Häntzschel H, Bird H A, Seidel W, Krüger W, Neumann G, Schneider G, Wright V
Division of Rheumatology, Karl-Marx-University, Leipzig, Germany.
Ann Rheum Dis. 1991 Sep;50(9):619-22. doi: 10.1136/ard.50.9.619.
Clinical, laboratory, and scintigraphic features of 16 patients with polymyalgia rheumatica and 23 patients matched for age presenting with classical or definite rheumatoid arthritis (American Rheumatism Association 1958 criteria) of the elderly were compared in order to define features that might distinguish between these two syndromes. The sensitivity of proposed diagnostic criteria for polymyalgia rheumatica was always higher in the group with polymyalgia rheumatica, though only significantly so for morning stiffness. A comparison of 27 different laboratory features showed few significant differences between the diseases, though correlation between laboratory variables within each of the disease groups differed, perhaps suggesting a fundamental pathogenetic difference between them. Scintigraphy of the shoulder joint proved of no value in differential diagnosis. It was concluded that polymyalgia rheumatica and rheumatoid arthritis of the elderly are probably discrete clinical entities. Bilateral upper arm tenderness, lack of positive rheumatoid factor, and a normal caeruloplasmin are the most valuable features for distinguishing polymyalgia rheumatica from rheumatoid arthritis of the elderly.
比较了16例风湿性多肌痛患者和23例年龄匹配的患有典型或确诊类风湿关节炎（根据1958年美国风湿病协会标准）的老年患者的临床、实验室及闪烁扫描特征，以确定可能区分这两种综合征的特征。风湿性多肌痛组中，所提出的风湿性多肌痛诊断标准的敏感性总是更高，不过仅晨僵情况差异具有显著性。对27项不同实验室特征进行比较，发现这两种疾病之间几乎没有显著差异，尽管每个疾病组内实验室变量之间的相关性有所不同，这可能提示它们之间存在根本的发病机制差异。肩关节闪烁扫描在鉴别诊断中无价值。得出的结论是，老年风湿性多肌痛和类风湿关节炎可能是不同的临床实体。双侧上臂压痛、类风湿因子阴性以及血浆铜蓝蛋白正常是将老年风湿性多肌痛与类风湿关节炎区分开来的最有价值的特征。
