Inokuma Shigeko, Sasaki Akio, Fukushima Shun, Miike Satoshi, Tamura Jun, Gotoh Yoshimasa, Hara Kazuaki, Motoshima Takayuki
Department of Allergy and Rheumatism, Chiba Central Medical Center, Chiba, JPN.
Department of Rheumatism and Collagen Diseases, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, JPN.
Cureus. 2025 May 1;17(5):e83319. doi: 10.7759/cureus.83319. eCollection 2025 May.
A new regimen of oral steroid pulse therapy (oral-P), involving intermittent administration of a sufficient oral steroid dose, was adopted for the treatment of polymyalgia rheumatica (PMR). A retrospective evaluation of oral-P in a clinical setting was conducted.
The medical records of PMR patients, diagnosed according to the American College of Rheumatology/European League Against Rheumatism criteria and treated with oral prednisone (P) between April 2015 and July 2020, were reviewed. One course of oral-P consisted of prednisolone at 0.4 mg/kg/day for three consecutive days, followed by 0.1 mg/kg/day for 11 days (0.4P), or 0.8 mg/kg/day followed by 0.2 mg/kg/day (0.8P). After three or five courses, the dose was tapered. The attending physician selected the treatment regimen. Serum C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESRs) were monitored. The duration of disease prior to oral-P initiation, follow-up duration after its withdrawal, and any adverse events were assessed.
Thirty-four patients (22 women and 12 men, aged 66-86 years; 15 on 0.4P and 19 on 0.8P; 11/4 on three/five courses with 0.4P, and 13/6 with 0.8P) were included. Prior to oral-P initiation, CRP levels and ESRs were significantly higher in the 0.8P group than in the 0.4P group (CRP: 8.93 (4.83-12.0) vs. 4.96 (4.15-6.31) mg/dL; ESR: 113.5 (92.75-129) vs. 84 (66-95.5) mm/h). Although the disease duration before oral-P initiation was longer in the 0.8P group, the difference was not statistically significant. After the first course, both CRP levels and ESRs decreased significantly in both groups, with no significant differences observed between the groups in subsequent courses. Twenty-one patients were successfully withdrawn from steroid therapy without relapse during a follow-up period of 27 (14-49) months. The remaining 13 patients were still undergoing dose tapering at their last visit, with a median dose of 3 (2-6) mg/day. No severe adverse events were reported.
Oral-P appears to be a promising treatment regimen for PMR, providing rapid symptom relief and enabling eventual steroid withdrawal.
采用一种新的口服类固醇脉冲疗法（oral-P），即间歇性给予足够剂量的口服类固醇，用于治疗风湿性多肌痛（PMR）。对临床环境中的oral-P进行回顾性评估。
回顾了2015年4月至2020年7月期间根据美国风湿病学会/欧洲抗风湿病联盟标准诊断并接受口服泼尼松（P）治疗的PMR患者的病历。一个疗程的oral-P包括连续三天给予泼尼松龙0.4mg/kg/天，随后11天给予0.1mg/kg/天（0.4P），或0.8mg/kg/天随后0.2mg/kg/天（0.8P）。三个或五个疗程后，逐渐减少剂量。主治医生选择治疗方案。监测血清C反应蛋白（CRP）水平和红细胞沉降率（ESR）。评估口服-P开始前的疾病持续时间、停药后的随访持续时间以及任何不良事件。
纳入34例患者（22例女性和12例男性，年龄66 - 86岁；15例接受0.4P治疗，19例接受0.8P治疗；11/4例接受0.4P三个/五个疗程治疗，13/6例接受0.8P治疗）。在口服-P开始前，0.8P组的CRP水平和ESR显著高于0.4P组（CRP：8.93（4.83 - 12.0） vs. 4.96（4.15 - 6.31）mg/dL；ESR：113.5（92.75 - 129） vs. 84（66 - 95.5）mm/h）。尽管口服-P开始前0.8P组的疾病持续时间较长，但差异无统计学意义。第一个疗程后，两组的CRP水平和ESR均显著下降，后续疗程两组间无显著差异。21例患者在27（14 - 49）个月的随访期内成功停用类固醇治疗且未复发。其余13例患者在最后一次就诊时仍在逐渐减少剂量，中位剂量为3（2 - 6）mg/天。未报告严重不良事件。
oral-P似乎是一种有前景的PMR治疗方案，能快速缓解症状并最终停用类固醇。
