2026年英国风湿病学会风湿性多肌痛治疗指南。
完整摘要 · 中文译文
风湿性多肌痛（PMR）是老年人中常见的炎症性风湿病。糖皮质激素（GCs）仍是治疗的基石，但许多PMR患者在减量期间复发，并因长期GC治疗而暴露于相关毒性风险。因此，需要有循证策略来优化疾病控制，同时尽量减少GC相关损害。本指南依据英国风湿病学会《制定临床指南方案》（v6.0）制定，采用GRADE和AGREE II框架，取代此前发布的2009年BSR/BHPR PMR指南。本次指南更新纳入了若干关键建议。这些建议包括：何时就PMR患者进行讨论或转诊至风湿科；启动GCs及减量方案，可选择更快减量；考虑早期使用甲氨蝶呤；对于无法减停GCs或反应不佳的PMR患者，使用IL-6受体拮抗剂；以及所有PMR患者的骨保护。此外，本指南强调持续进行患者教育和咨询的重要性，监测糖皮质激素毒性，并建议何时将PMR患者转诊至二级医疗机构。本指南旨在帮助临床医生为PMR患者提供安全、有效且个体化的诊疗，同时促进GC的合理使用，并在适当时机及时引入减少GC用量的药物。
完整摘要 · 英文原文
Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic condition in older adults. Glucocorticoids (GCs) remain the cornerstone of treatment, but many people with PMR relapse during tapering and are exposed to prolonged GC therapy with associated toxicity. There is therefore a need for evidence-based strategies that optimize disease control while minimizing GC-related harm. This guideline was developed in line with the British Society for Rheumatology's Creating Clinical Guidelines Protocol (v6.0), using GRADE and AGREE II frameworks, and supersedes previously published 2009 BSR/BHPR PMR guidelines. Several key recommendations have been included in this guideline update. These include when to discuss or refer people with PMR to rheumatology; initiation of GCs and tapering with options for a faster GC taper; consideration of early methotrexate; IL-6 receptor antagonist use in people with PMR who are unable to taper GCs or have had an inadequate response; and bone protection in all people with PMR. Furthermore, the guideline emphazises the importance of ongoing patient education and counselling, monitoring for glucocorticoid toxicity and suggestions for when to refer people with PMR to secondary care. This guideline aims to support clinicians in delivering safe, effective and individualized care for people with PMR, while promoting judicious use of GCs and timely introduction of GC-sparing therapies where appropriate.