Rheumatology Unit, Brest Teaching Hospital, Brest, France.
J Rheumatol. 2012 Feb;39(2):310-3. doi: 10.3899/jrheum.110866. Epub 2011 Dec 15.
To evaluate the usefulness of the polymyalgia rheumatica (PMR) activity score (PMR-AS) in guiding adjustment of glucocorticoid (GC) dosage.
Rheumatologists prospectively included patients receiving GC therapy for PMR. At each visit, they assessed disease activity using a visual analog scale for physician's global assessment (VASph) and recorded whether a flare was diagnosed and/or the GC dosage was changed. In each patient, the PMR-AS was calculated using the formula of Leeb and Bird: C-reactive protein (mg/dl) + VAS pain score (0 to 10) + VASph (0 to 10) + (morning stiffness in min × 0.1) + elevation of upper limbs (0-3). We evaluated the correlation between PMR-AS and GC dosage changes in the group already treated with GC.
We included 89 patients (mean age 74.6 ± 6.2 yrs; disease duration 1.6 ± 2.2 yrs), who had a total of 149 visits. PMR-AS was available for 137 visits. Of those, 124 involved patients already treated with GC, and 13 patients who started GC treatment. The Spearman correlation coefficient between PMR-AS values and GC dosage change was 0.58 (p < 0.001). In the group already treated with GC, when the PMR-AS was higher than 20, GC dosages were never decreased. When the PMR-AS was between 10 and 20, GC dosages were decreased in 4 patients, unchanged in 4, and increased by < 5 mg in 4 patients. When PMR-AS was < 10, GC dosages were generally decreased.
The PMR-AS is helpful for diagnosing flares of PMR and may also assist in everyday practice to decide how to change the GC dosage.
评估巨细胞动脉炎（PMR）活动评分（PMR-AS）在指导糖皮质激素（GC）剂量调整中的作用。
风湿病学家前瞻性地纳入接受 GC 治疗 PMR 的患者。每次就诊时，他们使用医生总体评估的视觉模拟量表（VASph）评估疾病活动，并记录是否诊断出疾病发作以及/或 GC 剂量是否发生变化。在每位患者中，使用 Leeb 和 Bird 的公式计算 PMR-AS：C-反应蛋白（mg/dl）+ VAS 疼痛评分（0 至 10）+ VASph（0 至 10）+（晨僵时间×0.1）+上肢抬高（0-3）。我们评估了已接受 GC 治疗的患者中 PMR-AS 与 GC 剂量变化之间的相关性。
我们纳入了 89 名患者（平均年龄 74.6±6.2 岁；疾病持续时间 1.6±2.2 年），共进行了 149 次就诊。有 137 次就诊时可获得 PMR-AS。其中，124 次涉及已接受 GC 治疗的患者，13 次涉及开始 GC 治疗的患者。PMR-AS 值与 GC 剂量变化之间的 Spearman 相关系数为 0.58（p<0.001）。在已接受 GC 治疗的患者中，当 PMR-AS 高于 20 时，GC 剂量从未减少过。当 PMR-AS 在 10 到 20 之间时，4 名患者的 GC 剂量减少，4 名患者的 GC 剂量不变，4 名患者的 GC 剂量增加<5mg。当 PMR-AS 低于 10 时，GC 剂量通常会减少。
PMR-AS 有助于诊断 PMR 发作，也可能有助于在日常实践中决定如何调整 GC 剂量。
