摘要
風濕性多肌痛症(Polymyalgia Rheumatica)為一種炎症性病症，其特徵是在頸。肩關節與骨盆關節肌肉產生突發進行性嚴重疼痛及僵硬，好發於年齡超過五十歲族群，平均被診斷時的年齡約七十歲左右，常發生在年長歐洲女性白種人，然而，在台灣則相當罕見。 本病例是一位84歲男性，主訴全身性多發性肌痛時間超過l個月以上。肌痛以近端肌肉疼痛為主，隨著時間進展愈趨於嚴重，同時合併有頸部、肩及髖關節僵硬。實驗室檢查發現血液之白血球數正常，但發炎指數包含C-反應蛋白(c-reactive protein, CRP)與紅血球沉降速率(erythrocyte sedimentation rate, ESR)均有升高。根據病人的臨床症狀。實驗室檢查的結果，及照會風濕免疫科專科醫師的意見，在排除感染之可能性復，給予methylprednisolone sodium succinate針劑20mg作經驗治療，合併每天口服低劑量類固醇(prednisolone 10mg)，發現病人症狀迅速改善，疼痛指數與僵硬程度明穎下降，並恢復能自行處理日常生活事項及活動。爾後症狀有稍加劇情形，將口服類固醇劑量增加為prednisolone 20mg後，病患症狀再度迅速獲得控制，且持續能自理生活。 對於風濕性多肌痛症而言，因為無特定的診斷工具且個案不多，一般病患從症狀發生到診斷結果出來，往往需要數週到數個月以上的時問。在罹病過程中，病患常因無法得到確切診斷而無法獲得完善治療，或因嚴重疼痛的折磨，產生厭世心理。本文希望藉此病例，將此疾病的臨床表現、實驗室檢查要點、診斷原則、治療方法及病情、追蹤等作一報導，以提升此病之臨床診斷率及病患照護品質。
關鍵字
無資料並列摘要
Polymyalgia Rheumatica is one kind of inflammatory disorder characterized by progressively severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle. It occurs mainly in persons older than 50 years. The mean age at diagnosis was often about 70 years old. Elderly white women of European ancestry are most commonly affected. It is rarely reported in Taiwan. This 84 year-old man presented with initial manifestation of progressive myalgia at multiple sites for more than a month. His severe aching and stiffness mainly involved neck, shoulder girdle, and pelvic girdle that occurred simultaneously. He visited several hospitals and clinics with no improvement and myalgia deteriorated. His laboratory data showed elevated ESR and CRP, but WBC count was normal. Since Rheumatoid Arthritis, Polymyositis, Myofascial Pain Syndrome, Fibromyalgia and infectious disease were not likely, low dose steroid was given for his myalgia and joints stiffness as an empirical treatment. His symptoms improved dramatically to a degree that he was able to perform his daily activity again, the dose of oral steroid dose was later titrated to 20 mg prednisolone per day accord with his clinical symptoms. Polymyalgia Rheumatica normally takes weeks to months before the final diagnosis is made. Patients often develop depression or have suicide attempt owing to excessive and prolonged pain. Physicians should be alert with Polymyalgia Rheumatica, and be familiar with its clinical symptoms, laboratory findings, diagnostic tools, treatments and clinical course.