Cutolo M, Oliveri M, Secchi M E, Cimmino M A
U.O.C. Clinica Reumatologica, Dipartimento di Medicina Interna Università degli Studi di Genova, 16132 Genova, Italia.
Reumatismo. 2007 Oct-Dec;59(4):271-9. doi: 10.4081/reumatismo.2007.271.
Polymyalgia rheumatica (PMR) is an inflammatory syndrome affecting older people whose prevalence has increased in recent years. The suppression of the hypothalamic-pituitary-adrenal axis (HPA) and ageing may contribute to the pathogenesis of PMR. Chronic stress (i.e. interpersonal, chronic infections etc.) in elderly people may represent a risk factor for the development of PMR. In fact, elderly represent per se a condition of endocrine senescence including adrenal hypofunction, in addition chronic stress represents a further harmful stimulus to seriously compromise endogenous glucocorticoid production. Synovitis and vasculitis characterize the majority of the patients. Serum cytokine and steroidal hormone patterns suggest that patients with PMR have an intensive inflammatory reaction. As a matter of fact, glucocorticoids represent the most useful temporary "replacement" treatment during the active phase of PMR. The use of modified-release glucocorticoids that might induce higher levels during the night (circadian rhythms as in physiological conditions), will represent another important approach to optimize PMR treatment and reduce the side effects. Combination therapy between glucocorticoids and inhibitors of pro-inflammatory cytokines should be tested in large studies and early cases of PMR.
风湿性多肌痛（PMR）是一种影响老年人的炎症综合征，近年来其患病率有所上升。下丘脑 - 垂体 - 肾上腺轴（HPA）的抑制和衰老可能与PMR的发病机制有关。老年人的慢性应激（如人际关系、慢性感染等）可能是PMR发生的危险因素。事实上，老年人本身就存在内分泌衰老的情况，包括肾上腺功能减退，此外，慢性应激是另一种有害刺激，会严重损害内源性糖皮质激素的产生。滑膜炎和血管炎是大多数患者的特征。血清细胞因子和甾体激素模式表明，PMR患者存在强烈的炎症反应。事实上，糖皮质激素是PMR活动期最有效的临时“替代”治疗药物。使用可能在夜间诱导更高水平（如同生理状态下的昼夜节律）的缓释糖皮质激素，将是优化PMR治疗并减少副作用的另一种重要方法。糖皮质激素与促炎细胞因子抑制剂的联合治疗应在大型研究和PMR早期病例中进行试验。
