Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatica (PMR)
Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatica (PMR)
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DOI：
10.1007/s00296-012-2580-4
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发表时间：
2013-06-01
影响因子：
4
通讯作者：
Kim, Hae-Rim
中科院分区：
文献类型：
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作者：
Lee, Jung Hwa;Choi, Sang Tae;Kim, Hae-Rim
风湿性多肌痛（PMR）是西方国家老年人常见的炎症性疾病，但其患病率在种族和国家之间存在明显差异。到目前为止，PMR的流行病学研究在韩国是有限的。我们回顾性评估了在5家三级医院接受治疗的78例PMR患者的临床资料，并分析了初始实验室数据、症状、治疗反应和治疗后1年复发的预后因素。60%的患者有肩和髋关节疼痛，持续时间为10.6周，红细胞沉降率（ESR）为75.9 +/- A 32.7 mm/h，C反应蛋白为6.2 +/- A 6.4 mg/dl。1年复发率和缓解率分别为38.4%和2.5%。总复发率为46.1%，复发多发生在1年内，尤其是6 ~ 12个月。复发组中女性较多（88.9%，p = 0.037），复发组1年累积类固醇剂量显著较高（5.5 +/- A 2.7 vs. 4.4 +/- A 2.5 g，p = 0.018）。复发的独立危险因素是初始CRP a每千日元2.5 mg/dl（OR 6.296，p = 0.047）和使用羟氯喹（OR 6.798，p = 0.035）。激素初始剂量和减量速度对预后无影响。在韩国PMR患者中，基线临床特征和复发率与以前的研究相似，但我们的患者不伴巨细胞动脉炎，缓解率较低，治疗反应延迟，复发发生较晚。根据患者的临床状况，需要更积极的管理。
Polymyalgia rheumatica (PMR) is a common inflammatory disease of the elderly in western countries, but the prevalence is apparently different between races and countries. Until now, an epidemiologic study of PMR is limited in Korea. We retrospectively evaluated the clinical data of 78 patients with PMR who were treated in 5 tertiary hospitals, and analyzed initial laboratory data, symptoms, therapeutic responses, and prognostic factors for relapse 1 year after treatments. Sixty percent of patients had pain in both shoulder and hip girdles with 10.6 weeks of duration, 75.9 +/- A 32.7 mm/h of erythrocyte sedimentation rate (ESR), and 6.2 +/- A 6.4 mg/dl of C-reactive protein. The rate of relapse and remission at 1 year was 38.4 and 2.5 %, respectively. The rate of overall relapse was 46.1 %, and the relapse occurred mostly in a year, especially between 6 and 12 months after diagnosis. There were more female in relapse group (88.9 %, p = 0.037), and cumulative steroid dose of 1 year was significantly higher in relapse group (5.5 +/- A 2.7 vs. 4.4 +/- A 2.5 g, p = 0.018). Independent risk factors for relapse were initial CRP a parts per thousand yen 2.5 mg/dl (OR 6.296, p = 0.047) and the use of hydroxychloroquine (OR 6.798, p = 0.035). Initial dosage or tapering speed of steroid did not influence on prognosis. In Korean patients with PMR, baseline clinical characteristics and relapse rate were similar to previous studies, but our patients accompanied no giant cell arteritis and showed lower remission rate as well as delayed therapeutic response and later occurrence of relapse. More aggressive management would be needed according to the clinical status of patients.