Nissen Michael J, Gabay Cabay
Service de rhumatologie, Département de médecine interne, HUG, 1211 Genève 14.
Rev Med Suisse. 2010 Mar 17;6(240):575-6, 578, 580.
Polymyalgia rheumatica (PMR) and temporal arteritis (TA) are 2 common conditions in the elderly patient. Early diagnosis and rapid introduction of treatment with corticosteroids is critical, in order to avoid potentially serious complications. The diagnosis is largely clinical for PMR, whereas it is both clinical and histopathological for TA. Certain situations may require complementary investigations such as ultrasound or PET-CT. Bilateral subacromial/subdeltoid bursitis is extremely frequent in patients with PMR, but rarely present in healthy subjects. Intravenous bolus corticosteroids may be useful at presentation with TA, particularly when associated with visual symptoms. There may be a role for disease-modifying antirheumatic drugs (DMARD) such as methotrexate in reducing the requirement for corticosteroids. Finally, clinical and radiological follow-up is important in order to detect aortic aneurysms or large vessel involvement.
风湿性多肌痛（PMR）和颞动脉炎（TA）是老年患者的两种常见病症。早期诊断并迅速开始使用皮质类固醇进行治疗至关重要，以避免潜在的严重并发症。PMR的诊断主要基于临床症状，而TA的诊断则需要临床和组织病理学检查。某些情况可能需要进行超声或PET-CT等辅助检查。双侧肩峰下/三角肌下滑囊炎在PMR患者中极为常见，但在健康受试者中很少出现。静脉推注皮质类固醇在TA发病时可能有用，尤其是伴有视觉症状时。抗风湿药物（DMARD）如甲氨蝶呤在减少皮质类固醇需求方面可能发挥作用。最后，临床和影像学随访对于检测主动脉瘤或大血管受累情况很重要。
