Rheumatology Research Fellow, Southend University Hospital.
Int J Clin Pract. 2012 Sep;66(9):906-9. doi: 10.1111/j.1742-1241.2012.02981.x.
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are related inflammatory rheumatic conditions affecting adults over the age of 50 years. Both conditions respond to initial glucocorticoid (GC) therapy. However, most patients require 12-36 months of a tapering steroid regime. Adverse events at 2 years are seen in up to 65% of patients with PMR and 86% of patients with GCA with over 50% developing serious events. There is also a high incidence of relapse in both diseases -40% within 2 years for GCA and 50% of patients with PMR at some point having a relapse. Effective steroid-sparing adjuvant therapies are urgently required especially in incomplete, poorly sustained or non-responders to glucocorticoids. In this case series, we found that Leflunomide is efficacious, with 22 out of our 23 patients exhibiting a complete or partial response. It was also steroid sparing and well tolerated. It may be a useful adjunctive agent in difficult-to-treat GCA and PMR. Prospective randomised controlled trials of Leflunomide in both GCA and PMR are now required.
巨细胞动脉炎（GCA）和多发性肌炎（PMR）是两种与年龄相关的炎症性风湿性疾病，影响 50 岁以上的成年人。这两种疾病对初始糖皮质激素（GC）治疗均有反应。然而，大多数患者需要 12-36 个月的逐渐减少类固醇剂量的治疗方案。高达 65%的 PMR 患者和 86%的 GCA 患者在 2 年内出现不良反应，超过 50%的患者出现严重不良反应。这两种疾病的复发率也很高——GCA 患者在 2 年内复发率为 40%，PMR 患者中有 50%在某个时候会复发。因此，特别需要有效的、能够减少激素用量的辅助治疗药物，以应对那些对激素治疗反应不完全、效果维持不佳或不耐受的患者。在本病例系列研究中，我们发现来氟米特治疗有效，23 例患者中有 22 例出现完全或部分缓解。同时，来氟米特还具有减少激素用量和良好耐受性的作用。对于治疗困难的 GCA 和 PMR，来氟米特可能是一种有用的辅助药物。目前需要开展前瞻性随机对照试验，以评估来氟米特治疗 GCA 和 PMR 的效果。
