风湿性多肌痛二例并文献复习
|
摘要
目的探讨风湿性多肌痛(PMR)的临床特点及治疗方法,提高PMR的诊治水平。方法分析北京航天总医院分别于2014年12月22日和2018年4月25日收治的2例PMR患者的临床资料,结合国内外相关文献总结PMR的临床表现、诊断及治疗。结果 2例PMR患者均为老年男性,以肌肉酸痛、晨僵、发热、关节疼痛、乏力、贫血、体重下降等为主要临床表现,血沉和C反应蛋白明显升高,单用糖皮质激素或联合雷公藤总甙治疗有效。出院后糖皮质激素缓慢减量,2例患者均无复发。结论 PMR是老年人群中常见的炎性风湿性疾病,较易误诊或漏诊,糖皮质激素是主要治疗药物,推荐早期联合使用甲氨蝶呤,注意患者的心理护理和肌肉功能锻炼,预防复发及减少并发症。
Objective To explore the characteristics and treatment of polymyalgia rheumatica(PMR) in order to improve the level of diagnosis and treatment. Methods The clinical data of 2 patients with PMR admitted in Beijing Aerospace General Hospital on December 22, 2014 and April 25, 2018 were retrospectively reviewed. The clinical manifestations, diagnosis and treatment of PMR were summarized in combination with relevant literature at home and abroad. Results The two PMR patients were all elderly males. The main clinical manifestations were muscle ache,morning stiffness, fever, joint pain, fatigue, anemia, and weight loss. The erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) increased significantly. Glucocorticoid alone or combined with total glycosides of Tripterygium wilfordii were effective for treating PMR. After discharge, glucocorticoid decreased slowly, and no recurrence occurred in the 2 patients. Conclusion PMR is a common inflammatory rheumatic disease in the elderly, which is easy to be misdiagnosed or missed. Glucocorticoid is the main therapeutic drug. It is recommended to use methotrexate in early stage. At the same time, attention should be paid to patients' psychological nursing and muscle function exercise to prevent recurrence and reduce complications.
Objective To explore the characteristics and treatment of polymyalgia rheumatica(PMR) in order to improve the level of diagnosis and treatment. Methods The clinical data of 2 patients with PMR admitted in Beijing Aerospace General Hospital on December 22, 2014 and April 25, 2018 were retrospectively reviewed. The clinical manifestations, diagnosis and treatment of PMR were summarized in combination with relevant literature at home and abroad. Results The two PMR patients were all elderly males. The main clinical manifestations were muscle ache,morning stiffness, fever, joint pain, fatigue, anemia, and weight loss. The erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) increased significantly. Glucocorticoid alone or combined with total glycosides of Tripterygium wilfordii were effective for treating PMR. After discharge, glucocorticoid decreased slowly, and no recurrence occurred in the 2 patients. Conclusion PMR is a common inflammatory rheumatic disease in the elderly, which is easy to be misdiagnosed or missed. Glucocorticoid is the main therapeutic drug. It is recommended to use methotrexate in early stage. At the same time, attention should be paid to patients' psychological nursing and muscle function exercise to prevent recurrence and reduce complications.
引文
[1] DEGACO C, SINGH YP, PEREL P, et al. 2015 recommendations for the management of polymyalgia rheumatica:a European league against rheumatism/American college of rheumatology collaborative initiative[J]. Arthritis Rheumatol, 2015, 74(10):1799-1807.
[2] CROWSON CS, MATTESON EL, MYASOEDOVA E, et al. The lifetime risk of adult-onsetrheumatoid arthritis and other inflammatory autoimmune rheumatic diseases[J]. Arthritis Rheum, 2014, 63(3):633-639.
[3] SALVARANI C, CANTINI F, BOIARDI L, et al. Polymyalgiarheumatica and giant-cell arteritis[J]. N Engl J Med, 2002, 347(4):261-271.
[4] DEJACO C, DUFTNER C, DASGUPTA B, et al. Polymyalgia rheumatica and giant cell arteritis:management of two diseases of the elderly[J]. Aging Health, 2011, 7(4):633-645.
[5] CHRISTENSEN K, DOBLHAMMER G, RAU R, et al. Ageing populations:the challenges ahead[J]. Lancet, 2009, 374(9696):1196-1208.
[6] CARMONA FD, GONZALEZ-GAY MA, MATIN J. Genetic compoment of giant cell arteritis[J]. Rheumatology, 2014, 53(1):6-18.
[7] SMEETH L, COOK C, HALL AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom,1990-2001[J]. Ann Rheum Dis, 2006, 65(8):1093-1098.
[8] CIMMINO M, CAPORALI R, MONTECUCCO C, et al. A seasonal pattern in the onset of polymyalgia rheumatic[J]. Ann Rheuma Dis,1990, 49(9):521-523.
[9] PERFETTO F, MOGGI-PIGNONE A, BECUCCI A, et al. Seasonal pattern in the onset of polymyalgia rheumatic[J]. Ann Rheum Dis,2005, 64(11):1662.
[10] ELLING P, OLSSON A, ELLING H. Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatic in different regions of Denmark; association with epidemics of Mycoplasma pneumonia infection[J]. Rheumatol, 1996, 23(1):112-119.
[11] KREINER F, LANGBERG H, GALBO H. Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatic[J].Arthritis Rheum, 2010, 62(12):3768-3775.
[12] CHATELAIN D, DUHAUT P, LOIRE R et al. Small-vessel vasculitis surrounding an uninflamed temporal artery:a new diagnostic criterion for polymyalgia rheumatic?[J]. Arthritis Rheum, 2008, 58(8):2565-2573.
[13] MELICONI R, PULSATELLI L, UGUCCIONI M, et al. Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatic. Quantitative analysis and influence of corticosteroid treatment[J]. Arthritis Rheum, 1996, 39(7):1199-1207.
[14]中华医学会风湿病学分会.风湿性多肌痛和巨细胞动脉炎诊断及治疗指南[J].中华风湿病学杂志, 2011, 15(5):348-350.
[15] DASGUPTA B, CIMMINO MA, KREMERS HM, et al. 2012 provisional classification criteria for polymyalgia rheumatic:a European league against rheumatism/American college of rheumatology collaborative initiative[J]. Arthritis Rheum, 2012, 64(4):943-954.
[16]高克明,许忠仁.风湿性多肌痛误诊分析[J].海南医学, 2002, 13(7):43.
[17]戴巧定,宋欣伟. 64例风湿性多肌痛临床特点及诊治分析[J].中华全科医学,2015, 13(5):725-728.
[18] MULLER S, HIDER SL, BELCHER J, et al. Is cancer associated with polymyalgia rheumatica? A cohort study in the General Pratice Research Database[J]. Ann Rheum Dis, 2014, 73(10):1769-1773.
[19] JI J, LIU X, SUNDQUIST K, et al. Cancer risk in patients hospitalized with polymyalgia rheumatica and giant cell arteritis:a follow-up study in Sweden[J]. Rheumatology(Oxford), 2010, 49(6):1158-1163.
[20] LEE JH, CHOI ST, KIM JS, et al. Clinical chaoracteristics and prognostic factors for relapse in patients with polymyalgia rheumatic(PMR)[J]. Rheumatol Int, 2013, 33(6):1475-1480.
[21] SALVARANI C, MACCHIONI P, MANZINI C, et al. Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatic:a randomized trial[J]. Ann Intern Med,2007, 146(9):631-639.
[22] CATANOSO MG, MACCHIONI P, BOIARDI L, et al. Treatment of refractory polymyalgia rheumatica with etanercept:an open pilot study[J]. Arthritis Rheum, 2007, 57(8):1514-1519.
[23] DEVAUCHELLE-PENSE V, BERTHELOT JM, CORNEC D, et al.Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatic:a prospective longitudinal study[J]. Ann Rheum Dis, 2016, 75(8):1506-1510.
[24] RAMIRO S, GAUJOUX-VIALA C, NAM JL, et al. Safety of synthetic and biological DMARDs:a systematic literature review informing the 2013 update of the EULAR recommendations for management of arthritis[J]. Ann Rheum Dis, 2014, 73(3):529-535.
[25] PIPITONE N, SALVARANI C. Update on polymyalgia rheumatica[J]. Eur J Intern Med, 2013, 24(7):583-589.
[26] CANTINI F, SALVARANI C, OLIVIERI I, et al. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatic:a prospective follow-up study[J]. Semin Arthritis Rheum, 2000, 30(1):17-24.
[27] NARVAZE J, NOLLA-SOLE JM, CLAVAGUERA MT, et al.Long-term therapy in polymyalgia rheumatic:effect of coexistent temporal arteritis[J]. J Rheumatol, 1999, 26(9):1945-1952.
[28] SALVARANI C, CANTINI F, NICCOLI L, et al. Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica:A prospective followup study[J]. Arthritis Rheum, 2005, 53(1):33-38.
[29] MURATORE F, PIPITONE N, HUNDER GG, et al. Discontinuation of therapies in polymyalgia rheumatica and giant cell arteritis[J].Clin Exp Rheumatol, 2013, 31(4 Suppl 78):S86-S92.
[30] LEE JH, CHOI ST, KIM JS, et al. Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatic(PMR)[J]. Rheumatol Int, 2013, 33(6):1475-1480.
[2] CROWSON CS, MATTESON EL, MYASOEDOVA E, et al. The lifetime risk of adult-onsetrheumatoid arthritis and other inflammatory autoimmune rheumatic diseases[J]. Arthritis Rheum, 2014, 63(3):633-639.
[3] SALVARANI C, CANTINI F, BOIARDI L, et al. Polymyalgiarheumatica and giant-cell arteritis[J]. N Engl J Med, 2002, 347(4):261-271.
[4] DEJACO C, DUFTNER C, DASGUPTA B, et al. Polymyalgia rheumatica and giant cell arteritis:management of two diseases of the elderly[J]. Aging Health, 2011, 7(4):633-645.
[5] CHRISTENSEN K, DOBLHAMMER G, RAU R, et al. Ageing populations:the challenges ahead[J]. Lancet, 2009, 374(9696):1196-1208.
[6] CARMONA FD, GONZALEZ-GAY MA, MATIN J. Genetic compoment of giant cell arteritis[J]. Rheumatology, 2014, 53(1):6-18.
[7] SMEETH L, COOK C, HALL AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom,1990-2001[J]. Ann Rheum Dis, 2006, 65(8):1093-1098.
[8] CIMMINO M, CAPORALI R, MONTECUCCO C, et al. A seasonal pattern in the onset of polymyalgia rheumatic[J]. Ann Rheuma Dis,1990, 49(9):521-523.
[9] PERFETTO F, MOGGI-PIGNONE A, BECUCCI A, et al. Seasonal pattern in the onset of polymyalgia rheumatic[J]. Ann Rheum Dis,2005, 64(11):1662.
[10] ELLING P, OLSSON A, ELLING H. Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatic in different regions of Denmark; association with epidemics of Mycoplasma pneumonia infection[J]. Rheumatol, 1996, 23(1):112-119.
[11] KREINER F, LANGBERG H, GALBO H. Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatic[J].Arthritis Rheum, 2010, 62(12):3768-3775.
[12] CHATELAIN D, DUHAUT P, LOIRE R et al. Small-vessel vasculitis surrounding an uninflamed temporal artery:a new diagnostic criterion for polymyalgia rheumatic?[J]. Arthritis Rheum, 2008, 58(8):2565-2573.
[13] MELICONI R, PULSATELLI L, UGUCCIONI M, et al. Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatic. Quantitative analysis and influence of corticosteroid treatment[J]. Arthritis Rheum, 1996, 39(7):1199-1207.
[14]中华医学会风湿病学分会.风湿性多肌痛和巨细胞动脉炎诊断及治疗指南[J].中华风湿病学杂志, 2011, 15(5):348-350.
[15] DASGUPTA B, CIMMINO MA, KREMERS HM, et al. 2012 provisional classification criteria for polymyalgia rheumatic:a European league against rheumatism/American college of rheumatology collaborative initiative[J]. Arthritis Rheum, 2012, 64(4):943-954.
[16]高克明,许忠仁.风湿性多肌痛误诊分析[J].海南医学, 2002, 13(7):43.
[17]戴巧定,宋欣伟. 64例风湿性多肌痛临床特点及诊治分析[J].中华全科医学,2015, 13(5):725-728.
[18] MULLER S, HIDER SL, BELCHER J, et al. Is cancer associated with polymyalgia rheumatica? A cohort study in the General Pratice Research Database[J]. Ann Rheum Dis, 2014, 73(10):1769-1773.
[19] JI J, LIU X, SUNDQUIST K, et al. Cancer risk in patients hospitalized with polymyalgia rheumatica and giant cell arteritis:a follow-up study in Sweden[J]. Rheumatology(Oxford), 2010, 49(6):1158-1163.
[20] LEE JH, CHOI ST, KIM JS, et al. Clinical chaoracteristics and prognostic factors for relapse in patients with polymyalgia rheumatic(PMR)[J]. Rheumatol Int, 2013, 33(6):1475-1480.
[21] SALVARANI C, MACCHIONI P, MANZINI C, et al. Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatic:a randomized trial[J]. Ann Intern Med,2007, 146(9):631-639.
[22] CATANOSO MG, MACCHIONI P, BOIARDI L, et al. Treatment of refractory polymyalgia rheumatica with etanercept:an open pilot study[J]. Arthritis Rheum, 2007, 57(8):1514-1519.
[23] DEVAUCHELLE-PENSE V, BERTHELOT JM, CORNEC D, et al.Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatic:a prospective longitudinal study[J]. Ann Rheum Dis, 2016, 75(8):1506-1510.
[24] RAMIRO S, GAUJOUX-VIALA C, NAM JL, et al. Safety of synthetic and biological DMARDs:a systematic literature review informing the 2013 update of the EULAR recommendations for management of arthritis[J]. Ann Rheum Dis, 2014, 73(3):529-535.
[25] PIPITONE N, SALVARANI C. Update on polymyalgia rheumatica[J]. Eur J Intern Med, 2013, 24(7):583-589.
[26] CANTINI F, SALVARANI C, OLIVIERI I, et al. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatic:a prospective follow-up study[J]. Semin Arthritis Rheum, 2000, 30(1):17-24.
[27] NARVAZE J, NOLLA-SOLE JM, CLAVAGUERA MT, et al.Long-term therapy in polymyalgia rheumatic:effect of coexistent temporal arteritis[J]. J Rheumatol, 1999, 26(9):1945-1952.
[28] SALVARANI C, CANTINI F, NICCOLI L, et al. Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica:A prospective followup study[J]. Arthritis Rheum, 2005, 53(1):33-38.
[29] MURATORE F, PIPITONE N, HUNDER GG, et al. Discontinuation of therapies in polymyalgia rheumatica and giant cell arteritis[J].Clin Exp Rheumatol, 2013, 31(4 Suppl 78):S86-S92.
[30] LEE JH, CHOI ST, KIM JS, et al. Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatic(PMR)[J]. Rheumatol Int, 2013, 33(6):1475-1480.