Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: A prospective followup study
Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: A prospective followup study
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DOI：
10.1002/art.20901
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发表时间：
2005-02-15
期刊：
影响因子：
--
通讯作者：
Boiardi, L
中科院分区：
文献类型：
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作者：
Salvarani, C;Cantini, F;Boiardi, L
客观的。确定可能有助于识别需要长期皮质类固醇治疗的风湿性多肌痛 (PMR) 患者的实验室参数。方法。一项前瞻性随访研究对 94 名连续未经治疗的 PMR 患者进行了平均 39 个月的复发/复发评估。该队列代表了 4 年期间在 2 个意大利二级转诊中心诊断的所有患者。监测患者的临床体征和症状、红细胞沉降率 (ESR)、C 反应蛋白 (CRP) 和血清白介素 6 (IL-6)。还测量了 43 名与患者年龄和性别相匹配的对照者的 IL-6 水平。结果 在治疗开始前，91.5% 的患者 ESR 升高，CRP 升高（98.9%），血清 IL-6 升高（92.6%）。 47 名 (50.0%) 患者在随访期间至少出现 1 次复发/复发，24 名 (25.5%) 患者至少出现 2 次。泼尼松治疗 4 周后，13.2% 的患者 ESR 升高，41.9% 的患者 CRP 升高，37.2% 的血清 IL-6 升高。在随访的第一年，9.9% 的患者 IL-6 水平持续升高，8.7% 的患者 CRP 水平持续升高，但没有患者的 ESR 持续升高。持续升高的 CRP 和 IL-6 水平与复发风险增加显着相关。特别是，治疗第一年期间 IL-6 水平持续升高的患者相对风险最高。结论。尽管可以控制临床症状，但皮质类固醇并不能充分控制部分 PMR 患者的炎症过程，这些患者的 CRP 和 IL-6 水平持续升高，且复发风险较高。
Objective. To determine laboratory parameters that may be useful in identifying polymyalgia rheumatica (PMR) patients who require long-term corticosteroid therapy.Methods. A prospective followup study of 94 consecutive untreated patients with PMR were assessed for relapse/recurrence for a mean of 39 months. This cohort represented all the patients diagnosed over a 4-year period in 2 Italian secondary referral centers. Patients were monitored for clinical signs and symptoms, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum interleukin-6 (IL-6). IL-6 levels were also measured in 43 controls matched to the patients for age and sex.Results The ESR was elevated in 91.5% of the patients prior to therapy initiation, as were CRP in 98.9% and serum IL-6 in 92.6%. Forty-seven (50.0%) patients had at least 1 relapse/recurrence during the followup period and 24 (25.5%) had at lease 2. After 4 weeks of prednisone therapy, ESR was elevated in 13.2% patients, CRP in 41.9%, and serum IL-6 in 37.2%. IL-6 levels remained persistently elevated in 9.9% and CRP in 8.7% of patients during the first year of followup, whereas no patient had persistently elevated ESR. Persistently elevated CRP and IL-6 levels were significantly associated with an increased risk of relapse/recurrence. In particular, patients with persistently elevated levels of IL-6 during the first year of therapy had the highest relative risk.Conclusion. Despite the control of clinical symptoms, corticosteroids do not adequately control the inflammatory process in a subset of patients with PMR who have persistently elevated levels of CRP and IL-6 and who have a higher risk of relapsing.