Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Division of Rheumatology and Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Lancet. 2017 Oct 7;390(10103):1700-1712. doi: 10.1016/S0140-6736(17)31825-1. Epub 2017 Jul 31.
Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease. Vascular uptake on PET scans is seen in some patients. A dose of 12·5-25·0 mg prednisolone daily or equivalent leads to rapid improvement of symptoms in most patients with isolated disease. However, relapses are common when prednisolone is tapered. Methotrexate might be used in patients who relapse. The effectiveness of biological therapies, such as anti-interleukin 6, in patients with polymyalgia rheumatica that is refractory to glucocorticoids requires further investigation. Most population-based studies indicate that mortality is not increased in patients with isolated disease.
巨细胞动脉炎是一种炎症性疾病，影响肩部、骨盆带和颈部，通常发生在 50 岁以上的个体中。巨细胞动脉炎的典型特征是急性期反应物增加。该疾病可能表现为孤立性疾病，也可能与巨细胞动脉炎相关。包括炎症性风湿病和自身免疫性疾病、感染和恶性肿瘤在内的几种疾病可模仿巨细胞动脉炎。影像学技术已在一半以上患有活动性疾病的患者中识别出滑囊炎的存在。一些患者的 PET 扫描可见血管摄取。大多数患有孤立性疾病的患者每天服用 12.5-25.0 毫克泼尼松龙或等效剂量的药物，症状会迅速改善。然而，当泼尼松龙逐渐减少时，常会复发。对于复发的患者，可以使用甲氨蝶呤。对于对糖皮质激素治疗无反应的巨细胞动脉炎患者，生物疗法（如抗白细胞介素 6）的疗效尚需进一步研究。大多数基于人群的研究表明，孤立性疾病患者的死亡率没有增加。
