风湿性多肌痛合并肥胖患者的症状严重程度与糖皮质激素剂量

Symptom Severity and Glucocorticoid Dosing in Patients With Polymyalgia Rheumatica and Obesity.

作者信息

Cimmino Marco A, Crowson Cynthia S, Dasgupta Bhaskar, Schirmer Michael, Dejaco Christian, Salvarani Carlo, Matteson Eric L, Camellino Dario

机构信息

M.A. Cimmino, MD, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy;

C.S. Crowson, PhD, E.L. Matteson, MD, MPH, Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.

出版信息

J Rheumatol. 2025 Feb 1;52(2):151-157. doi: 10.3899/jrheum.2024-0353.

DOI:10.3899/jrheum.2024-0353

PMID:39486856

Abstract

OBJECTIVE

Polymyalgia rheumatica (PMR) is an inflammatory disorder of the elderly characterized by girdle pain and stiffness. Obesity has an influence on disease activity and outcome in rheumatic diseases like osteoarthritis and rheumatoid arthritis. We aimed to investigate the relationship between high BMI and the severity and outcome of PMR, which is incompletely understood.

METHODS

In a post hoc analysis, 83 patients with recent-onset PMR were studied over 6 months using clinical examination, laboratory evaluation, and girdle ultrasound (US). The modified Health Assessment Questionnaire (mHAQ), 36-item Short Form Health Survey (SF-36), and PMR visual analog scale (VAS) scores, as well as prednisone therapy data, were recorded. Patients were grouped according to their BMI.

RESULTS

At baseline, the 12 patients with obesity had significantly more shoulder pain ( = 0.03), global pain ( = 0.03), PMR VAS ( < 0.01), and fatigue ( = 0.03); higher mHAQ ( = 0.01); and lower SF-36 physical component summary ( = 0.048) and SF-36 pain index ( < 0.001). The mean initial prednisone dose was similar among groups, but patients with obesity received a lower dose/kg (1.9 [SD 0.7] mg vs 2.2 [SD 0.7] mg; < 0.01). At 6 months, patients with obesity were being treated with higher mean daily prednisone doses (8.5 [SD 3.2] mg/d vs 6.2 [SD 5.2] mg/d; = 0.02), and 40% of them were receiving higher daily prednisone doses than the standard protocol compared with 14% patients without obesity ( = 0.048). Clinical features, laboratory results, and US results were similar between patients with and without obesity.

CONCLUSION

Obesity affects both symptom severity and prednisone utilization in patients with PMR. The reason for this may relate to different subjective pain perception rather than increased inflammation in patients with obesity. BMI should be considered when interpreting symptoms in patients with PMR and deciding their prednisone doses.

摘要

目的

风湿性多肌痛（PMR）是一种以肩胛带疼痛和僵硬为特征的老年炎症性疾病。肥胖对骨关节炎和类风湿关节炎等风湿性疾病的疾病活动度和预后有影响。我们旨在研究高体重指数（BMI）与PMR严重程度及预后之间的关系，目前对此关系的了解尚不完全。

方法

在一项事后分析中，对83例近期发病的PMR患者进行了为期6个月的研究，采用临床检查、实验室评估和肩胛带超声（US）检查。记录改良健康评估问卷（mHAQ）、36项简短健康调查（SF-36）、PMR视觉模拟量表（VAS）评分以及泼尼松治疗数据。患者根据BMI分组。

结果

在基线时，12例肥胖患者的肩部疼痛（P = 0.03）、全身疼痛（P = 0.03）、PMR VAS（P < 0.01）和疲劳（P = 0.03）明显更多；mHAQ更高（P = 0.01）；SF-36身体成分总结得分更低（P = 0.048），SF-36疼痛指数更低（P < 0.001）。各组间初始泼尼松平均剂量相似，但肥胖患者的剂量/千克更低（1.9[标准差0.7]毫克对2.2[标准差0.7]毫克；P < 0.01）。在6个月时，肥胖患者接受的泼尼松平均每日剂量更高（8.5[标准差3.2]毫克/天对6.2[标准差5.2]毫克/天；P = 0.02），其中40%的患者接受的每日泼尼松剂量高于标准方案，而无肥胖患者为14%（P = 0.048）。肥胖患者与非肥胖患者的临床特征、实验室检查结果和超声检查结果相似。