风湿性多肌痛和巨细胞动脉炎的诊疗规范

Recommendations of diagnosis and treatment of giant cell arteritis and polymyalgia rheumatic in China

风湿性多肌痛(PMR)是一种以颈部、肩胛带和骨盆带肌肉疼痛、晨僵,红细胞沉降率升高,伴或不伴发热等全身反应为表现的综合征。巨细胞动脉炎(GCA)是一种原因不明的几乎全身血管均可受累的系统性血管炎,主要侵犯大、中动脉,病变呈节段性、坏死性,组织病理学呈肉芽肿样炎症。我国目前尚缺乏GCA的流行病学资料,实际患病率可能被低估。GCA较为严重的并发症是不可逆的视觉丧失及脑血管事件。PMR发病率为GCA的3倍,临床上需排除其他特异性疾病。GCA患者中40%~60%合并PMR,PMR患者中约15%合并GCA。为推进GCA和PMR的规范化诊断与治疗,中华医学会风湿病学分会在2005年临床诊疗指南的基础上,借鉴国内外诊治经验和指南,制定了本规范,旨在规范GCA和PMR的诊断和治疗,改善患者预后。

Polymyalgia rheumatica(PMR)is a syndrome characterized by pain and morning stiffness in the neck and shoulder and pelvic girdles,as well as raised acute-phase reactants,with or without systemic symptoms,such as fever.Giant cell arteritis(GCA)is a systemic vasculitis of unclear etiology that involves systemic arteries,principally affecting medium-and large-sized arteries with skipped,segmental alterations and granulomatous vasculitis seen on histopathology.In China,epidemiological data describing GCA are still limited;thus,the prevalence might be underestimated.The involvement of vessels in GCA can cause irreversible visual impairment or loss and stroke,which are serious complications.PMR is three times more prevalent than GCA,and other specific diseases should be excluded before the diagnosis is established.PMR symptoms can be present in 40%-60%of patients with GCA.Conversely,GCA can develop in 15%of patients with PMR.Chinese Rheumatology Association,based on the clinical diagnosis and treatment guidelines in 2005,utilizing the experience and guidelines of diagnosis and treatment at home and abroad,formulated this specification to standardize the diagnosis and treatment of GCA and PMR and improve the patient′s prognosis.