Polimyaljia romatika hastalarının klinik izlemi: Tek merkezli, retrospektif kohort çalışması

Year 2022, Volume: 5 Issue: 3, 181 - 187, 15.10.2022

Fatma Tuncer Kuru , Neslihan Gökçen , Ayten Yazıcı , Ayşe Çefle

https://doi.org/10.53446/actamednicomedia.1109338

Abstract

Bu çalışmada izole polimyaljia romatika (PMR) tanılı hastaların demografik, klinik durum, laboratuvar bulguları, hastalık seyri ve tedavi yanıtlarının kısa dönem verilerinin taranması ve kortizon başlangıç dozunun ve idame tedavi rejimlerinin, klinik ve laboratuvar progresyonuna etkisinin incelenmesi amaçlanmıştır. Çalışmada 2001-2020 yılları arasında takip edilen toplam 39 PMR hastasının dosyaları tarandı. Eşlik eden temporal arteriti ve kanseri olan hastalar ise çalışmadan dışlanarak toplam 19 hasta (K:16, E:3) çalışmaya dahil edildi. Hastaların demografik verileri, antropometrik ölçümleri, ek hastalıkları, geliş şikayetleri, fizik muayene bulguları, klinik bulguları, laboratuvar bulguları (akut faz yanıtları), tedavileri, tedavi değişiklikleri, kümülatif kortizon dozları kaydedildi. Hastaların 1. ay, 4. ay ve 7. ay poliklinik kontrollerinde elde edilen medikal kayıtları bir olgu formu yardımı ile not edildi. Hastaların yaş ortalamaları 68±8 yıl iken ortalama kortizon başlangıç dozu 21,5±8,9 mg idi. Birinci poliklinik kontrolünde, hastaların %52,6’sının (n=10) şikayetleri tamamen gerilerken, bu oran 2. ve 3. poliklinik kontrolünde sırası ile %47,4 (n=9) ve %73,7 (n=14) idi. Birinci poliklinik kontrolü ortalama eritrosit sedimentasyon hızı (ESH) ve C-reaktif protein (CRP) değerleri sırası ile 21,7±12,3 mm/saat ve 5,8±5,1 mg/dl idi. İkinci ve 3. poliklinik kontrolünde ortalama ESH değerleri sırası ile 36,5±27,3 mm/saat ve 27,3±18,6 mm/saat iken ortalama CRP değerleri sırası ile 27,2±43,0 mg/dl ve 17,6±30,2 mg/dl idi. Hastaların takipleri sırasındaki remisyon oranları ise 2. poliklinik kontrolünde %47,4 (n=9) ve 3. poliklinik kontrolünde%31,6 (n=6) olarak bulundu. Sonuç olarak, çalışmamızda klinik özellikler ve başlangıç kortizon dozları literatürle uyumlu bulundu. Remisyon oranımız düşük saptandı ve bu durum hastaların tedaviye uyumsuz olmaları ile ilişkilendirildi.

Keywords

Polimyaljia romatika, remisyon oranları, akut faz yanıtları, kortizon

Isolated polymyalgia rheumatica: a cross-sectional, single-center, retrospective cohort study

Abstract

Aim: The aim of the study was to review sociodemographic variables, clinical and laboratory findings, disease progression and treatment response of patients with isolated polymyalgia rheumatica and to investigate the effect of initial steroid dose and maintenance treatment on the progression of clinical and laboratory outcome.
Material and Method: The medical records of 39 polymyalgia rheumatic patients who followed up between 2001 and 2020 were screened. After excluding patients with overlapped giant cell arteritis and malignancies, 19 polymyalgia rheumatica patients (female:16 and male:3) were included in the study. Demographic data, anthropometric measurements, comorbidities, initial symptom, physical examination, clinical and laboratory (acute phase reactants) findings, medications, changes in treatment status, and cumulative steroid dose were recorded. The medical data of first (1st month), second (4th month), and third (7th month) visits were noted according to the structured form.
Results: The mean age was 68±8 years and the mean initial steroid dose was 21.5±8.9 mg. While the complaints regarding polymyalgia rheumatica decreased in 52.6% of patients (n=10) in the first visit, those complaints regressed in 47.4% (n=9) and 73.7% (n=14) of patients in the second and third visit, respectively. In the first visit (1st month), the mean erythrocyte sedimentation rate and C-reactive protein values were 21.7±12.3 mm/h and 5.8±5.1 mg/dl. In the second (4th month) and third visits (7th month), while the mean erythrocyte sedimentation rate was found as 36.5±27.3 mm/h and 27.3±18.6 mm/h, the mean C-reactive protein was 27.2±43.0 mg/dl and 17.6±30.2 mg/dl, respectively. Clinical remission was observed in 47.4% of patients (n=9) in the second visit and in 31.6% of patients (n=6) in the third visit. Median cumulative corticosteroid doses were 600 mg in first visit, 960 mg in second visit, and 1346 mg in the third visit.
Conclusion: The clinical characteristics and the initial steroid dose were compatible with the literature. Even though cumulative corticosteroid doses were quite high, lower remission rates were observed in these patients. The possible reason for this was considered to be the non-adherence of the patients to the treatment.

Keywords

Polymyalgia rheumatica, remission rates, acute-phase reactants, corticosteroids

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