POLIMIALGIYA RHEUMATIC (grech, poly is a lot of + a mialgiya; grech, rheumatikos suffering from the expirations) — the disease of elderly people which is characterized by pains and constraint in muscles of a shoulder and pelvic girdle.
Etiology it is unknown. The virus nature of a disease as are noted seasonal (spring and fall) increase of a disease * communication with acute respiratory diseases is supposed; at a number of patients P.'s communication by the river with Century hepatitis Fessel is traced (W. Fessel, 1971) indicates value of contact with birds, especially with little parrots, Hamrin (V. Hamrin) — developing of a disease at members of one family. The pathogeny is not studied, there are not numerous data on a role of immune disturbances and genetic predisposition.
At morfol, a research of muscles, as a rule, changes are not found; minimum expressed signs of a nonspecific inflammation of a synovial membrane and periartikulyarny tissues of shoulder joints are in some cases noted.
The item of river begins suddenly with severe pains in muscles of a shoulder girdle, a neck, a back, then in patol, process muscles of a pelvic girdle are involved. At the same time patients have a feeling of constraint in the same groups of muscles, especially considerable in the mornings that does not give the chance to the patient independently to get up, complicates lifting of hands. Pains at the movements and palpation of these groups of muscles amplify. More often muscles of a shoulder girdle suffer; pains, feeling of constraint in them are expressed more sharply.
Quite often temperature (to 38 °, is more rare above) increases, develops anorexia (see), apathy up to a depression (see. Depressive syndromes ), the patient quickly loses flesh. At inspection of considerable changes in the affected groups of muscles do not find. In rare instances the passing swelling of periartikulyarny fabrics in shoulder joints can be observed. The insignificant exudate in knee joints is possible, and at a research with technetium 99m Tc are found the phenomena synovitis (see).
The item of river is often combined with giant-cell (temporal) arteritis (see. Arteritis giant-cell ): quite often rubles at a biopsy of a temporal (temporal) artery find symptoms of giant-cell arteritis in sick P. P.'s signs of river and temporal arteritis can develop at the same time or consistently. Timely recognition is hidden the proceeding temporal arteritis important for performing adequate therapy by high doses of Prednisolonum since it allows to prevent development of a blindness — the heaviest complication of temporal arteritis.
Diagnosis Items of river put in the presence at patients 55 years which are sharply expressed are more senior mialgiya (see) and constraint in the muscles of a shoulder and pelvic girdle which are followed sharply accelerated (to 60 — 80 mm an hour) ROE.
At a laboratory research also slight normokhromny anemia and high rates of inflammatory activity (is noted (^-globulins, fibrinogen, seromucoid, etc.). Besides, it is necessary to consider bystry to lay down. effect of use of small or average doses of corticosteroids.
The item of river needs to be differentiated with initial stages pseudorheumatism (see), a polymiositis (see. Dermatomyositis ). At P. the ruble unlike a pseudorheumatism is not persistent arthritis, small joints of brushes and feet are not surprised. Unlike a polymiositis neither at a biopsy of muscles, nor at an elektromiografichesky research of changes it is not noted; level of a kreatinfosfokinaza and transaminases of blood serum remains normal.
Treatment it is carried out by Prednisolonum (10 — 15 mg a day). At the same time bystry reduction, and then and total disappearance of pains and constraint in muscles is observed, weight is gradually recovered. The specified dose of Prednisolonum appoint during 2 — 3 weeks before total disappearance a wedge, P.'s signs of river and normalization of ROE, further begin to lower a dose of drug by 2,5 mg a week under control of ROE and other laboratory indicators of inflammatory activity. Shall accept a maintenance dose of Prednisolonum (7,5 - 5 mg) of the patient once in the mornings within several months or even years (1 — 2 years). In the presence of symptoms of temporal arteritis the initial dose of Prednisolonum makes 40 — 60 mg a day.
Forecast at early recognition of P. of river, adequate treatment and systematic reception of maintenance doses of glucocorticosteroids favorable. At untimely cancellation of Prednisolonum the aggravation is possible. The forecast is more serious at P.'s combination of river to temporal arteritis.
Bibliography: Sidelnikova S. M. and Agababov E. R. Rheumatic polimialgiya, Vopr, revm., No. 1 with 62 1977; Yaryg in H. E., Nasonova V. A. and Potekhina R. N. System allergic vasculites, page 259, M., 1980; Arthritis and allied conditions, ed. by D. J. McCarty, p. 681, Philadelphia, 1979; Dixon A. S. a. o. Polymyalgia rheumatica and temporal arterii-tis, Ann. rheum. Dis., v. 25, p. 203 1966 * Hamrin B. Bernstrup S.’ Polymyalgia arteritica, Nord. Med., v. 84. p. 1498, 1970; Hughes G. R. V. Connective tissue diseases, Oxford, 1977; Waaler E., Ton der O. a. M i 1-d e E. J. Immunological and histological studies of temporal arteries from patients with temporal arteriitis and/or polymyalgia rheumatica, Acta path, microbiol. scand., v. 84(A), p. 55, 1976.
V. A. Nasonova.