Division of Rheumatology, University of Pavia, IRCCS S. Matteo Foundation, Pavia, Italy.
Clin Exp Rheumatol. 2011 Sep-Oct;29(5 Suppl 68):S143-7. Epub 2011 Oct 22.
Glucocorticoids are the mainstay of treatment in patients with polymyalgia rheumatica (PMR). Moreover, lower serum cortisol levels have been reported in patients with PMR, suggesting an important role of impaired hypothalamus-pituitary-adrenal (HPA) axis in the pathogenesis of the disease. Therefore, a good response to glucocorticoids has been recognised as a feature of PMR, even if disagreement remains concerning an exact starting dose, duration of treatment and schedule of administration. The role of glucocorticoids in the pathogenesis of PMR, as well as the available evidence concerning different schedules of glucocorticoid treatment, including administration according to circadian rhythms, are discussed.
糖皮质激素是巨细胞动脉炎（PMR）患者治疗的基础。此外，有研究报道 PMR 患者的血清皮质醇水平较低，这表明下丘脑-垂体-肾上腺（HPA）轴功能障碍在疾病发病机制中起重要作用。因此，即使对于确切的起始剂量、治疗持续时间和给药方案仍存在争议，但糖皮质激素的良好反应已被认为是 PMR 的特征之一。本文讨论了糖皮质激素在 PMR 发病机制中的作用，以及关于不同糖皮质激素治疗方案的现有证据，包括根据昼夜节律给药。
