风湿性多肌痛误诊为类风湿关节炎六例临床分析

Clinical Analysis of 6 Patients with Polymyalgia Rheumatica Misdiagnosed as Rheumatoid Arthritis

目的 探讨风湿性多肌痛(PMR)的临床特点及误诊原因和防范措施。方法 回顾性分析2020年3月—2023年3月收治的被误诊为类风湿关节炎(RA)PMR 6例的临床资料。结果 本组4例无诱因出现多处外周关节轻微疼痛持续1个月~1.5年,疼痛加剧3 d;2例肩颈部肌肉僵痛,全身关节痛,并伴发热症状。6例均误诊为RA,误诊时间9 d~6个月。给予相应治疗后效果不佳,进一步完善相关检查,磁共振发现患者疼痛处无侵袭或破坏性病变,查抗环瓜氨酸肽抗体阴性,使用小剂量糖皮质激素治疗有效。详细询问家族史,并结合疼痛部位的特点及检查、试验治疗结果,最终确诊为PMR。给予小剂量糖皮质激素联合非甾体抗炎药或不同的免疫抑制剂治疗,症状消失后减量维持治疗,效果较好。结论 PMR临床表现多样化,缺少特异性实验检查指标,极其容易误诊为RA。临床医师需加强对该病的鉴别诊断能力,及时完善相关检查,减少PMR误诊或漏诊。

Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of polymyalgia rheumatica(PMR).Methods Clinical data of 6 PMR patients misdiagnosed with rheumatoid arthritis(RA) from March 2020 to March 2023 were retrospectively analyzed.Results In this group,4 patients had multiple mild peripheral joint pain without inducement lasting from 1 month to 1.5 years,and the pain worsened for 3 days.In this group,2 patients had stiff shoulder and neck muscles,joint pain and fever symptoms.All the 6 patients were misdiagnosed as RA,and the duration of misdiagnosis was 9 d-6 months.Corresponding treatment was far from satisfactory.Further relevant examination was performed,and MRI showed that the patient had no invasive or destructive lesions in the pain area,the anti-cyclic citrulline peptide antibody was negative,and the treatment with low-dose glucocorticoid was effective.After inquiring about the family history in detail,combined with the characteristics of the pain site and the examination and test results,the final diagnosis of PMR was made.They were given low-dose glucocorticoid combined with non-steroidal anti-inflammatory drugs or different immunosuppressant treatment,and after the symptoms disappeared,the dosage was reduced to maintain treatment,showing favorable effect.Conclusion PMR is more likely to be misdiagnosed as RA due to its diverse clinical manifestations and lack of specific test indicators.Clinicians should strengthen the ability of differential diagnosis of PMR,perform relevant examination in time,and reduce the misdiagnosis or missed diagnosis of PMR.