DOI QR코드

DOI QR Code

Diagnosis and Treatment of Polymyalgia Rheumatica

류마티스 다발근통의 진단과 치료

  • Hong, Seokchan (Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yong-Gil (Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 홍석찬 (울산대학교 의과대학 서울아산병원 류마티스내과) ;
  • 김용길 (울산대학교 의과대학 서울아산병원 류마티스내과)
  • Published : 2014.07.01

Abstract

Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder that usually affects adults over 50 years of age. It is characterized by pain and stiffness of the neck, shoulders and hips. Laboratory tests have shown marked elevation of acute phase reactants (ESR and CRP), but there is no specific test to diagnose PMR. Recently, the European League Against Rheumatism and the American College of Rheumatology jointly proposed a new set of classification criteria for PMR. The mainstay of PMR treatment is low-dose glucocorticoids (prednisolone 10-20 mg/day). patients with PMR usually respond very well to steroid therapy within a few days to one week, but will often relapse despite treatment.

류마티스 다발근통은 고령에서 발생하는 만성 염증성 류마티스 질환으로 급성으로 발생한 어깨 및 고관절의 통증과 경직 증상을 호소하는 환자에서 의심할 수 있다. 류마티스 다발근통의 진단을 위한 특징적인 실험실 혹은 방사선적 검사가 없으므로 다양한 임상 소견에 근거하여 진단을 내리게 되며 다발성 근육통증을 호소할 수 있는 다양한 질병을 감별하는 것이 중요하다. 저용량 글루코코르티코이드가 표준 치료로서 치료에 신속하고 뚜렷한 반응을 보이지만 재발이 비교적 흔한 만성 염증성 질환이다. 최근에는 류마티스 다발근통의 분류 기준이 새롭게 제시되었으며 만성 재발성 환자에서 생물학적 제제의 투여에 대한 연구가 활발히 진행되고 있다.

Keywords

References

  1. Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med 1982;97:672-680. https://doi.org/10.7326/0003-4819-97-5-672
  2. Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet 2013;381:63-72. https://doi.org/10.1016/S0140-6736(12)60680-1
  3. Elling P, Olsson AT, Elling H. Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatica in different regions of Denmark; association with epidemics of Mycoplasma pneumoniae infection. J Rheumatol 1996;23:112-119.
  4. Smeeth L, Cook C, Hall AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990-2001. Ann Rheum Dis 2006;65:1093-1098. https://doi.org/10.1136/ard.2005.046912
  5. Perfetto F, Moggi-Pignone A, Becucci A, et al. Seasonal pattern in the onset of polymyalgia rheumatica. Ann Rheum Dis 2005;64:1662-1663. https://doi.org/10.1136/ard.2005.038901
  6. Weyand CM, Hunder NN, Hicok KC, Hunder GG, Goronzy JJ. HLA-DRB1 alleles in polymyalgia rheumatica, giant cell arteritis, and rheumatoid arthritis. Arthritis Rheum 1994;37:514-520. https://doi.org/10.1002/art.1780370411
  7. Cid MC, Ercilla G, Vilaseca J, et al. Polymyalgia rheumatica: a syndrome associated with HLA-DR4 antigen. Arthritis Rheum 1988;31:678-682. https://doi.org/10.1002/art.1780310515
  8. Gonzalez-Gay MA, Amoli MM, Garcia-Porrua C, Ollier WE. Genetic markers of disease susceptibility and severity in giant cell arteritis and polymyalgia rheumatica. Semin Arthritis Rheum 2003;33:38-48. https://doi.org/10.1053/sarh.2002.50025
  9. Salvarani C, Cantini F, Macchioni P, et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum 1998;41:1221-1226. https://doi.org/10.1002/1529-0131(199807)41:7<1221::AID-ART12>3.0.CO;2-W
  10. Caporali R, Montecucco C, Epis O, Bobbio-Pallavicini F, Maio T, Cimmino MA. Presenting features of polymyalgia rheumatica (PMR) and rheumatoid arthritis with PMR-like onset: a prospective study. Ann Rheum Dis 2001;60:1021-1024. https://doi.org/10.1136/ard.60.11.1021
  11. Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum 2012;64:943-954.
  12. Muller S, Hider SL, Belcher J, Helliwell T, Mallen CD. Is cancer associated with polymyalgia rheumatica? a cohort study in the General Practice Research Database. Ann Rheum Dis 2013. doi: 10.1136/annrheumdis-2013-203465.
  13. Healey LA. Long-term follow-up of polymyalgia rheumatica: evidence for synovitis. Semin Arthritis Rheum 1984;13:322-328. https://doi.org/10.1016/0049-0172(84)90012-X
  14. Hernandez-Rodriguez J, Cid MC, Lopez-Soto A, Espigol-Frigole G, Bosch X. Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med 2009;169:1839-1850. https://doi.org/10.1001/archinternmed.2009.352
  15. Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol 2005;32:65-73.
  16. Gabriel SE, Sunku J, Salvarani C, O'Fallon WM, Hunder GG. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 1997;40:1873-1878. https://doi.org/10.1002/art.1780401022
  17. Caporali R, Cimmino MA, Ferraccioli G, et al. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2004;141:493-500. https://doi.org/10.7326/0003-4819-141-7-200410050-00005
  18. Cimmino MA, Salvarani C, Macchioni P, et al. Long-term follow-up of polymyalgia rheumatica patients treated with methotrexate and steroids. Clin Exp Rheumatol 2008;26:395-400.
  19. Van der Veen MJ, Dinant HJ, van Booma-Frankfort C, van Albada-Kuipers GA, Bijlsma JW. Can methotrexate be used as a steroid sparing agent in the treatment of polymyalgia rheumatica and giant cell arteritis? Ann Rheum Dis 1996;55:218-223. https://doi.org/10.1136/ard.55.4.218
  20. Salvarani C, Macchioni P, Manzini C, et al. Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial. Ann Intern Med 2007;146:631-639. https://doi.org/10.7326/0003-4819-146-9-200705010-00005
  21. Macchioni P, Boiardi L, Catanoso M, et al. Tocilizumab for polymyalgia rheumatica: report of two cases and review of the literature. Semin Arthritis Rheum 2013;43:113-118. https://doi.org/10.1016/j.semarthrit.2013.01.003
  22. Salvarani C, Cantini F, Niccoli L, et al. Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum 2005;53:33-38. https://doi.org/10.1002/art.20901
  23. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 2002;347:261-271. https://doi.org/10.1056/NEJMra011913
  24. Ayoub WT, Franklin CM, Torretti D. Polymyalgia rheumatica: duration of therapy and long-term outcome. Am J Med 1985;79:309-315. https://doi.org/10.1016/0002-9343(85)90309-2