Unità Operativa di Reumatologia, Arcispedale S Maria Nuova, Reggio Emilia, Italy.
Rheumatology (Oxford). 2009 Dec;48(12):1566-9. doi: 10.1093/rheumatology/kep286. Epub 2009 Oct 5.
To determine if ultrasonography (US) and power Doppler (PD) may be useful in identifying polymyalgia rheumatica (PMR) patients with relapsing disease.
For a mean of 41 months, 57 consecutive untreated patients with PMR were prospectively assessed for relapses/recurrences. This cohort represented all the patients diagnosed over a 18-month period in one Italian secondary referral centre. Clinical signs and symptoms as well as ESR and CRP were evaluated. US examination of the shoulders was performed in all 57 patients at diagnosis and after the onset of prednisone treatment (mean 24 +/- 3 weeks). Power Doppler ultrasonography (PDUS) was performed in 24 patients. Shoulder sonograms were obtained according to standardized techniques.
Prednisone therapy significantly reduced the frequency and the degree of subacromial/subdeltoid bursitis, long head biceps tenosynovitis and glenohumeral synovitis. At diagnosis, a positive PD signal was observed more frequently in the subacromial/subdeltoid bursae (33%). Prednisone therapy significantly reduced the frequency of patients with positive PD signal. Of the 44 patients in remission or with low disease activity at the time of the second US, 26 (59%) still had evidence of persistent inflammatory lesions. There was no association between the persistence of inflammation at US and relapses/recurrences; in contrast, a positive PD signal at diagnosis was significantly associated with the occurrence of relapses/recurrences at follow-up.
Subclinical inflammation detected by US persists in most PMR patients despite glucocorticoid treatment. PDUS may be useful to detect at diagnosis the patients with most active inflammation who have a higher risk of relapses/recurrences.
确定超声（US）和能量多普勒（PD）是否可用于识别复发性巨细胞动脉炎（PMR）患者。
在平均 41 个月的时间里，对 57 例未经治疗的连续 PMR 患者进行前瞻性评估以确定复发/再发情况。该队列代表了意大利二级转诊中心在 18 个月期间诊断的所有患者。评估了临床症状和体征以及 ESR 和 CRP。在 57 例患者的诊断时以及泼尼松治疗开始后（平均 24 +/- 3 周）对所有患者进行了肩部超声检查。对 24 例患者进行了能量多普勒超声（PDUS）检查。根据标准化技术获得肩部超声图像。
泼尼松治疗显著降低了肩峰下/三角肌下囊炎、肱二头肌长头腱鞘炎和盂肱关节滑膜炎的频率和程度。在诊断时，在肩峰下/三角肌下囊（33%）中更频繁地观察到阳性 PD 信号。泼尼松治疗显著降低了 PD 信号阳性患者的频率。在第二次超声检查时处于缓解或低疾病活动状态的 44 例患者中，26 例（59%）仍有持续性炎症病变的证据。在超声上炎症的持续存在与复发/再发之间没有关联；相反，在诊断时存在阳性 PD 信号与随访时发生复发/再发明显相关。
尽管接受了糖皮质激素治疗，但超声检测到的亚临床炎症在大多数 PMR 患者中仍然存在。PDUS 可能有助于在诊断时检测出炎症最活跃的患者，这些患者复发/再发的风险更高。
