[Polymyalgia rheumatica: What's new?]

Deutsche medizinische Wochenschrift (1946) Pub Date : 2024-08-01 Epub Date: 2024-08-15 DOI:10.1055/a-2144-8222
Wolfgang A Schmidt
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Abstract

Currently, only 25% of all polymyalgia rheumatica (PMR) patients are referred to specialists. An expert committee has recently recommended confirmation of diagnosis by specialist care. This can help to avoid misdiagnoses and hospital stays and can result in lower glucocorticoid doses.Using ultrasound, magnetic resonance imagining (MRI), or positron emission tomography-computed tomography (PET-CT), typical periarticular inflammatory changes are observed, especially in the shoulder and pelvic girdle area. However, for clinical use, ultrasound is usually sufficient.In 20-25% of newly diagnosed PMR patients without symptoms of giant cell arteritis (GCA), GCA can be detected through vascular ultrasound. These patients require higher glucocorticoid doses in analogy to GCA therapy. There is growing awareness of a joint GCA-PMR spectrum disease.Glucocorticoids remain the primary treatment. The interleukin-6 inhibitor Sarilumab has recently been approved in the USA for patients with recurrent PMR. Studies have also demonstrated the effectiveness of Tocilizumab in PMR.

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[多发性风湿病:有什么新进展?]
目前,只有 25% 的多发性风湿痛(PMR)患者被转诊至专科医生。最近,一个专家委员会建议由专科医生进行确诊。通过超声波、磁共振成像(MRI)或正电子发射计算机断层扫描(PET-CT),可以观察到典型的关节周围炎症变化,尤其是在肩部和骨盆部位。然而,就临床应用而言,超声检查通常就足够了。在20%-25%没有巨细胞动脉炎(GCA)症状的新诊断PMR患者中,可通过血管超声检查发现GCA。这些患者需要更高的糖皮质激素剂量,以类比GCA治疗。糖皮质激素仍是主要的治疗手段。白细胞介素-6抑制剂沙利鲁单抗(Sarilumab)最近在美国获准用于复发性 PMR 患者的治疗。研究还证明了托珠单抗对 PMR 的疗效。
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