35例风湿性多肌痛的临床表现及预后

Clinical Features and Prognosis in 35 Cases with Polymyalgia Rheumatica

目的探讨风湿性多肌痛(polymyalgia rheumatica, PMR)的临床特点及预后。方法入选并随访2013年6月—2016年6月在金华市中心医院住院确诊为PMR的35例患者,分析其临床表现及预后。结果 35例患者中28例(80%)表现为上举下蹲困难,血沉≥100 mm/hr者症状更显著(P<0.05),8例患者(22.9%)伴低热,7例患者(20%)伴周围神经病变,5例患者(14.3%)伴关节肿痛。12例患者(34.3%)在确诊前曾被误诊,常见误诊疾病为骨质疏松症和椎间盘突出。所有患者对小剂量激素有效,治疗半年内激素减停过程中再发血沉升高达42.9%,症状再发占20%,2年内停用激素率为31.3%;发病时血沉≥100 mm/hr的患者激素减药或停药时复发率升高,但差异无统计学意义。结论 PMR对小剂量激素反应良好,疾病复发高峰在治疗半年内,缓慢激素减量、加强对患者的宣教及严密监测血沉可能会减少疾病复发。

Objective To investigate the clinical features and prognosis of rheumatic polymyalgia(PMR).Methods 35 cases with PMR of confirmed diagnosis hospitalized in Jinhua Central Hospital during the period from June,2013 to June,2016 were enrolled and followed up;their clinical manifestations and prognosis were analyzed.Results 28 cases out of the 35 had difficulties in squatting down and arm upward holding,which was more obvious in cases with erythrocyte sedimentation rate(ESR)≥100 mm/hr(P<0.05);8 cases(22.9%)were complicated with low fever,7 cases(20%)with peripheral neuropathy and 5 cases(14.3%)with articular pain;12 cases were misdiagnosed before the confirmed diagnosis,the common misdiagnosed diseases included osteoporosis and disc herniation;small dose of glucocorticoid was of effect on all the cases;within the half a year of glucocorticoid reduction and withdrawal after treatment,the recurrence of ESR increase was 42.9%and that of symptoms was 20%;the cases with ESR≥100 mm/hr at the onset had a higher recurrence during glucocorticoid reduction and withdrawal while the difference was of no statistical significance.Conclusions PMR responses well to small dose of glucocorticoid;the recurrence peak appears within half a year after treatment;it may reduce the recurrence to slow down the glucocorticoid reduction,strengthen the education of the cases and strictly monitor erythrocyte sedimentation.