Aoki Yoko, Iwamoto Masahiro, Minota Seiji
Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Nihon Rinsho Meneki Gakkai Kaishi. 2009 Aug;32(4):274-8. doi: 10.2177/jsci.32.274.
Polymyalgia rheumatica (PMR) is an inflammatory disease of unknown etiology affecting elderly patients and characterized by muscle pain and morning stiffness in proximal areas (pelvic and shoulder girdles and neck). It is sometimes difficult to distinguish PMR from rheumatoid arthritis (RA), or vasculitis. In the present study, we examined the clinical characteristics of the patients diagnosed with PMR in our hospital retrospectively. There were 44 patients with the median age of 71s. Eighty percent of the patients were in their 60s or 70s, and 3 patients (6.8%) were in there 50s or younger. There was no sex preponderance in frequency. Fifteen patients (34%) presented with both proximal and distal muscle pain. Arthritis occurred in 16 patients (36%), the half of which was monarthritis or oligoarthritis, and was more involved in wrist or knee joint. Only 3 patients had temporal arteritis (TA) complicated with PMR. Mean of maximum serum CRP was 8.18 mg/dl, and rheumatoid factor and anti-CCP antibodies were positive in 2 patients and a patient, respectively. There was no patient positive for ANCA. Serum MMP-3 levels tended to be higher in female patients. Median of maximum prednisolone (PSL) dose used for the treatment was 0.195 mg/kg of body weight daily. No patient needed any immunosuppressants. In the 26 patients we had a chance to follow, there were no patients who developed RA 6 months after the initial diagnosis. Progression from PMR to RA was reported, and mean period between the diagnosis of PMR and RA was one to 5 years.
风湿性多肌痛（PMR）是一种病因不明的炎症性疾病，影响老年患者，其特征为近端部位（骨盆带、肩胛带和颈部）肌肉疼痛和晨僵。有时很难将PMR与类风湿关节炎（RA）或血管炎区分开来。在本研究中，我们回顾性地研究了我院诊断为PMR的患者的临床特征。共有44例患者，中位年龄为71岁。80%的患者年龄在60或70多岁，3例患者（6.8%）年龄在50多岁或更年轻。发病频率无性别差异。15例患者（34%）同时出现近端和远端肌肉疼痛。16例患者（36%）发生关节炎，其中一半为单关节炎或少关节炎，且更多累及腕关节或膝关节。只有3例患者合并颞动脉炎（TA）与PMR。血清CRP最高均值为8.18mg/dl，类风湿因子和抗CCP抗体分别在2例和1例患者中呈阳性。无患者ANCA阳性。女性患者血清MMP-3水平往往较高。治疗所用泼尼松龙（PSL）最大剂量的中位数为每日0.195mg/kg体重。无患者需要任何免疫抑制剂。在我们有机会随访的26例患者中，初次诊断后6个月内无患者发展为RA。有报道称PMR可进展为RA，PMR诊断与RA诊断之间的平均间隔为1至5年。
