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[风湿性多肌痛:有哪些新进展?]

[Polymyalgia rheumatica: What's new?].

作者信息

Schmidt Wolfgang A

机构信息

Klinik für Innere Medizin, Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin-Buch, Deutschland.

出版信息

Dtsch Med Wochenschr. 2024 Aug;149(17):1051-1055. doi: 10.1055/a-2144-8222. Epub 2024 Aug 15.

Abstract

Currently, only 25% of all polymyalgia rheumatica (PMR) patients are referred to specialists. An expert committee has recently recommended confirmation of diagnosis by specialist care. This can help to avoid misdiagnoses and hospital stays and can result in lower glucocorticoid doses.Using ultrasound, magnetic resonance imagining (MRI), or positron emission tomography-computed tomography (PET-CT), typical periarticular inflammatory changes are observed, especially in the shoulder and pelvic girdle area. However, for clinical use, ultrasound is usually sufficient.In 20-25% of newly diagnosed PMR patients without symptoms of giant cell arteritis (GCA), GCA can be detected through vascular ultrasound. These patients require higher glucocorticoid doses in analogy to GCA therapy. There is growing awareness of a joint GCA-PMR spectrum disease.Glucocorticoids remain the primary treatment. The interleukin-6 inhibitor Sarilumab has recently been approved in the USA for patients with recurrent PMR. Studies have also demonstrated the effectiveness of Tocilizumab in PMR.

摘要

目前,所有风湿性多肌痛(PMR)患者中只有25%会转诊至专科医生处。一个专家委员会最近建议由专科护理来确诊。这有助于避免误诊和住院,并可降低糖皮质激素剂量。通过超声、磁共振成像(MRI)或正电子发射断层扫描-计算机断层扫描(PET-CT),可观察到典型的关节周围炎症改变,尤其是在肩部和骨盆带区域。然而,对于临床应用,超声通常就足够了。在20%-25%新诊断的无巨细胞动脉炎(GCA)症状的PMR患者中,通过血管超声可检测出GCA。这些患者按照GCA治疗方案需要更高剂量的糖皮质激素。人们越来越认识到存在GCA-PMR联合频谱疾病。糖皮质激素仍然是主要治疗方法。白细胞介素-6抑制剂萨瑞鲁单抗最近在美国已被批准用于复发性PMR患者。研究也已证明托珠单抗在PMR中的有效性。

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