Manzo Ciro, Milchert Marcin, Natale Maria, Brzosko Marek
Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic Hospital "Mariano Lauro", Sant'Angello, Italy.
Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland.
Reumatologia. 2020;58(3):184-186. doi: 10.5114/reum.2020.96549. Epub 2020 Jun 29.
The existence of polymyalgia rheumatica (PMR) with normal inflammatory indices at the time of diagnosis still represents a diagnostic conundrum. According to the literature, some patients with PMR following immune checkpoint inhibitory therapy had normal values of both erythrocyte sedimentation rate and C-reactive protein concentrations at the time of diagnosis. In this short communication we investigated the possibility that in some patients with PMR the main pathogenic mechanism is constituted by inhibition of some checkpoints, such as programmed death receptor-1, programmed death ligand 1, and "cytotoxic" lymphocyte antigen 4. In these patients, the pathogenetic mechanisms underlying PMR can act much more upstream than commonly suggested. Also, we addressed the question of whether these patients should be considered as affected by PMR-like syndromes or by PMR subset.
诊断时炎症指标正常的风湿性多肌痛（PMR）的存在仍然是一个诊断难题。根据文献，一些接受免疫检查点抑制治疗后发生PMR的患者在诊断时红细胞沉降率和C反应蛋白浓度均正常。在这篇简短的通讯中，我们研究了在一些PMR患者中主要致病机制是否由对某些检查点（如程序性死亡受体-1、程序性死亡配体1和“细胞毒性”淋巴细胞抗原4）的抑制构成的可能性。在这些患者中，PMR潜在的致病机制可能比通常认为的作用更靠前。此外，我们还探讨了这些患者应被视为患有PMR样综合征还是PMR亚型的问题。
