Salvarani C, Gabriel S, Hunder G G
Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis Rheum. 1996 Jan;39(1):73-80. doi: 10.1002/art.1780390110.
To determine the frequency and clinical characteristics of diffuse distal extremity swelling with pitting edema occurring in polymyalgia rheumatica (PMR).
Clinical features and laboratory findings were recorded for all 245 residents of Olmsted County, Minnesota who developed PMR over a 22-year period (1970-1991). Those who exhibited > or = 1 episode of diffuse distal extremity edema with pitting were selected for this study, and were evaluated further.
Thirteen women and 6 men in this incidence cohort of PMR had > or = 1 episode of distal extremity swelling with pitting edema. Giant cell arteritis was also identified in 5 patients. In 11 patients, the swelling and edema development concurrently with proximal PMR symptoms. In 2 patients, the distal swelling was the initial manifestation, and in 6 patients, the distal symptoms developed during relapses or recurrences of PMR. Both upper and lower extremities were affected, usually in a symmetric manner. Other peripheral manifestations were also common. The distal swelling and pitting edema responded promptly to corticosteroids, and slowly or incompletely to nonsteroidal anti-inflammatory drugs; a similar response was observed in the proximal symptoms. The distal swelling appeared to represent tenosynovitis and synovitis of regional structures.
Distal extremity swelling with pitting edema represents a manifestation of PMR that has not been well described in previous studies. Awareness of this finding will help facilitate the proper diagnosis and institution of appropriate therapy for this disease.
确定风湿性多肌痛（PMR）中出现的伴有凹陷性水肿的弥漫性远端肢体肿胀的发生率及临床特征。
记录了明尼苏达州奥姆斯特德县在1970年至1991年这22年间发生PMR的所有245名居民的临床特征和实验室检查结果。选择那些出现≥1次伴有凹陷性水肿的弥漫性远端肢体水肿发作的患者进行本研究，并进一步评估。
在这个PMR发病队列中，13名女性和6名男性出现≥1次伴有凹陷性水肿的远端肢体肿胀。5名患者还被诊断为巨细胞动脉炎。11名患者的肿胀和水肿与近端PMR症状同时出现。2名患者中，远端肿胀是初始表现，6名患者中，远端症状在PMR复发或再发期间出现。上下肢均受累，通常呈对称方式。其他外周表现也很常见。远端肿胀和凹陷性水肿对皮质类固醇反应迅速，对非甾体抗炎药反应缓慢或不完全；近端症状也观察到类似反应。远端肿胀似乎代表局部结构的腱鞘炎和滑膜炎。
伴有凹陷性水肿的远端肢体肿胀是PMR的一种表现，此前研究中对此描述较少。认识到这一发现将有助于促进对该疾病的正确诊断和适当治疗的实施。
