Meskimen S, Cook T D, Blake R L
Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, 65212, USA.
Am Fam Physician. 2000 Apr 1;61(7):2061-8, 2073.
Giant cell arteritis and polymyalgia rheumatica are closely related disorders that affect persons more than 50 years of age and cause substantial morbidity. Patients with giant cell arteritis typically have a localized headache, nonspecific systemic symptoms, temporal artery tenderness and a high erythrocyte sedimentation rate (ESR). The diagnosis is confirmed by characteristic pathologic findings on temporal artery biopsy. Patients with polymyalgia rheumatica usually have similar nonspecific systemic symptoms, proximal muscle pain and stiffness, and an elevated ESR. The diagnosis is based on the clinical findings. Both disorders are treated with corticosteroids: high dosages for giant cell arteritis (prednisone in a dosage of 40 to 60 mg per day) and lower dosages for polymyalgia rheumatica (prednisone in a dosage of 10 to 20 mg per day). Symptom relief in response to treatment is rapid and reinforces the diagnosis. After normalization of the ESR, the corticosteroid is tapered, with the patient monitored closely for symptom recurrence. Most patients require corticosteroid therapy for two to three years and experience one or more treatment complications.
巨细胞动脉炎和风湿性多肌痛是密切相关的疾病，多见于50岁以上人群，可导致严重发病。巨细胞动脉炎患者通常有局部头痛、非特异性全身症状、颞动脉压痛及血沉（ESR）升高。颞动脉活检的特征性病理表现可确诊。风湿性多肌痛患者通常有类似的非特异性全身症状、近端肌肉疼痛和僵硬，以及血沉升高。诊断基于临床表现。两种疾病均用皮质类固醇治疗：巨细胞动脉炎用高剂量（泼尼松每日剂量40至60毫克），风湿性多肌痛用低剂量（泼尼松每日剂量10至20毫克）。治疗后症状迅速缓解，这也支持诊断。血沉恢复正常后，逐渐减少皮质类固醇用量，密切监测患者有无症状复发。大多数患者需要接受两到三年的皮质类固醇治疗，并会经历一种或多种治疗并发症。
