Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Diagnostic Center, Svendborg Hospital, OUH, Baagøes Allé 15, 5700, Svendborg, Denmark.
Sci Rep. 2021 Mar 18;11(1):6220. doi: 10.1038/s41598-021-85857-4.
Identifying comorbidities in polymyalgia rheumatica/giant cell arteritis (PMR/GCA) is crucial for patients' outcomes. The present study aimed to evaluate the impact of the inflammatory process and glucocorticoid treatment on aortic arterial stiffness and body composition in PMR/GCA. 77 patients with newly diagnosed PMR/GCA were treated with oral glucocorticoids and followed for 40 weeks. Aortic pulse wave velocity (PWV) was measured at baseline and during the follow-up period and compared to the results of temporal artery biopsy (TAB) and 18F-FDG PET/CT. Body composition was assessed by total body DXA at baseline and the end of the study. Of 77 patients (49 (63.6%) female, mean of age: (71.8 ± 8.0)), 64 (83.1%) had pure PMR, 10 (13.0%) concomitant PMR and GCA, and 3 (3.9%) pure GCA. Compared to baseline values, aortic PWV was initially decreased at week 16 (p = 0.010) and remained lower than baseline at week 28 (p = 0.002) and week 40 (p < 0.001), with no association with results of TAB and 18F-FDG PET/CT. Aortic PWV was significantly associated with age, male gender, left systolic and diastolic blood pressure, right diastolic blood pressure, and CRP. Total bone mineral content (BMC) was decreased in both genders (p < 0.001), while fat mass (FM) was significantly increased (p < 0.001). However, lean body mass did not significantly change during the study. Changes in FM were correlated with cumulative prednisolone dose (rho: 0.26, p = 0.031). Glucocorticoid treatment of patients with PMR/GCA had several prognostic impacts. Arterial stiffness was decreased due either to the treatment or a reduction in the inflammatory load. Additionally, treatment led to changes in body composition, including a decrease in BMC and FM excess.
鉴别巨细胞动脉炎/风湿性多肌痛（PMR/GCA）合并症对患者预后至关重要。本研究旨在评估炎症过程和糖皮质激素治疗对 PMR/GCA 患者主动脉动脉僵硬度和身体成分的影响。77 例新诊断的 PMR/GCA 患者接受口服糖皮质激素治疗，并随访 40 周。在基线和随访期间测量主动脉脉搏波速度（PWV），并与颞动脉活检（TAB）和 18F-FDG PET/CT 结果进行比较。在基线和研究结束时使用全身 DXA 评估身体成分。77 例患者中（49 例（63.6%）为女性，平均年龄为（71.8±8.0）），64 例（83.1%）为单纯 PMR，10 例（13.0%）为 PMR 合并 GCA，3 例（3.9%）为单纯 GCA。与基线值相比，主动脉 PWV 在第 16 周（p=0.010）初始下降，并在第 28 周（p=0.002）和第 40 周（p<0.001）持续低于基线，与 TAB 和 18F-FDG PET/CT 结果无关。主动脉 PWV 与年龄、男性、左收缩压和舒张压、右舒张压和 CRP 显著相关。两性的总骨矿物质含量（BMC）均下降（p<0.001），而脂肪量（FM）显著增加（p<0.001）。然而，在研究过程中，瘦体重没有明显变化。FM 的变化与累积泼尼松剂量呈正相关（rho：0.26，p=0.031）。PMR/GCA 患者的糖皮质激素治疗有多种预后影响。动脉僵硬度的降低可能是由于治疗或炎症负荷的减轻。此外，治疗还导致身体成分发生变化，包括 BMC 减少和 FM 过多。
