Rooney Patrick J, Rooney Jennifer, Balint Geza, Balint Peter
Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
Associate Professor of Medicine, Department of Clinical Skills, St George's University, Grenada.
Scott Med J. 2014 Nov;59(4):220-8. doi: 10.1177/0036933014548144. Epub 2014 Sep 7.
On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the clinical care of affected patients.
The authors searched Medline and PubMed using the search terms 'polymyalgia rheumatica', 'giant cell arteritis' and 'temporal arteritis'. As much as possible, efforts were made to focus on studies where polymyalgia rheumatica and giant cell arteritis were treated as separate entities. The selection of articles was influenced by the authors' bias that polymyalgia rheumatica is a separate clinical condition from giant cell arteritis and that, as yet, the diagnosis is a clinical one. Apart from the elevation of circulating acute phase proteins, which has been recognised as a feature of polymyalgia rheumatica for over 60 years, the diagnosis receives no significant help from the laboratory or from diagnostic imaging.
This review has shown that, following the recognition of polymyalgia as a distinct clinical problem of the elderly, the results of a considerable amount of research efforts including those using the advances in clinical imaging technology over the past 60 years, have done little to change the ability of clinicians to define the disease more accurately. Since the introduction of corticosteroids in the 1950s, there has been also very little change in the clinical management of the condition.
Polymyalgia rheumatica remains a clinical enigma, and its relationship to giant cell arteritis is no clearer now than it has been for the past 125 years. Diagnosing this disease is still almost exclusively dependent on the clinical acumen of a patient's medical attendant. Until an objective method of identifying it clearly in the clinical setting is available, uncovering the aetiology is still unlikely, and until then, preventing the pain and stiffness of the disease while avoiding the problems of prolonged exoposure to corticosteroids is likely to remain elusive or serendipitous.
在关于风湿性多肌痛的首次公认出版物发表125周年之际，进行了一项文献综述，以评估从受影响患者的临床护理角度来看取得了哪些进展。
作者使用搜索词“风湿性多肌痛”“巨细胞动脉炎”和“颞动脉炎”在Medline和PubMed上进行搜索。尽可能将重点放在将风湿性多肌痛和巨细胞动脉炎视为不同实体的研究上。文章的选择受到作者偏见的影响，即风湿性多肌痛是一种与巨细胞动脉炎不同的临床病症，并且目前诊断仍主要依靠临床判断。除了循环急性期蛋白升高（60多年来一直被认为是风湿性多肌痛的一个特征）外，实验室检查或诊断成像对该诊断并无显著帮助。
该综述表明，自从将多肌痛识别为老年人的一种独特临床问题以来，包括那些利用过去60年临床成像技术进步所做的大量研究工作，几乎没有改变临床医生更准确界定该疾病的能力。自20世纪50年代引入皮质类固醇以来，该病症的临床管理也几乎没有变化。
风湿性多肌痛仍然是一个临床谜团，其与巨细胞动脉炎的关系如今并不比过去125年中更清晰。诊断这种疾病几乎仍然完全依赖于患者医护人员的临床敏锐度。在临床环境中找到一种客观明确的识别方法之前，病因仍不太可能被揭示，在此之前，在避免长期使用皮质类固醇带来问题的同时预防该疾病的疼痛和僵硬可能仍然难以捉摸或靠运气。
