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Fjölvöðvagigt og gagnaugaslagæðabólga : aftursæ rannsókn 1970 til 1984

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Authors
Gunnar Gunnarsson
Sigurður Thorlacius
Halldór Steinsen
Issue Date
1989-08-15

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Læknablaðið 1989, 75(6):217-22
Abstract
Symptoms, signs, laboratory parameters, treatment and fate of all patients, diagnosed as having polymyalgia rheumatica and/or temporal arteritis at Landakotsspitali in Reykjavik during the years 1970 to 1984 were studied retrospectally. A total of 68 patients were diagnosed as having either or both diseases, 39 (57,6%) females and 29 (42,7%) males. Those diseases are diagnosed with increasing frequency in recent years. The sex ratio was found different from most other places where the diseases are 4 to 5 times more common among females than males. 2 patients were diagnosed before the age of 50. 10 patients had had symptoms for less than four weeks at the time of diagnosis. 27,9% had ESR below 50. We propose the following criteria for the diagnosis of polymyalgia rheumatica: Age above 50, symptoms lasting for more than four weeks at the time of diagnosis and ESR above 50 are not valid. A higher percentage of our patients was receiving steroid treatment for more than three years than in most other studies. Those patients in whom temporal arteritis was found did receive steroids for shorter period of time than those having polymyalgia rheumatica but their average maintenance dose was higher and so was their ESR.
Polymyalgia rheumatica sem á íslensku hefur verið nefnd fjölvöðvagigt (FVG) og arteritis temporalis eða gagnaugaslagæðabólga (GSB) eru ekki óalgengir gigtsjúkdómar hjá rosknu fólki. Talið er að GSB sé algengari á norðlægum en suðlægum breiddargráðum. GSB er útbreidd hnúðabólga í slagæðum sem leggst fyrst og fremst á greinar hálsslagæðar, oftast í einstaklingum sem náð hafa fimmtugsaldri (1). Í bókum er oft talað um GSB og risafrumuslagæðabólgu sem sama hlutinn en í raun nær hugtakið risafrumuslagæðabólga einnig yfir Takayasu slagæðabólgu, sem sést aðallega í Austurlöndum (2). FVG einkennist af verkjum og morgunstirðleika í nálægum útlimavöðvum og oftast hækkuðu sökki. Sumir telja að einkenni eigi að hafa staðið lengur en fjórar vikur. Aðrir miða við 8 vikur (3) og enn aðrir við tvær (4). Einkenni svara mjög vel lágskammta sterameðferð (2). FVG er útilokunargreining. Flestir álíta að hér sé um tvo mismunandi sjúkdóma að ræða, sem skarist þó töluvert, því um helmingur sjúklinga með GSB reynist einnig hafa FVG Aðrir álíta að um sama sjúkdóm sé að ræða en hann geri vart við sig á mismunandi hátt undir tveimur heitum. Við höfum grennslast fyrir um það, hvenær þessi sjúkdómur var fyrst greindur á Íslandi. Mun það hafa verið 1960 eða 1961 sem Valtýr Albertsson lagði sjúkling inn á Borgarspítala með greininguna »arteritis temporalis«. Árin 1964 til 1966 koma greiningarnar »arteritis temporalis« og »polymyalgia rheumatica« fyrst fram á skýrslum Landspítala og Landakotsspítala. Tilgangur þessarar rannsóknar var að kanna hegðun, gang og meðferð FVG og GSB hjá íslenskum sjúklingum
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