Pease C T, Haugeberg G, Montague B, Hensor E M A, Bhakta B B, Thomson W, Ollier W E R, Morgan A W
Department of Rheumatology, Chapel Allerton Hospital, Chapeltown Road, Leeds LS74SA, UK.
Rheumatology (Oxford). 2009 Feb;48(2):123-7. doi: 10.1093/rheumatology/ken343. Epub 2008 Nov 2.
To describe the pattern of arthropathy and HLA-DRB1 alleles associated with PMR in order to develop a diagnostic algorithm that could help distinguish PMR and RF-negative (RF -ve) late-onset RA (LO-RA) at presentation.
This was a prospective study of all patients presenting with PMR or LO-RA over a 10-yr period to one physician. Demographic, clinical and laboratory data were collected at presentation and during a minimum of 5 yrs of follow-up. The accuracy of the initial diagnosis was systematically reviewed.
One hundred and forty-two patients with LO-RA, 147 with PMR and 42 with PMR + TA were studied. Peripheral synovitis was observed in 23% of the PMR patients. In comparison with RF -ve LO-RA, PMR patients were younger (P < 0.001), myalgia more frequent [100 vs 16% (P < 0.001)] and arthritis of PIP, MCP and wrist were less frequent (P < 0.001). The combination of wrist + MCP/PIP or wrist + PIP + MCP were highly suggestive of RF -ve LO-RA (P < 0.001). HLA-DRB1*0101/0102 and *0401 were significantly increased in PMR patients compared with healthy controls. Plasma viscosity and arthritis in the wrist, in combination with at least one MCP or PIP joint at disease onset, were predictive of whether a non-erosive RF -ve patient would ultimately be diagnosed as having RF -ve LO-RA or PMR (+/-/arthritis).
Our longitudinal follow-up data were consistent with RF -ve LO-RA being a separate disease entity to PMR despite some phenotypic and immunogenetic similarities at disease onset. A diagnostic algorithm was derived using baseline clinical features to predict the final diagnosis of RF -ve, non-erosive patients.
描述与巨细胞动脉炎（PMR）相关的关节病模式及人类白细胞抗原-DRB1（HLA-DRB1）等位基因，以开发一种诊断算法，帮助在初诊时鉴别PMR和类风湿因子阴性（RF-ve）的晚发型类风湿关节炎（LO-RA）。
这是一项对一位医生在10年期间接诊的所有PMR或LO-RA患者进行的前瞻性研究。收集初诊时及至少5年随访期间的人口统计学、临床和实验室数据。系统回顾初始诊断的准确性。
研究了142例LO-RA患者、147例PMR患者和42例PMR合并颞动脉炎（TA）患者。23%的PMR患者观察到外周滑膜炎。与RF-ve LO-RA相比，PMR患者更年轻（P<0.001），肌痛更常见[100%对16%（P<0.001）]，近端指间关节（PIP）、掌指关节（MCP）和腕关节的关节炎较少见（P<0.001）。腕关节+MCP/PIP或腕关节+PIP+MCP的组合高度提示RF-ve LO-RA（P<0.001）。与健康对照相比，PMR患者中HLA-DRB10101/0102和0401显著增加。血浆粘度以及疾病发作时腕关节关节炎与至少一个MCP或PIP关节的组合，可预测非侵蚀性RF-ve患者最终是否会被诊断为RF-ve LO-RA或PMR（+/-/关节炎）。
我们的纵向随访数据表明，尽管在疾病发作时有一些表型和免疫遗传学相似性，但RF-ve LO-RA是与PMR不同的疾病实体。利用基线临床特征得出一种诊断算法，以预测RF-ve、非侵蚀性患者的最终诊断。
