Prieto-Peña Diana, Castañeda Santos, Atienza-Mateo Belén, Blanco Ricardo, González-Gay Miguel A
Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués De Valdecilla, IDIVAL, Santander, Spain.
Rheumatology Division, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
Expert Rev Clin Immunol. 2021 Mar;17(3):225-232. doi: 10.1080/1744666X.2021.1890032. Epub 2021 Apr 9.
Polymyalgia rheumatica (PMR) is a common inflammatory disease found in people older than 50 years of Northern European descent. It is characterized by pain and stiffness in the shoulders, arms, hips, and neck. Relapses are common in patients with PMR.
This review describes when and how relapses occur in patients with PMR. Potential predisposing factors associated with relapses and management are also discussed. An extensive literature search on the PubMed database was conducted for publications on 'polymyalgia rheumatica' AND 'relapses' AND 'risk factors'.
Relapses are common in PMR being observed in approximately half of the patients. They often occur when the dose of prednisone is below 5-7.5 mg/day. The speed of glucocorticoid tapering is considered to be the main factor influencing the development of relapses in isolated PMRs. In addition, a genetic component may favor the presence of relapses in isolated PMRs. HLA-DRB1*0401 alleles were associated with an increased risk of relapse. An implication of the IL-6 promoter -174 G/C polymorphism and the GG241 ICAM-1 genotype was also reported. With regard to serological biomarkers, elevated levels of angiopoietin-2 were associated with an unfavorable course of PMR. Methotrexate and anti-IL6 receptor antibody tocilizumab may be required in PMR patients with multiple relapses.
风湿性多肌痛（PMR）是一种常见的炎症性疾病，多见于50岁以上的北欧后裔人群。其特征为肩部、手臂、臀部和颈部疼痛及僵硬。PMR患者复发很常见。
本综述描述了PMR患者复发的时间和方式。还讨论了与复发相关的潜在诱发因素及管理方法。在PubMed数据库上进行了广泛的文献检索，以查找关于“风湿性多肌痛”、“复发”和“危险因素”的出版物。
PMR患者复发很常见，约一半的患者会出现复发。复发常发生在泼尼松剂量低于5 - 7.5毫克/天时。糖皮质激素减量速度被认为是影响单纯性PMR复发发生的主要因素。此外，遗传因素可能促使单纯性PMR出现复发。HLA - DRB1*0401等位基因与复发风险增加有关。也有报道称IL - 6启动子 - 174 G/C多态性和GG241 ICAM - 1基因型有一定影响。关于血清生物标志物，血管生成素 - 2水平升高与PMR的不良病程相关。对于多次复发的PMR患者，可能需要使用甲氨蝶呤和抗IL - 6受体抗体托珠单抗。
