Alaska Family Medicine Residency, Anchorage, AK, USA.
University of South Alabama, Mobile, AL, USA.
Am Fam Physician. 2013 Nov 15;88(10):676-84.
Polymyalgia rheumatica affects proximal muscles and joints, causing disability in older adults. Giant cell arteritis affects medium and large arteries and can result in blindness. These conditions overlap significantly, often occurring together. Despite the similarities, each has distinct symptoms, corticosteroid dosing requirements, and prognosis. The hallmark of both conditions is inflammation. Polymyalgia rheumatica primarily affects the shoulders, neck, and hips with prominent bilateral pain. Systemic findings such as fatigue and weight loss are common, and there is no definitive diagnostic test. Moderate-dose corticosteroid therapy with a slow taper rapidly resolves symptoms. Management of patients responding to treatment can occur in the primary care setting, if there is no concomitant giant cell arteritis. The clinical presentation of giant cell arteritis varies widely, from new-onset headache and constitutional symptoms, to jaw claudication, to less common isolated visual changes and upper extremity claudication. Treatment requires higher dosages of corticosteroids and urgent referral to a rheumatologist. Relapse is common in both diseases. Surveillance is important, as is monitoring for long-term complications of corticosteroid use. Osteoporosis management and gastrointestinal ulcer prophylaxis should be initiated. The primary care physician's coordination of care with a rheumatologist and with other subspecialists, if needed, is essential in the management of giant cell arteritis.
巨细胞动脉炎影响大中动脉，可导致失明。这些病症有很多重叠之处，常同时发生。尽管有很多相似之处，但每种病症都有其独特的症状、皮质类固醇剂量要求和预后。这两种病症的主要特征都是炎症。风湿性多肌痛主要影响肩部、颈部和臀部，表现为双侧明显疼痛。常见全身性表现，如疲劳和体重减轻，但没有明确的诊断性检查。采用中剂量皮质类固醇治疗，并逐渐缓慢减量，可迅速缓解症状。如果没有并发巨细胞动脉炎，对治疗有反应的患者可在初级保健机构进行管理。巨细胞动脉炎的临床表现差异很大，从新发头痛和全身症状，到咀嚼肌疼痛，再到不常见的孤立性视觉改变和上肢跛行。治疗需要更高剂量的皮质类固醇，并需要紧急转介到风湿病专家处。这两种疾病都容易复发。监测很重要，应监测皮质类固醇使用的长期并发症。应开始骨质疏松症管理和胃肠道溃疡预防。初级保健医生与风湿病专家以及其他专科医生协调护理，对巨细胞动脉炎的管理至关重要。
