Polymyalgia rheumatica (PMR)

多肌痛性风湿病（Poly-my-al-ger ru-mah Ticker）或PMR是一种相对常见的疾病，会导致肌肉僵硬和疼痛。“ poly”一词的意思是很多，“肌痛”一词表示肌肉疼痛。

It can start at any age from 50, but mainly affects people over the age of 70. More women are affected than men.

Polymyalgia rheumatica can cause pain and stiffness in the shoulders, neck, hips and thighs.

Polymyalgia rheumatica often comes on quickly, perhaps over a week or two. It can start just after a flu-like illness. The stiffness may be so severe that dressing, reaching, washing, climbing stairs or even getting out of bed may be difficult.

症状与运动后可能不习惯的疼痛不同。多肌痛风湿病的疼痛和僵硬通常是普遍的，休息或休息后会更糟。症状可以随着活动而改善，或者随着一天的进行。疼痛也可能在晚上唤醒您。

感觉不适或轻度发烧也很常见，您可能会减轻体重。有时，疲倦可能是压倒性的，这被称为fatigue。这种情况还会使您感到沮丧和焦虑，并且沮丧。

If you have polymyalgia rheumatica, you are at a higher risk of getting a condition called巨细胞动脉炎（GCA）。这涉及称为动脉的血管发炎。

This needs urgent treatment as there’s a risk of permanent loss of your eyesight or having a stroke with giant cell arteritis.

巨型c的症状ell arteritis are:

• 头部肌肉的严重头痛和疼痛
• tenderness at the temples, the soft part of the head at the side of the eyes
• 咀嚼时的下巴，舌头或脸部疼痛
• 头皮疼痛或肿胀
• 模糊或双视力。

If your doctor suspects giant cell arteritis, you’ll be referred to a specialist and may have a biopsy of the temporal artery. This is where a small piece of the artery is taken from the head and examined under a microscope. You’ll be given a local anaesthetic to numb the area.

在您看到专家以防止可能失去视力之前，您的医生可能会开始使用大量的类固醇。

没有特定的测试来诊断风湿性多肌痛。

Your doctor will make a diagnosis after listening to you talk about the history of your symptoms and by carrying out a physical examination. You’ll also have blood tests to check for any inflammation in your body, and to rule out other conditions.

If you’re over 50 and have the following symptoms and signs your GP will probably diagnose polymyalgia rheumatica, and start treatment straight away:

• 身体两侧的新肩，脖子，臀部或大腿疼痛，至少存在两个星期
• pain and stiff muscles in the shoulders, hips or thighs in the mornings that lasts at least 30 minutes
• high levels of inflammation measured by blood tests
• no evidence ofrheumatoid arthritis，例如关节肿胀或阳性血液检查。

你可能会被称为一个rheumatologist如果对诊断或是否存在复杂因素有任何疑问。这可能是如果症状无法通过类固醇治疗改善，或者您对治疗的副作用。

仅炎症的存在无法确认诊断为风湿性多肌痛。炎症是许多其他疾病的特征，包括感染和类风湿关节炎，因此您的医生可能会进行一些测试以寻找其他疾病的迹象。您可能需要进行X射线或超声扫描等测试。

风湿病学家有时可能会要求其他形式的成像扫描来排除其他条件。这些包括磁共振成像（MRI）和正电子发射断层扫描（PET）扫描。

A condition called anaemia (an-ee-me-a), which is a lack of red blood cells that carry oxygen around the body, is quite common in polymyalgia rheumatica. Your doctor may test for this. However, anaemia can also occur in other conditions.

Guidelines setting out the best treatment and care for people with polymyalgia rheumatica state there should be shared decision making between a patient and their healthcare professionals.

如果您有这种情况，则应为您制定治疗计划，其中包括：

• 初始剂量的类固醇and a schedule for when this dose will ideally be reduced and by how much, if your condition remains under control
• 接受教育，重点关注病情的影响。

You may be given a contact phone number or helpline number for access to your doctor or nurses, if you have concerns about any changes in your condition such as flares or side effects to drugs.

Steroids

类固醇治疗通常非常有效治疗风湿性多肌痛。

Steroids work by reducing inflammation. They can’t cure your condition, but the symptoms will improve significantly within two weeks once steroid treatment is started. Normally, steroid treatment for polymyalgia rheumatica will be taken as tablets.

经过四个星期的类固醇治疗后，您的症状几乎可能消失。但是，治疗通常需要持续长达两年或偶尔需要更长的时间才能阻止症状恢复。

The类固醇片most often prescribed is called prednisolone.

潜在的副作用可能包括体重增加和状况骨质疏松症, which can cause people’s bones to become thinner and more fragile, and therefore may fracture more easily.

有成群的人可能面临副作用的风险，包括那些有：

• 糖尿病
• 高血压
• 最近的骨折
• a peptic ulcer
• a cataract
• 青光眼。

如果您是其中一个小组，您的医生将与您谈论可能与类固醇一起开处方的药物，以降低任何风险。

After two to four weeks, your doctor will gradually reduce the dose of steroids.

The reduction will be made in stages depending mainly on your symptoms but helped by carrying out repeated blood tests to look for inflammation.

If symptoms return when the dose is reduced, your doctor may have to increase the dose for a short time, possibly several weeks, and then try to reduce it again.

即使您的症状已完全清除，除非医生的建议，否则您不应停止服用类固醇片或更改剂量。这是因为当您服用类固醇片时，您的身体停止生产自己的类固醇，称为皮质醇。当药物降低或停止时，您的身体将需要一些时间才能恢复正常的天然类固醇。

Even when you feel well, your doctor may wish to see you regularly so that you can be assessed for signs of the condition coming back, or side effects from the drugs. Your doctor may want to check your general health and check your blood pressure, blood sugar and cholesterol. You may also be asked to have a bone density (DEXA) scan to check the strength of your bones.

建议您携带一张类固醇卡，以显示您使用的平板电脑以及服用多长时间的剂量。

如果您需要去看另一位医生，例如，当您出门在外或其他医疗保健专业人员（例如牙医）时，这将有所帮助。请向他们展示卡 - 取决于您需要的其他治疗方法，可能需要调整类固醇剂量。

Steroid cards are available from most pharmacies.

其他治疗方法

预防骨质疏松症

像所有药物一样，类固醇可以产生副作用。类固醇的副作用之一是骨质疏松症, which can cause bones to become thinner and then fracture.

全国推荐的治疗方法称为药物bisphosphonates（Biss-Foss-Fo-nates）。这些是一组可以减慢或防止骨质流失的药物。您可以向医生询问双膦酸盐治疗。示例包括丙膦酸盐和risdronate。

Pain relief

Painkillers, such as paracetamol, or short courses ofnon-steroidal anti-inflammatory drugs (NSAIDs), such asibuprofenor naproxen, can help ease pain and stiffness. They can be taken at the same time as steroid tablets.

Disease-modifying anti-rheumatic drugs (DMARDs)

There may be some situations where your doctor will want to prescribe a type of drug called a疾病改良的抗风湿药（DMARD），与类固醇一起。

These drugs work by reducing inflammation that is causing symptoms such as pain and stiffness.

DMARDs allow a lower dose of steroid to be used.

These drugs could be prescribed if:

• 您的症状无法改善类固醇
• you have unusual symptoms
• 很难减少类固醇的剂量
• you get frequent flare-ups of your condition, where your symptoms rapidly get worse.

You may need to see a specialist to be prescribed a DMARD.

专家可以决定与类固醇片一起开出DMARD，这可能有助于减少炎症并降低类固醇剂量。一个例子是methotrexate。

If you’re taking a DMARD it’s important to have regular check-ups, blood pressure checks and blood tests to check for potential side effects.

Steroid treatment is usually very effective at treating polymyalgia rheumatica. However, because it can increase your risk of getting骨质疏松症, it’s important to think about other risk factors associated with this condition.

Smoking or drinking a lot of alcohol will increase your risk of developing osteoporosis.

Ensuring you get enoughcalcium and vitamin D，并且您进行一些承重运动将降低患骨质疏松症的风险。

保持活跃

如果您患有多肌痛性风湿病，则需要在休息和活动之间找到适当的平衡。过多的运动可能会使您的症状恶化，但是活动通常有助于缓解肩膀，臀部和大腿的肌肉的疼痛和僵硬。

理疗，包括肩膀的运动锻炼范围，可以帮助减轻疼痛并保持活动能力。

Weight-bearing exercise is good for maintaining bone strength and reducing the risk of骨质疏松症。

Weight-bearing exercise is anything like jogging, walking, tennis, dancing or lifting weights, where some force or the weight of the body is impacted on bones during the exercise. This is in contrast to swimming, for example, where the water supports the weight of the body. Walking is usually the most suitable weight-bearing exercise for people with polymyalgia rheumatica.

Sitting for any length of time may cause stiffness, making activities such as driving more difficult. Stop from time to time on a long journey to stretch your shoulders, arms and legs.

Simple measures such as a hot bath or shower can help to ease pain and stiffness, either first thing in the morning or after exercise.

Diet and nutrition

Steroid treatment reduces the amount of calcium in the body.

If you’re on steroid treatment, it’s recommended you aim for a daily intake of 700–1200 mg of calcium.

每天一品脱牛奶，以及合理数量的含钙的食物应该足够了。

Appropriate calcium content of some common foods

Food	钙含量
115 g (4 oz) whitebait (fried in flour)	980毫克
60 g (2 oz) sardines (including bones)	260毫克
0.2 litre (1/3 pint) semi-skimmed milk	230毫克
0.2 litre (1/3 pint) whole milk	220毫克
3 large slices brown or white bread	215 mg
125 g (4 1/2 oz) low-fat yogurt	205 mg
30克（1盎司）硬奶酪	190毫克
0.2 litre (1/3 pint) calcium-enriched soya milk	180 mg
125 g（4 1/2盎司）钙 - 富含大豆酸奶	150 mg
115 g (4 oz) cottage cheese	145 mg
115 g (4 oz) baked beans	60 mg
115 g (4 oz) boiled cabbage	40毫克

注意：以盎司或品脱显示的度量仅是近似转换。

Vitamin D

Vitamin D is needed to help the body absorb calcium.

最好的来源维生素Dis sunlight on bare skin. However, sunshine in the UK isn’t good enough all year round to guarantee we get the vitamin D needed.

Because of this, and because it’s an important nutrient, it’s recommended that we all take vitamin D supplements in the autumn and winter months. These can be bought from supermarkets and health food shops. You can also discuss this with a pharmacist.

There are some at risk groups who are advised to take vitamin D supplements all year round, including:

• people who are housebound and therefore don’t go out in the sunshine often enough
• people who wear clothes that cover their whole body, limiting the amount of sunshine on their skin
• people with dark skin, because dark skin is not as good as absorbing vitamin D from sunlight, compared to pale skin.

当我开发多肌痛性风湿病时，我才57岁巨细胞动脉炎。I was head of news and current affairs at Channel Four television and a single parent of a child of 12.

它始于脖子酸痛。我尝试了按摩，但它不起作用。然后我的肩膀开始疼痛。

早晨，当我醒来时，我发现很难移动手臂，尽管我的手很容易移动。问题会很快消失，我会忘记它。

Then one morning I woke up and my arms wouldn’t move at all for 20 minutes. Although I was young to get the condition, I knew I had polymyalgia rheumatica, as my mother had it.

It makes you suddenly feel like an old lady as you can’t move properly.

I was given a blood test to check inflammation levels and was put onto steroid tablets. Unfortunately, I wasn’t put on a high enough dose and the aches, pains and weakness got worse.

一天晚上，我生病了，疲倦，我什至无法睁开眼睛。几个晚上，我不得不告诉我的女儿吃晚饭，因为我无法动弹。

我的女儿很沮丧和恐惧。我回家后不得不上床睡觉。有时候，白天，我会在停车场上睡觉。当我服用正确剂量的类固醇时，我感觉还不错，但确实减少了我的社交生活。

最终，我出现了可怕的头痛，下巴变得非常僵硬。我立刻知道这是巨细胞动脉炎。我不得不立即服用大剂量的类固醇来防止视力丧失，这对于GCA来说是非常真实的风险。

For two-and-a-half years I had to take steroids and then I was moved onto methotrexate for a year. I put on weight and my face took on a moon shape. I became tired much more easily.

Early on I joined the patient groupPMRGCAuk。I found it really helpful to meet other people with the condition and swap experiences and ideas.

三年半后，病情消失了。我从毒品中脱下来。我的体重下降了，我的脸恢复了正常的形状。当我开发GCA时服用了高剂量的类固醇时，我的视力很好。

作为新闻和时事负责人，我对频道四个新闻，派遣，未报告的世界以及所有其他新闻和时事节目的最终责任。我通常每周至少工作60个小时的调试计划，观看电影和处理各种节目。

I would say that I should have taken time off work and that I had to learn to expect less of myself and to tell others I had a debilitating illness, so they should expect less of me.