Department of Neurology, Mayo Clinic, Rochester, Minnesota.
Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
J Am Acad Dermatol. 2017 Mar;76(3):506-511.e1. doi: 10.1016/j.jaad.2016.08.048. Epub 2016 Oct 26.
Corticosteroids (CS) may benefit certain patients with erythromelalgia.
Our objective was to determine clinical predictors of corticosteroid-responsive erythromelalgia.
Patients with erythromelalgia who received CS were identified and stratified into corticosteroid nonresponders (NRs), partial corticosteroid responders (PSRs), complete corticosteroid responders (CSRs), and steroid responders (SRs = PSRs + CSRs). In the study variable analysis, P < .05 was considered statistically significant.
The median (interquartile range) age of the 31-patient cohort was 47 years (26-57 years), and 22 (71%) were female. Fourteen (45%) were NRs, 17 (55%) SRs, 8 (26%) PSRs, and 9 (29%) CSRs. A subacute temporal profile to disease zenith (<21 days) was described in 15 (48%) patients, of whom 13 (87%) were SRs (P = .003; odds ratio [OR] = 0.069 [95% confidence interval {CI}, 0.011-0.431]). Six (67%) CSRs reported a disease precipitant (eg, surgery, trauma, or infection; P = .007; OR = 12.667 [95% CI, 2-80.142]). SR patients received CS sooner than NR at 3 (3-12) versus 24 (17-45) months (P = .003). A high-dose CS trial (≥200 mg prednisone cumulatively) was administered to 17 (55%) patients, of whom 13 (76%) were SRs (P = .012; OR = 8.125 [95% CI, 1.612-40.752]).
This was a retrospective case series.
An infectious, traumatic, or surgical precipitant and subacute presentation may portend CR erythromelalgia. A transient "golden window" where CS intervention is useful may exist before irreversible nociceptive remodeling and central sensitization occurs.
皮质类固醇（CS）可能对某些红斑性肢痛症患者有益。
我们的目的是确定皮质类固醇反应性红斑性肢痛症的临床预测因子。
确定接受 CS 治疗的红斑性肢痛症患者，并将其分为皮质类固醇无反应者（NRs）、部分皮质类固醇反应者（PSRs）、完全皮质类固醇反应者（CSRs）和类固醇反应者（SRs=PSRs+CSRs）。在研究变量分析中，P<.05 被认为具有统计学意义。
31 例患者队列的中位（四分位间距）年龄为 47 岁（26-57 岁），其中 22 例（71%）为女性。14 例（45%）为 NRs，17 例（55%）为 SRs，8 例（26%）为 PSRs，9 例（29%）为 CSRs。15 例（48%）患者疾病高峰呈亚急性时间模式（<21 天），其中 13 例（87%）为 SRs（P=.003；优势比[OR]=0.069[95%置信区间{CI}，0.011-0.431]）。6 例（67%）CSRs 报告有疾病诱发因素（例如手术、创伤或感染；P=.007；OR=12.667[95%CI，2-80.142]）。SR 患者接受 CS 的时间早于 NR 患者，分别为 3（3-12）个月和 24（17-45）个月（P=.003）。17 例（55%）患者接受了高剂量 CS 试验（累积>200mg 泼尼松），其中 13 例（76%）为 SRs（P=.012；OR=8.125[95%CI，1.612-40.752]）。
这是一项回顾性病例系列研究。
感染、创伤或手术诱发因素和亚急性表现可能预示着 CR 红斑性肢痛症。在不可逆的伤害性重塑和中枢敏化发生之前，可能存在 CS 干预有用的短暂“黄金窗口”。
