Li Jun, Tang Fu-lin, Wang Xiao-dong, Yu Jian-hua
Department of Rheumatology and Immunology, PUMC Hospital, CAMS, PUMC, Beijing 100730, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2002 Dec;24(6):643-5.
To analyze the clinical course and duration of therapy in 28 patients with polymyalgia rheumatica (PMR) and/or temporal arteritis (TA) for identifying factors that influence prolonged steroid use and relapses.
28 cases of PMR and/or TA diagnosed from 1992 to 2001 were retrospectively studied in PUMC hospital. Patients were grouped according to the absence or presence of corticosteroid resistant and relapses.
Of 28 patients, 22 had pure PMR, 3 had both PMR and TA and 3 had pure TA. 15 patients received corticosteroid therapy and 13 had both corticosteroid and immunosuppressor therapy. The median duration was (25.5 +/- 24.0) months. Increase of white blood cell level and higher baseline erythrocyte sedimentation rate (ESR) were significant risk factors associated with corticosteroid resistant (P < 0.01). Quicker reduction of corticosteroid dose was associated with relapse (P < 0.05).
Patients with increase of white blood cell level and higher baseline erythrocyte sedimentation rate (ESR) are more likely to be resistant to corticosteroid therapy. Quicker reduction in corticosteroid is more likely to relapse. Immunosuppressor therapy should be added to patients who has corticosteroid resistant, and relapse or PMR associated with TA.
分析28例风湿性多肌痛（PMR）和/或颞动脉炎（TA）患者的临床病程及治疗持续时间，以确定影响长期使用类固醇及复发的因素。
对1992年至2001年在协和医院确诊的28例PMR和/或TA患者进行回顾性研究。根据是否存在糖皮质激素抵抗及复发情况对患者进行分组。
28例患者中，22例为单纯PMR，3例同时患有PMR和TA，3例为单纯TA。15例患者接受糖皮质激素治疗，13例同时接受糖皮质激素和免疫抑制剂治疗。中位病程为（25.5±24.0）个月。白细胞水平升高及基线红细胞沉降率（ESR）较高是与糖皮质激素抵抗相关的显著危险因素（P<0.01）。糖皮质激素剂量更快降低与复发相关（P<0.05）。
白细胞水平升高及基线红细胞沉降率（ESR）较高的患者更可能对糖皮质激素治疗耐药。糖皮质激素更快减量更易复发。对于糖皮质激素抵抗、复发或与TA相关的PMR患者，应加用免疫抑制剂治疗。
