González-Gay M A, Rodríguez-Valverde V, Blanco R, Fernández-Sueiro J L, Armona J, Figueroa M, Martínez-Taboada V M
Division of Rheumatology, Hospital Xeral-Calde, Lugo, Spain.
Arch Intern Med. 1997 Feb 10;157(3):317-20. doi: 10.1001/archinte.1997.00440240081012.
An erythrocyte sedimentation rate (ESR) of at least 40 mm/h is considered an important requisite for the diagnosis of polymyalgia rheumatica (PMR). However, the relative frequency and clinical features of PMR in patients without a significantly increased ESR are unclear.
We performed a retrospective study of patients diagnosed as having PMR at the rheumatology divisions of 3 teaching hospitals. The diagnosis of PMR was established, regardless of the ESR, in 201 consecutive patients fulfilling the following criteria: (1) age 50 years or older, (2) severe proximal pain for more than 1 month in at least 2 of 3 areas: neck, shoulder, and/or pelvic girdles, and (3) rapid resolution of the syndrome while taking low-dose prednisone. Patients with giant cell arteritis were previously excluded from the study. The frequency and clinical features of patients with PMR and an ESR lower than 40 mm/h were analyzed. A comparative study between these patients and those with high ESRs was performed.
An ESR lower than 40 mm/h was found in 41 patients (20.4%). These patients were younger (P = .02), were more frequently men (P = .006), and experienced a lower frequency of fever (P = .003) and weight loss (P = .07). Furthermore, these patients were characterized by an absence of anemia (P = .002) and a lower frequency of abnormal protein electrophoresis results (P < .001). Otherwise, their clinical syndrome, response to therapy, and frequency of relapses were similar to those of patients with classic PMR. In the entire population of 201 patients, the ESR was related to the length of treatment, number of areas involved, presence of fever, weight loss, and laboratory test result abnormalities, but it was unrelated to the duration of the illness prior to diagnosis.
It is not uncommon to find a patient with PMR with an ESR lower than 40 mm/h. This syndrome is more frequent in men and it is clinically less severe than the classic form of PMR. Its recognition will allow these patients to benefit from an effective treatment with low-dose corticosteroids.
红细胞沉降率（ESR）至少40mm/h被认为是诊断风湿性多肌痛（PMR）的重要必要条件。然而，ESR未显著升高的患者中PMR的相对频率和临床特征尚不清楚。
我们对3家教学医院风湿科诊断为PMR的患者进行了一项回顾性研究。在201例符合以下标准的患者中确立了PMR的诊断，无论其ESR如何：（1）年龄50岁或以上；（2）在颈部、肩部和/或骨盆带这3个区域中的至少2个区域存在严重的近端疼痛超过1个月；（3）在服用低剂量泼尼松时综合征迅速缓解。巨细胞动脉炎患者先前已被排除在研究之外。分析了ESR低于40mm/h的PMR患者的频率和临床特征。对这些患者与ESR高的患者进行了比较研究。
41例患者（20.4%）的ESR低于40mm/h。这些患者更年轻（P = 0.02），男性更常见（P = 0.006），发热频率较低（P = 0.003），体重减轻频率较低（P = 0.07）。此外，这些患者的特点是无贫血（P = 0.002），异常蛋白电泳结果的频率较低（P < 0.001）。否则，他们的临床综合征、对治疗的反应和复发频率与经典PMR患者相似。在201例患者的总体中，ESR与治疗时间、受累区域数量、发热的存在、体重减轻和实验室检查结果异常有关，但与诊断前疾病的持续时间无关。
发现ESR低于40mm/h的PMR患者并不罕见。这种综合征在男性中更常见，临床上比经典形式的PMR轻。对其的认识将使这些患者受益于低剂量皮质类固醇的有效治疗。
