De Miguel Eugenio, Karalilova Rositsa, Macchioni Pierluigi, Ponte Cristina, Conticini Edoardo, Cowley Sharon, Tomelleri Alessandro, Monti Sara, Monjo Irene, Batalov Zguro, Klinowski Giulia, Falsetti Paolo, Kane David J, Campochiaro Corrado, Hočevar Alojzija
Rheumatology, La Paz University Hospital, Madrid, Spain
Clinic of Rheumatology, Medical University Plovdiv, Plovdiv, Bulgaria.
Ann Rheum Dis. 2024 Feb 15;83(3):335-341. doi: 10.1136/ard-2023-224768.
The aim of the present study was to determine the clinical significance of subclinical giant cell arteritis (GCA) in polymyalgia rheumatica (PMR) and ascertain its optimal treatment approach.
Patients with PMR who fulfilled the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology Provisional Classification Criteria for PMR, did not have GCA symptoms and were routinely followed up for 2 years and were stratified into two groups, according to their ultrasound results: isolated PMR and PMR with subclinical GCA. The outcomes (relapses, glucocorticoid use and disease-modifying antirheumatic drug treatments) between groups were compared.
We included 150 patients with PMR (50 with subclinical GCA) with a median (IQR) follow-up of 22 (20-24) months. Overall, 47 patients (31.3 %) had a relapse, 31 (62%) in the subclinical GCA group and 16 (16%) in the isolated PMR group (p<0.001). Among patients with subclinical GCA, no differences were found in the mean (SD) prednisone starting dosage between relapsed and non-relapsed patients (32.4±15.6 vs 35.5±12.1 mg, respectively, p=0.722). Patients with subclinical GCA who relapsed had a faster prednisone dose tapering in the first 3 months compared with the non-relapsed patients, with a mean dose at the third month of 10.0±5.2 versus 15.2±7.9 mg daily (p<0.001). No differences were found between relapsing and non-relapsed patients with subclinical GCA regarding age, sex, C reactive protein and erythrocyte sedimentation rate.
Patients with PMR and subclinical GCA had a significantly higher number of relapses during a 2-year follow-up than patients with isolated PMR. Lower starting doses and rapid glucocorticoid tapering in the first 3 months emerged as risk factors for relapse.
本研究旨在确定亚临床巨细胞动脉炎（GCA）在风湿性多肌痛（PMR）中的临床意义，并确定其最佳治疗方法。
符合2012年欧洲风湿病联盟/美国风湿病学会PMR临时分类标准、无GCA症状且常规随访2年的PMR患者，根据超声结果分为两组：孤立性PMR和伴有亚临床GCA的PMR。比较两组间的结局（复发、糖皮质激素使用和改善病情抗风湿药物治疗）。
我们纳入了150例PMR患者（50例伴有亚临床GCA），中位（IQR）随访时间为22（20 - 24）个月。总体而言，47例患者（31.3%）复发，亚临床GCA组31例（62%），孤立性PMR组16例（16%）（p<0.001）。在亚临床GCA患者中，复发患者与未复发患者的泼尼松起始平均（SD）剂量无差异（分别为32.4±15.6 vs 35.5±12.1mg，p = 0.722）。与未复发患者相比，复发的亚临床GCA患者在最初3个月泼尼松剂量减量更快，第三个月的平均剂量为每日10.0±5.2 vs 15.2±7.9mg（p<0.001）。在复发和未复发的亚临床GCA患者之间，年龄、性别、C反应蛋白和红细胞沉降率无差异。
在2年随访期间，伴有亚临床GCA的PMR患者的复发次数明显高于孤立性PMR患者。较低的起始剂量和最初3个月快速的糖皮质激素减量是复发的危险因素。
