| Objective: To explore the characteristics of demographic data,clinical features,laboratory examination and imaging features of polymyalgia rheumatica(PMR).To evaluate the efficacy and safety of low dose prednisone,tripterygium wilfordii(TW)and methotrexate(MTX)in the treatment of PMR.Methods:Clinical data,laboratory examination,ultrasonography and magnetic resonance imagings of 26 patients with PMR who were newly diagnosed were collected into the study.Imaging methods: a senior radiologist performed a ultrasonography(US)of the shoulders and hips and a magnetic resonance imaging(MRI)scan of the shoulder,recording the data and preserving the images.According to the random principle,patients were enrolled according to the random number table,and were divided into low dose prednisolone group(10mg/d),prednisolone combined with tripterygium wilfordii group and prednisolone combined with methotrexate group.Patients were followed up for half a year,and the time of morning stiffness,joint pain,visual analogue scale(VAS),PMR activity score(PMR-AS),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)of the patients were recorded monthly,and the results were statistically analyzed.Results: 1.Among the 26 patients with PMR,23 were female and 3 were male.Theaverage age was 66.42±8.50 years old.The incidence in autumn and winter was57.69%.At the initial diagnosis,the average ESR was 68.20±26.19mm/h,and the average CRP was 42.24±20.91mg/L.2.All patients had shoulder pain(26 cases,100.0%).In 23 cases(88.46%),both shoulders and hips were involved simultaneously.Peripheral joint involvement was found in 12 patients(46.15%),and knee joint involvement was found in 10 patients(38.46%).3.Eighteen patients(85.71%)were diagnosed with long head of biceps tendon tenosynovitis in the shoulder by joint US,and three patients(14.29%)were diagnosed with subacromial-subdeltoid in the shoulder by joint ultrasound.Twelve(50%)patients with long head of biceps tendon tenosynovitis were found by MRI of shoulder joint,and19(79.17%)patients with subacromial-subdeltoid were found by MRI of shoulder joint.4.After treatment,8 of the 26 patients(30.77%)had complete remission,and 8 patients(30.77%)had low disease activity.Compared with before treatment,there were significant decreases in morning stiffness time,ESR,CRP,PMR-AS,PLT and VAS scores after treatment.Meanwhile,hemoglobin index increased to a certain extent(all P<0.01).5.In the prednisone group,the prednisone combined with tripterygton group and the prednisone combined with methotrexate group,changes in PMR-AS,ESR,CRP,time of morning stiffness,VAS score,hemoglobin and platelet variables before and after treatment among the three groups showed no significant difference in efficacy(P >0.05).6.The cumulative response rate of prednisone combined with methotrexate group(70%)was significantly higher than that of prednisone combined with tripterygium wilfordii group(0%)(P =0.048).7.Analysis of risk factors for disease recurrence(non-remission)revealed that patientswith baseline CRP levels more than 3 times were independent risk factors for sustained non-remission of disease.Conclusion: It was effective that oral low dose prednisone could control the disease activity of PMR.There was no significant difference in the efficacy of low doseprednisone alone,TW combined with prednisone and MTX combined with prednisone,but MTX combined with prednisone could make the patients' condition reach remission in advance.Analysis of risk factors for disease recurrence(non-remission)revealed that patients with baseline CRP levels more than 3 times were independent risk factors for sustained non-remission of disease. |
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