polymyalgia rheumatica
Introduction
Introduction to rheumatic polymyalgia Rheumatoid polymyalgia (PMR) is a clinical syndrome characterized by pain in the proximal extremities and trunk. It generally includes the following three points: 50 or more years of onset; 2 of the 3 susceptibility areas of the scapula, pelvis and neck have pain and morning stiffness, more than 30 minutes, lasting more than 1 month; plus Evidence of systemic response such as ESR increased by more than 40 mm/h or 50 mm/h, except for giant cell arteritis (GCA), if there are other specific diseases such as rheumatoid arthritis, chronic infection, polymyositis or malignancy The diagnosis of rheumatic polymyalgia can be ruled out. PMR and GCA are closely related. About 1/4 of PMR eventually develops into GCA, and 40% of GCA can exhibit PMR performance. Therefore, some people think that PMR and GCA are different manifestations of the same disease, that is, PMR is only one of the clinical manifestations of GCA. However, it has also been suggested that they belong to independent diseases. basic knowledge The proportion of sickness: 0.0036% Susceptible people: occur in people over 50 years old Mode of infection: non-infectious Complications: myocarditis
Cause
Causes of rheumatic polymyalgia
Age and gender factors (30%)
The disease is almost all over 50 years old, suggesting that the disease is definitely related to age, the incidence of women is significantly higher than that of men, and there may be some correlation with changes in endocrine hormones.
Genetic factors (30%)
Includes effects of major genes, specific genes, and chromosomal aberrations. Due to the destruction of environmental pollution and ecological balance in the contemporary era, the frequency of gene mutations has increased, and the number of disease-causing genes in the population has increased. Patients with rheumatic polymyalgia (PMR) have a family aggregation phenomenon associated with the HLA-DR4 gene.
Environmental factors (25%)
Rheumatoid polymyalgia (PMR) disease is caused by an immune mechanism under the joint action of internal factors and environment.
Pathogenesis
The etiology and pathogenesis of PMR are still unclear. The cause may be multi-factor. Under the combination of internal factors and environment, the pathogenesis of the disease is considered to be related to HLA-DR4, suggesting that genetically susceptible infection may be the disease. One of the causes of the disease, in addition, the disease is almost all over 50 years old, suggesting that the disease is definitely related to age, the incidence of women is significantly higher than that of men, suggesting that this disease may also have a certain correlation with endocrine hormone changes.
There are few pathological studies of PMR. There is no special pathological feature in PMR alone. The radial artery biopsy of some patients with PMR showed typical GCA pathological findings, suggesting that it is a potential GCA. In recent years, although large joint synovitis has been reported (such as knee) , sterno-lock joints can explain the symptoms of myalgia, and arthroscopic biopsy and synovial examination support the presence of synovitis, but this is controversial, muscle biopsy is normal or non-specific changes, such as type II muscle atrophy, PMR There are reports of granulomatous myocarditis and hepatitis.
Chinese medicine believes that the disease is characterized by morning stiffness of the large joints and muscle pain in the body. It is related to wind, cold and dampness, but it is also related to spleen deficiency, spleen deficiency, lung deficiency and kidney deficiency.
Prevention
Rheumatoid polymyalgia prevention
1. Do a good job of psychological adjustment, relieve ideological concerns, and build confidence in the fight against disease.
2. Strengthen nutrition, increase protein, vitamins, and avoid irritating foods.
Complication
Rheumatoid polymyalgia complications Complications
The main complication of this disease is the inconvenience caused by patients, PMR occasional granulomatous myocarditis and hepatitis, as well as the possibility of acute arteritis.
Symptom
Rheumatic polymyalgia symptoms Common symptoms Epidemic myalgia fatigue morning stiffness, muscle soreness, muscle pain, low fever
PMR often occurs in people over 50 years old. There are very few patients under 50 years old. The ratio of male to female is 1:2. The incidence of the disease in China is unknown. A report in the United States: the annual incidence rate of people over 50 years old is 54/100,000, and the prevalence rate is 500/. 100,000.
PMR insidious onset, with low fever, fatigue, fatigue, weight loss and other systemic symptoms, typical clinical manifestations of symmetrical neck, scapular or pelvic belt proximal muscle soreness, stiffness and discomfort, can also be unilateral or limited to a group of muscles Group, stiffness is obvious in the morning or after the rest of the activity, the acute onset, every time you go to bed at night, fashion, wake up in the morning, sore and stiff, uncomfortable, combing hair, shaving, dressing, squatting, up and down stairs Difficulties, these active obstacles are not easily caused by muscle weakness, unlike the multiple myositis, the muscle strength is severely reduced, which is caused by muscle and joint stiffness, and can be gradually relieved or alleviated after the activity. No matter the main complaint, the physical examination has fewer positive signs. Mild anemia, mild tenderness of the shoulder and knee joints, swelling or a little synovial fluid sign, arthroscopy confirmed that there may be synovitis, generally no visceral or systemic involvement.
Examine
Rheumatoid polymyalgia
1. The most prominent experimental abnormality of PMR is an increase in erythrocyte sedimentation rate (40-50 mm/h) and an increase in C-reactive protein.
2. Rheumatoid factor, antinuclear antibody, serum complement, serum muscle enzyme activity were normal.
3. EMG examination showed no signs of myogenic and neurogenic damage.
4. Radiological examination and muscle biopsy are normal.
Diagnosis
Diagnosis and diagnosis of rheumatic polymyalgia
diagnosis
The diagnostic criteria should strictly meet the following 6 points:
1. The age of onset is over 50 years old.
2. There are at least 2 muscle pains and morning stiffness in the neck, shoulder strap and pelvis. The course of the disease should last for 1 month.
3. Laboratory tests showed a marked increase in erythrocyte sedimentation rate and elevated CRP.
4. The affected muscles are not red, swollen, and there is no muscle loss or muscle atrophy.
5. Need to rule out other diseases like rheumatoid polymyalgia, such as rheumatoid arthritis, chronic infection, polymyositis, malignant tumors.
6. Good response to small doses of glucocorticoids (equivalent to prednisone 10 mg / d).
Differential diagnosis
1. Rheumatoid arthritis in the onset of senile: The disease has morning stiffness, symmetry of small joint swelling and pain, deformity, and rheumatoid factor positive.
2. Polymyositis: This disease is also more common in elderly women, with proximal limb muscle weakness and pain, muscle strength is significantly weakened, ESR is increased, etc.; but this disease is characterized by myositis, serum muscle enzyme activity is increased, muscle Electrograms show myogenic damage and muscle biopsy has myositis characteristics.
3. Fibrositis syndrome: This syndrome is characterized by extra-articular musculoskeletal stiffness and fatigue. The body has fixed sensitive tender points, such as the occipital attachment point of the cervical muscle, and the middle of the upper trapezius. The second side of the chest muscle and the cartilage junction, 2cm outside the upper armpit, upper hip, 2cm behind the greater trochanter, the goose-like sac area of the knee joint, the junction of the gastrocnemius Achilles tendon, etc.; more sleep disorders, often Accompanied by irritable enteritis, irritation cystitis, tension headache, irregular menstruation and insensitivity to steroid or non-steroidal anti-inflammatory drugs, normal erythrocyte sedimentation rate.
4. Malignant tumors, some malignant tumors are associated with musculoskeletal pain, but there are other clinical manifestations, and the general condition is also easily identified with PMR.
5. Other rheumatic diseases and chronic infections, such as subacute bacterial endocarditis, may have systemic symptoms and proximal joint pain, similar to PMR, blood culture can be identified when fever.
6. Functional myalgia generally has no typical morning stiffness, and laboratory tests are normal or near normal.
7. Systemic lupus erythematosus, Sjogren's syndrome and other rheumatism may have some behavior similar to PMR, but it is not difficult to find other accompanying symptoms.
