Gonzalez-Gay Miguel A, Garcia-Porrua Carlos, Miranda-Filloy Jose A, Martin Javier
Division of Rheumatology, Hospital Xeral-Calde, Lugo, Spain.
Drugs Aging. 2006;23(8):627-49. doi: 10.2165/00002512-200623080-00002.
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common and often concurrent diseases in Western countries in individuals aged >50 years. Clinical features of GCA are mainly due to involvement of the cranial arteries. PMR is clinically characterised by pain, aching and morning stiffness involving the neck, shoulder and hip girdles. Both conditions are generally associated with elevation of erythrocyte sedimentation rate and C-reactive protein. A temporal artery biopsy is the gold standard test for the diagnosis of GCA. Some diseases may mimic PMR or present with polymyalgic symptoms. Corticosteroids are the cornerstone of the management of GCA and PMR. An initial dosage of prednisone 10-20 mg/day yields a dramatic improvement of PMR symptoms in most cases. In GCA, the initial prednisone dosage required is higher (40-60 mg/day). However, once established, visual loss, which is the most feared complication of GCA, does not usually improve following corticosteroid therapy. Some patients exhibit a chronic-relapsing course and may need low doses of corticosteroids for several years. Alternative corticosteroid-sparing therapies and some therapeutic agents aimed at restoring balanced bone cell activity in patients taking corticosteroids are potentially useful in the management of GCA and PMR.
巨细胞动脉炎（GCA）和风湿性多肌痛（PMR）在西方国家50岁以上人群中是常见且常并发的疾病。GCA的临床特征主要是由于颅动脉受累。PMR的临床特征是颈部、肩部和骨盆带出现疼痛、酸痛和晨僵。这两种疾病通常都与红细胞沉降率和C反应蛋白升高有关。颞动脉活检是诊断GCA的金标准检查。一些疾病可能会模仿PMR或表现出多肌痛症状。皮质类固醇是GCA和PMR治疗的基石。在大多数情况下，初始剂量为泼尼松10 - 20毫克/天可使PMR症状显著改善。在GCA中，所需的初始泼尼松剂量更高（40 - 60毫克/天）。然而，一旦发生视力丧失，这是GCA最可怕的并发症，通常在皮质类固醇治疗后不会改善。一些患者表现为慢性复发病程，可能需要低剂量皮质类固醇治疗数年。替代的皮质类固醇节省疗法以及一些旨在恢复服用皮质类固醇患者骨细胞活性平衡的治疗药物可能对GCA和PMR的治疗有用。
