de Jager J P
Gold Coast Hospital, Southport, Queensland.
Aust Fam Physician. 2001 Jul;30(7):643-7.
Polymyalgia rheumatica (PMR) needs to be considered in the patient over 55 years of age who presents with stiffness and pain. It appears to exist in a continuum with giant cell arteritis (GCA), and the differential diagnosis is large. It may affect one in 200 patients in this age group. Corticosteroid toxicity is a major problem, either because of inappropriate dosage or prolonged disease.
To provide an up to date understanding of the concepts of this group of disorders in order to allow rapid recognition, better management, and to minimise toxicity of the necessary treatment. The most important of these are the appropriate dose of corticosteroid and instituting preventive therapy for potential complications such as osteoporosis.
As there is no specific test for PMR, the diagnosis is still made on clinical grounds from the presentation, symptoms and signs, and the presence of serological markers of inflammation. Because these are all nonspecific, alternative diagnoses must be actively excluded. Certain newer investigations, such as high resolution ultrasound of the temporal arteries may be very helpful in directing temporal artery (TA) biopsies. When the response to treatment does not follow the usual course (and this may be prolonged: 18 months to five years or more), then re-evaluation is imperative.
对于55岁以上出现僵硬和疼痛的患者，需要考虑风湿性多肌痛（PMR）。它似乎与巨细胞动脉炎（GCA）处于连续统一体中，鉴别诊断范围广。在这个年龄组中，每200名患者中可能有1人受其影响。皮质类固醇毒性是一个主要问题，这可能是由于剂量不当或疾病持续时间过长所致。
提供对这组疾病概念的最新理解，以便能够快速识别、更好地管理并尽量减少必要治疗的毒性。其中最重要的是皮质类固醇的适当剂量以及对潜在并发症（如骨质疏松症）采取预防性治疗。
由于PMR没有特异性检测方法，诊断仍基于临床表现、症状和体征以及炎症血清学标志物来做出。因为这些都是非特异性的，所以必须积极排除其他诊断。某些更新的检查，如颞动脉高分辨率超声，可能对指导颞动脉（TA）活检非常有帮助。当治疗反应未遵循通常病程（且病程可能延长：18个月至5年或更长时间）时，则必须重新评估。
