role in the understanding of their symptoms. We conclude that overlapping forms of PMR and a predominate rheumatoid factor negative subgroup of EORA might exist and should be further characterized. Received: 25 August 1997 / Accepted 9 January 1998