Department of Clinical Immunology and Rheumatology, Tobata General Hospital, Kitakyushu, Japan.
The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Mod Rheumatol. 2023 Mar 2;33(2):318-322. doi: 10.1093/mr/roac024.
Differentiation between polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis (EORA), especially in elderly patients, is often difficult due to similarities in symptoms and serological kinetics. In this study, we aimed to analyse the predictors of EORA with PMR-like onset.
Seventy-two patients diagnosed with PMR, who attended our hospital for routine care and underwent musculoskeletal ultrasonography at that time were evaluated. Synovitis was evaluated semi-quantitatively (0-3) by grey scale (GS) and power Doppler (PD) in 24 joints [both hands (wrist, metacarpophalageal, and proximal interphalangeal joints) and both shoulder joints].
Overall, 18 patients had rheumatoid arthritis (25.0%); the mean age was 75.0 years, and 34.7% and 65.3% were male and female, respectively. In PMR and PMR/EORA groups, multivariate logistic analysis showed that rheumatoid factor positivity, GS ≥2 of hand joints, and PD ≥1 of hand joints were independent factors with significant differences. At least one of the three factors had a sensitivity of 88.9% and specificity of 92.6%.
The presence of at least one of the criteria: rheumatoid factor positivity, GS ≥ 2, and PD ≥ 1 of hand joints, suggested the possibility of developing EORA within 1 year of PMR diagnosis.
由于症状和血清动力学相似，巨细胞动脉炎（PMR）和老年发病型类风湿关节炎（EORA）的鉴别，尤其是在老年患者中，往往较为困难。本研究旨在分析具有 PMR 样起病的 EORA 的预测因子。
评估了 72 名在我院接受常规治疗且当时接受肌肉骨骼超声检查的 PMR 患者。在 24 个关节（双手[腕、掌指和近端指间关节]和双肩关节]）中通过灰阶（GS）和能量多普勒（PD）对滑膜炎进行半定量评估（0-3）。
总体而言，18 名患者患有类风湿关节炎（25.0%）；平均年龄为 75.0 岁，男性和女性分别占 34.7%和 65.3%。在 PMR 和 PMR/EORA 组中，多变量逻辑分析显示，类风湿因子阳性、手部关节 GS≥2 和手部关节 PD≥1 是具有显著差异的独立因素。这三个因素中的至少一个具有 88.9%的敏感性和 92.6%的特异性。
至少存在一个标准：类风湿因子阳性、GS≥2 和手部关节 PD≥1，提示在 PMR 诊断后 1 年内发生 EORA 的可能性。
