Moreel Lien, Boeckxstaens Lennert, Betrains Albrecht, Smans Timo, Molenberghs Geert, Van Laere Koen, De Langhe Ellen, Vanderschueren Steven, Blockmans Daniel
Department of General Internal Medicine, UZ Leuven, Leuven, Belgium.
Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
Rheumatology (Oxford). 2024 Dec 1;63(12):3331-3336. doi: 10.1093/rheumatology/keae208.
Two recent meta-analyses reported subclinical vasculitis in 22-23% of patients with PMR. We aimed to evaluate the prevalence, characteristics, and outcome of subclinical vasculitis among our PMR patients.
Consecutive patients with GCA/PMR spectrum disease with isolated PMR symptoms who underwent FDG PET imaging between 2003 and 2020 and who were followed for ≥6 months, were included retrospectively. Vasculitis was defined as FDG uptake ≥grade 2 in any vessel.
We included 337 patients, of whom 31 (9%) with subclinical vasculitis. Among those with subclinical vasculitis, 21 (58%) had isolated large vessel vasculitis, 3 (10%) had isolated cranial vasculitis and 7 (23%) had both cranial and large vessel vasculitis. The glucocorticoid (GC) starting dose and GC doses during follow-up were higher in those with subclinical vasculitis until 12 months after diagnosis (P < 0.001). There was no difference in the duration of GC treatment (25 vs 20 months, P = 0.187). Cox proportional hazard regression analyses showed no difference in the proportion of patients able to stop GC (HR 0.78 [95% CI 0.49-1.25], P = 0.303) and in the proportion of patients with relapse (HR 0.82 [95%CI 0.50-1.36], P = 0.441).
Only 9% of our PMR patients had subclinical vasculitis with a predilection for large vessel vasculitis. There were no differences in relapse rate and duration of GC treatment, however, those with subclinical vasculitis received higher GC doses until 12 months after diagnosis. Prospective interventional trials are needed to evaluate the outcome of PMR patients with and without subclinical vasculitis treated with a similar GC protocol.
两项近期的荟萃分析报告称，22%-23%的巨细胞动脉炎/风湿性多肌痛（GCA/PMR）谱系疾病患者存在亚临床血管炎。我们旨在评估我们的PMR患者中亚临床血管炎的患病率、特征及转归。
回顾性纳入2003年至2020年间接受氟代脱氧葡萄糖（FDG）PET成像检查、有孤立性PMR症状的连续性GCA/PMR谱系疾病患者，且这些患者随访时间≥6个月。血管炎定义为任何血管的FDG摄取≥2级。
我们纳入了337例患者，其中31例（9%）有亚临床血管炎。在有亚临床血管炎的患者中，21例（58%）有孤立性大血管血管炎，3例（10%）有孤立性颅血管炎，7例（23%）既有颅血管炎又有大血管血管炎。在诊断后12个月内，有亚临床血管炎的患者糖皮质激素（GC）起始剂量及随访期间的GC剂量更高（P<0.001）。GC治疗持续时间无差异（25个月对20个月，P=0.187）。Cox比例风险回归分析显示，能够停用GC的患者比例（风险比[HR]0.78[95%置信区间（CI）0.49-1.25]，P=0.303）及复发患者比例（HR 0.82[95%CI 0.50-1.36]，P=0.441）无差异。
我们的PMR患者中只有9%有亚临床血管炎，且以大血管血管炎为主。复发率和GC治疗持续时间无差异，然而，有亚临床血管炎的患者在诊断后12个月内接受的GC剂量更高。需要进行前瞻性干预试验，以评估采用相似GC方案治疗的有和无亚临床血管炎的PMR患者的转归。
