Helfgott S M, Kieval R I
Brigham and Women's Hospital, Boston, MA 02115, USA.
Arthritis Rheum. 1996 Feb;39(2):304-7. doi: 10.1002/art.1780390220.
To ascertain the frequency of polymyalgia rheumatica (PMR) with a normal erythrocyte sedimentation rate (ESR; < or = 30 mm/hour) and to determine any defining clinical characteristics.
A retrospective chart review study of all patients meeting the clinical criteria for PMR seen over a 5-year period in a hospital and an office-based rheumatology practice.
We evaluated 117 patients; 26 (22.2%) had a pretreatment ESR of < or = 30 mm/hour (mean +/- SD 19.8 +/- 7.5 versus 74.4 +/- 30.3 mm/hour for elevated ESR group; P<0.0001). Of the 26 normal ESR patients, 15 (58%) were female compared with 74 of the 91 elevated ESR patients (81%) (P<0.02, by Fisher's exact test). The mean hemoglobin concentration was significantly lower in the elevated ESR population (mean +/- SD 1.23 +/- 0.15 gm/liter versus 1.38 +/- 0.11 gm/liter; P<0.0001). The duration of symptoms prior to treatment with prednisone was significantly longer for patients with a normal ESR (149 +/- 95 days versus 103 +/- 95 days for elevated ESR patients; P<0.04).
In our series, PMR with a normal ESR accounted for approximately one-fifth of all PMR patients, more commonly in men. The lack of characteristically abnormal laboratory findings may result in a delay in the proper diagnosis and management of this condition.
确定红细胞沉降率（ESR；≤30毫米/小时）正常的风湿性多肌痛（PMR）的发生率，并确定其任何明确的临床特征。
对一家医院和一家门诊风湿病诊所5年内符合PMR临床标准的所有患者进行回顾性病历审查研究。
我们评估了117例患者；26例（22.2%）治疗前ESR≤30毫米/小时（ESR升高组平均±标准差为19.8±7.5，而ESR升高组为74.4±30.3毫米/小时；P<0.0001）。在26例ESR正常的患者中，15例（58%）为女性，而91例ESR升高的患者中有74例（81%）为女性（通过Fisher精确检验，P<0.02）。ESR升高人群的平均血红蛋白浓度显著较低（平均±标准差为1.23±0.15克/升，而ESR正常组为1.38±0.11克/升；P<0.0001）。ESR正常的患者在使用泼尼松治疗前症状持续时间显著更长（149±95天，而ESR升高的患者为103±95天；P<0.04）。
在我们的系列研究中，ESR正常的PMR约占所有PMR患者的五分之一，在男性中更为常见。缺乏典型的异常实验室检查结果可能导致对这种疾病的正确诊断和管理延迟。
