Inokuma Shigeko, Okazaki Taro, Morishita Hiroki, Tsuji Masanori, Goto Yoshimasa
Department of Allergy and Rheumatism, Chiba Central Medical Center, Chiba-shi, JPN.
Department of Rheumatism and Collagen Diseases, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa-shi, JPN.
Cureus. 2024 Apr 22;16(4):e58778. doi: 10.7759/cureus.58778. eCollection 2024 Apr.
The primary treatment of choice for polymyalgia rheumatica (PMR) is corticosteroids, which are better avoided for elderly patients susceptible to PMR. The cases of five patients cured with only a small dosage of 600 mg/day ibuprofen without steroids or methotrexate are reported. Their clinical features were compared with those of the 26 PMR patients who had steroids and/or methotrexate in addition to ibuprofen. PMR was diagnosed based on the 2015 EULAR/ACR criteria. They were all females aged 73-80. They all had no giant cell arteritis or autoantibodies. Nonsteroidal anti-inflammatory drugs (NSAIDs) other than ibuprofen had not worked in four cases; for the one, ibuprofen was the first NSAID. Their serum CRP levels were 1.57-12.8 mg/dL at ibuprofen introduction. Colchicine was co-administered in two patients. At the next visit three to seven days after ibuprofen introduction, they all showed a clear recovery with a CRP level decrease. Ibuprofen tapering was started within three months, and no relapse was until two to five years' follow-up. Comparison with the 26 patients who had additional steroid and/or methotrexate showed that the disease duration until ibuprofen introduction was statistically significantly shorter in the five patients (1.40±0.65 vs 3.28±2.98 months). Ibuprofen would be the first-line drug for PMR, and its earliest use would be beneficial.
风湿性多肌痛（PMR）的主要治疗选择是皮质类固醇，但对于易患PMR的老年患者应尽量避免使用。本文报告了5例仅使用小剂量（600毫克/天）布洛芬而未使用类固醇或甲氨蝶呤就治愈的病例。将他们的临床特征与另外26例除布洛芬外还使用了类固醇和/或甲氨蝶呤的PMR患者进行了比较。PMR的诊断依据是2015年欧洲抗风湿病联盟（EULAR）/美国风湿病学会（ACR）标准。这些患者均为73至80岁的女性。她们均无巨细胞动脉炎或自身抗体。除布洛芬外，其他非甾体抗炎药（NSAIDs）对其中4例无效；对另1例而言，布洛芬是其使用的第一种NSAID。在开始使用布洛芬时，她们的血清C反应蛋白（CRP）水平为1.57至12.8毫克/分升。2例患者同时服用了秋水仙碱。在开始使用布洛芬后三至七天的下次就诊时，她们均显示明显恢复，CRP水平下降。在三个月内开始逐渐减少布洛芬用量，在长达两至五年的随访中均未复发。与另外26例还使用了类固醇和/或甲氨蝶呤的患者相比，这5例患者在开始使用布洛芬之前的病程在统计学上显著更短（1.40±0.65个月对3.28±2.98个月）。布洛芬应作为PMR的一线药物，尽早使用将有益处。
