风湿性多肌痛的诊断和治疗进展

Research progress in diagnosis and treatment of polymyalgia rheumatica

风湿性多肌痛是一种以双侧疼痛为特征的炎症性疾病,主要累及肩部和手臂近端,颈部和盆腔腰带较少见。风湿性多肌痛可以独立发生,但也可与其他自身免疫性、感染性、恶性和内分泌疾病相关,尤其是巨细胞动脉炎。风湿性多发性肌痛的诊断通常基于临床表现和炎性标志物的增加。目前尚无符合诊断的病因学依据。然而,不同的成像技术,特别是超声检查,可以帮助识别风湿性多肌痛。糖皮质激素是治疗风湿性多肌痛的基石,但它们可能与不同的不良事件有关。有一部分患者表现为难治性病程,在这些病例中,加入生物制剂作为非类固醇药物可能是有用的。本文总结了风湿性多肌痛的发病机制、临床特点、诊断和治疗的最新研究成果,旨在提高对风湿性多肌痛认识,为临床提供诊断思路。

Polymyalgia rheumatic(PMR)is an inflammatory disease characterized by bilateral pain,which mainly involves the shoulder and proximal arm,and the neck and pelvic belt are rare.Rheumatic polymyalgia can occur independently,but it may be associated with the other autoimmune,infectious,malignant and endocrine diseases,especially giant cell arteritis.The diagnosis of rheumatic polymyalgia is usually based on clinical manifestations and an increase in inflammatory markers.At present,there is no etiological basis for diagnosis.However,different imaging techniques,especially ultrasonography is helpful to identify polymyalgia rheumatic.Glucocorticoids are the cornerstone of the treatment of polymyalgia rheumatic,however,which may be associated with different adverse events.In some patients with a refractory course of disease,it may be useful to add biological agents as non-steroid drugs.This article reviews the latest research progress on the pathogenesis,clinical features,diagnosis and treatment of rheumatic polymyalgia,in order to improve the understanding of polymyalgia rheumatic and provide diagnostic ideas for clinical practice.