ABSTRACT
Introducción. La polimialgia reumática (PMR) se caracteriza por dolor y rigidez de las cinturas cervicoescapular y pelviana; preséntase en mayores de 50 años, asociada frecuentemente a arteritis de células gigantes (ACG), y tiene excelente respuesta a dosis bajas de corticosteroides. Objetivo. Evaluar sus características clínicas, de laboratorio, terapéuticas y evolutivas en nuestro medio. Pacientes y método: 22 pacientes diagnosticados según criterios establecidos y controlados entre 1998 y 2008. Según protocolo se analizan sexo, edad, diagnósticos previos, clínica, laboratorio, tratamiento y evolución. Resultados. Edad 52 a 81 años (mediana 69,3); predominio femenino (17/5), y 9,2 meses promedio de evolución prediagnóstico. Todos presentaron dolor y rigidez cervicoescapular y pelviana, 2 pacientes (9 por ciento) tuvieron artritis y 2 (9 por ciento), características clínicas de arteritis de células gigantes (ACG). El laboratorio fue inespecífico, excepto velocidad de sedimentación elevada entre 38 y 131 mm/hora (promedio 80,7). Todos tuvieron factor reumatoídeo (-) y anticuerpos antinucleares (-). Todos, excepto los portadores de ACG, respondieron a dosis bajas de corticosteroides (20 mg/día de prednisona o menos), con dosis de mantención entre 5 y 10 mg/día. Excelente evolución en todos, excepto uno, con desaparición de síntomas, normalización de VHS y reintegración a actividades previas. Conclusiones. La PMR constituye un diagnóstico diferencial en personas mayores de 50 años con dolor de cintura escapular y pelviana, que suele asociarse con ACG. El diagnóstico se basa en criterios bien establecidos, destacando la VHS persistentemente alta y la respuesta a dosis bajas de corticosteroides, que es además la terapéutica de elección.
Polymyalgia rheumatica (PMR) is characterized by cervicoscapular and pelvic pain and rigidity, it manifests in people older than 50 years and is frequently associated with giant cell arteritis (GCA). It responds very well to low doses of corticosteroids. Objective: Evaluate clinical, laboratory, therapeutic and evolutionary characteristics in our environment. Patients and method: 22 patients diagnosed according to set criteria and controlled between 1998 and 2008. Sex, age, previous clinical and laboratory diagnosis, treatment and evolution were analyzed. Results: Age 52 to 81 (average 69.3); 17 females,5 males; and 9.2 month average prediagnostic evolution. All presented cervicoscapular and pelvic pain and rigidity, 2 patients (9 percent) had arthritis, and 2 (9 percent) presentedclinical characteristics of GCA. Laboratory tests were nonspecific, except for high sedimentation speed between 38 and 131 mm/hour (average 80.7). All patients presented rheumatoid factor (-) and antinuclear antibodies (-). All, except GCA carriers, responded to low doses of corticosteroids (20 mg/day or less of Prednisona), followed by a maintenance dose of 5 - 10 mg/day. Evolution was excellent in all patients except one, symptoms disappeared, ESR normalized and patients were reintegrated to their previous activities. Conclusions: PMR constitutes a differential diagnosis in people over 50 years of age, with cervicoscapular and pelvic pain, and is commonly associated with GCA. Diagnosis is based on well established criteria, with persistently high ESR and response to low doses of corticosteroids - the treatment therapy of choice - among the most significant.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Polymyalgia Rheumatica/diagnosis , Polymyalgia Rheumatica/epidemiology , Polymyalgia Rheumatica/drug therapy , Age Distribution , Giant Cell Arteritis/epidemiology , Clinical Evolution , Chile/epidemiology , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
Introdução: A doença de Horton, ou arterite temporal, é a vasculite sistêmica auto-imune mais comum em adultos, especialmente nos idosos. Objetivo: Realizar uma revisão de literatura sobre os diversos aspectos da doença de Horton, evidenciando as manifestações clínicas otorrinolaringológicas. Método: Foram consultadas as bases de dados on-line EMedicine, Encyclopedia of Medicine, FindArticles, LILACS, MEDLINE, Merck Manuals On-Line Medical Library e SciELO, aplicando à pesquisa os termos: Doença de Horton, Arterite Temporal e Arterite de Células Gigantes, para artigos publicados entre 1996 e 2008. Revisão de Literatura: As manifestações clínicas da doença têm início após os 50 anos de idade, sendo mais freqüentes próximo dos 72 anos. A cefaléia intensa, a tumefação temporal, a claudicação mandibular e o déficit visual são os principais sinais e sintomas. Pode haver ainda disacusia, necrose lingual e odinofagia. Considerações Finais: Múltiplos aspectos da Doença de Horton não têm esclarecimentos devidos e, mesmo sendo uma doença que acomete muitos adultos, não possui investigações profundas em grande quantidade. A melhor compreensão desta levará ao incremento das possibilidades de cura dos pacientes e redução da morbidade, especialmente nas áreas oftalmo e otorrinolaringológica.
Introduction: The Horton's disease, or temporal arteritis, is the most common autoimmune systemic vasculitis in adults, especially the old-aged. Objective: To review the literature about the several aspects of the Horton's disease, and confirm the otorhinolaryngologic clinical manifestations. Method: The study searched online databases such as EMedicine, Encyclopedia of Medicine, FindArticles, LILACS, MEDLINE, Merck Manuals On-Line Medical Library and Scielo, and applied to the search the terms: Horton's disease, Temporal Arteritis and Giant Cells Arteritis, for articles published between 1996 and 2008. Literature's Review: The disease's clinical manifestations start after 50 years old, and it's more frequent near 72 years old. The intense headache, temporal tumefaction, mandibular claudication and visual loss are the main signals and symptoms. There may occur dysacusis, necrosis of the tongue and odynophagia. Considerations: Lots of aspects of the Horton's disease do not have their due elucidation and, even being a disease that affects many adults, it doesn't have deep investigations in great quantity. A better understanding of this disease will lead to the increment of cure possibilities and reduction of morbidity in the patients, especially in ophthalmologic and otorhinolaryngologic areas.