风湿性多肌痛34例临床特征与误诊分析

Clinical Features of Polymyalgia Rheumatic in 34 Cases and Misdiagnosis Analysis

中文关键词: 风湿性多肌痛  巨细胞动脉炎  临床特征  小剂量激素

英文关键词: polymyalgia rheumatic (PMR)  giant cell arteritis (GCA)  clinical features  low-dose glucocorticoid

中文摘要:

      目的 探讨风湿性多肌痛(polymyalgia rheumatic,PMR)的临床特点及误诊分析.方法 回顾性分析2012年9月-2016年2月PMR住院患者34例的临床资料和治疗反应,以及起病时的误诊情况.结果 34例PMR患者平均发病年龄(67.9±10.8)岁.男性患者较女性患者病程短(P=0.003);临床表现有全身性肌肉痛者29例,男性患者可以仅表现为腰背部疼痛、僵硬.伴膝、踝关节疼痛者11例,多关节疼痛9例,发热15例,未发现合并巨细胞动脉炎.骨质疏松、高血压、糖尿病是PMR常见的合并症.首诊误诊病例16例占全部病例的47.06％,其中误诊为骨关节炎5例、强直性脊柱炎和类风湿关节炎各4例.33例患者接受初始小剂量激素(相当于泼尼松10～ 15 mg/d),单用激素31例,联合甲氨蝶呤或来氟米特3例.治疗反应好.结论 本组研究提示PMR老年人群发病,以全身肌肉僵硬、疼痛为主要特征,可有发热,关节痛和红细胞沉降率显著增快,小剂量激素治疗有效,一般不合并GCA.

英文摘要:

      Objective To explore the clinical features of polymyalgia rheumatic (PMR) and to analyze the misdiagnosis.Methods A retrospective analysis was made to the clinical data and therapeutic response of 34 cases with PMR hospitalized during the period from Sept.,2012 to Feb.,2016 and the misdiagnosis at the onset was analyzed.Results The average age at the onset was (67.9± 10.8) years in the 34 cases,the course of the male was shorter than that of the female (P=0.003);general myalgia was found in 29 cases,the male cases presented pain and stiffness in the waist and back;pain in knee and ankle was found in 1 1cases,pain in multi joints in 9 cases and fever in 15 cases;no case was found to be complicated with giant cell arteritis (GCA);the common complications of PMR were osteoporosis,hypertension and diabetes;misdiagnosis at first visit occurred in 16 cases,taking up 47.06 ％ of all the cases,in which,5 cases were misdiagnosed to be with osteoarthritis,4 cases to be with ankylosing spondylitis and 4 cases to be with rheumatoid arthritis;33 cases received low-dose glucocorticoid (prednisone,10 ～ 15 mg/d);31 cases received glucocorticoid alone while 3 cases received glucocorticoid combined with methotrexate or leflunomide;the therapeutic response was good.Conclusions Muscle stiffness and pain are the main symptoms of PMR in the elderly plus fever,joint pain and rapid erythrocyte sedimentation rate;low-dose glucocorticoid is effective and no complication with GCA will occur.