Polymyalgia rheumatica a temporálníarteriitida(přehledný referát)

Polymyalgia Rheumatica and Temporal Arteriitis (Review)

The author presents a review on polymyalgia rheumatica (PMR) and temporal arteriitis (TA).Although the etiopathogenesis of the two diseases is not known, recently some evidence wasassembled on the possible participation of external factors, most probably infectious ones (e.g.Chlamydia pneumoniae) or internal factors (genetic marker HLA-DRB1* 04). PMR and TA are closesyndromes which often occur concurrently. In both also some abnormalities were described whichsuggest a profound immunological disorder. In the treatment of PMR and TA corticosteroids stilldominate. In PMR an initial dose of 15 mg prednisone is recommended (for the first month) witha gradual change to maintenance doses of 5–7.5 mg within two months. The total period of treatmentshould be about 2 years, in some patients with PMR it must be however 4–5 years. In TA the initialdoses of corticosteroids are higher. If the patient has visual symptoms we start with 40–80 mgprednisone per day (an alternative is pulsed treatment) and in the absence of visual symptoms 20–40mg/day. Treatment of PMR and TA involving large doses of corticosteroids for a relatively long timeis associated with the risk of osteoporosis. An initial DEXA examination and further monitoring istherefore indicated. Preventively at least calcium plus vitamin D should be administered.

Key words:
polymyalgia rheumatica, temporal arteriitis, corticosteroids, osteoporosis