von Knorring J, Selroos O
Scand J Rheumatol. 1976;5(2):77-80. doi: 10.3109/03009747609099894.
Polymyalgia rheumatica developed in a 71-year-old patient within 2 years of the onset of acute sarcoidosis with biopsy-verified involvement of the thyroid, and concomitant autoimmune thyroiditis with hyperthyroid symptoms. Three years after the onset of muscle symptoms a non-metastasizing breast carcinoma was discovered and treated surgically. Neither the long interval between the onset of polymyalgia rheumatica and the discovery of the breast tumour, nor the good response of muscle symptoms to a one-year maintenance treatment with corticosteroids, was consistent with a paraneoplastic mechanism of the polymyalgia rheumatica syndrome. It was therefore hypothesized that the various disorders suffered by this patient might be related to a partly age-dependent depression of T-lymphocyte function, leading to an altered immunological reactivity to which the various clinical manifestations could be attributed. Such a hypothesis is supported by recent reports showing that in old people and in ageing experimental animals, a decrease in T-lymphocyte function and in the number of circulating T-cells occurs concomitantly with an increase in the incidence of a variety of neoplasms and autoimmune disorders.
一名71岁患者在急性结节病发病2年内出现了风湿性多肌痛，活检证实甲状腺受累，并伴有自身免疫性甲状腺炎及甲状腺功能亢进症状。肌肉症状出现3年后，发现了非转移性乳腺癌并接受了手术治疗。风湿性多肌痛发病与发现乳腺肿瘤之间的时间间隔较长，且肌肉症状对皮质类固醇维持治疗1年反应良好，这两者均不符合风湿性多肌痛综合征的副肿瘤机制。因此推测，该患者所患的各种疾病可能与T淋巴细胞功能部分随年龄下降有关，导致免疫反应性改变，各种临床表现可归因于此。最近的报告支持了这一假说，这些报告表明，在老年人和衰老的实验动物中，T淋巴细胞功能和循环T细胞数量的减少与各种肿瘤和自身免疫性疾病发病率的增加同时出现。
