M.R. Alexandrova - Ph.D. (Med.), Associate Professor, The Department of hospital therapy with course of clinical laboratory diagnostics, of the Medical Institute of the PFUR (Moscow) E-mail: 9166858759@bk.ru L.V. Bychkova - Ph.D. (Med.), Associate Professor, The Department of hospital therapy with course of clinical laboratory diagnostics, of the Medical Institute of the PFUR (Moscow) E-mail: lvb57@bk.ru K.O. Vorontsova - Intern, The Department of hospital therapy with course of clinical laboratory diagnostics, of the Medical Institute of the PFUR (Moscow) A.I. Kondratenko - Therapist, State budget institution of healthcare City clinical hospital named after S.S. Yudin (Moscow) T.U. Overchenko - Therapist, State budget institution of healthcare City clinical hospital named after S.S. Yudin (Moscow)

Although no clear diagnostic criteria have polymyalgia rheumatica, in recent years in the literature describing the clinical cases of this disease. Polymyalgia rheumatica is a rare disease. Timely diagnosis allows you to designate time in small dos-es, glucocorticoids and achieve proof remission. It is important to remember that the disease mostly occurs in people older than 50 years without any previous pathology. Diagnostic criteria for polymyalgia rheumatica include: Pain, stiffness in the muscles of the shoulder girdle, neck, thighs, buttocks; General weakness, fever; Deterioration of appetite; Weight loss; Signs of increased laboratory parameters of inflammatory process activity. Timely initiated therapy with small doses of glucocorticoids allows you to get an instant effect of the therapy and to achieve proof remission. Patients have the opportunity to a full life, return to work. With this disease there are doctors of various specialties. Often, these patients are observed in hematologists, oncologists, internists about misdiagnosis that separates the patient from the beginning of the appropriate therapy. The etiology of the disease is unknown. It is assumed the role of viral or bacterial infection. conducted an unsuccessful search infective: studied levels of antibodies to various viruses, but the search for antibodies did not lead to positive results. However, it assumes that cause disease and some types of parvovirus-pneumococcal infection. In Sweden in 1994 after an outbreak of parvovirus infection there was a high incidence of polymyalgia rheumatica rise for 12 months after the epidemic. It is known that viruses contribute to the appearance of inflammatory reaction with giant cells similar to those that occur in the temporal artery. In 40% of cases of arteritis in patients detected parainfluenza virus type 1. Knowledge of the main symptoms of the disease and the rapid effect of the therapy will allow a diagnosis of polymyalgia rheumatica in a short time. In the above article the clinical observation of the patient with polymyalgia rheumatica. this example shows the criteria for diagnosis, disease diagnosis difficulties faced by physicians in their daily practice. Patient A., 58 years old, was examined and treated in a hospital. I acted with complaints of increased body What to 38.5oS - 39oS expressed general weakness, pain in the cervical spine in the shoulder joints, non-productive cough, lack of appetite, a loss in weight of up to 5 kg within a month. On admission attracted attention - reduction in Hb to 97 g/l, leukocytosis - 13.4 10^9/L, thrombocytosis - 640 10^9/L, increased erythrocyte sedimentation rate to 43 mm/h in a clinical blood test; in the biochemical analysis of blood showed a significant increase in CRP to 293 mg/L, RF - Neg, procalcitonin - Neg. It involves a onkopoiska, the presence of infectious-inflammatory process cue to prolonged fever. However, given the age of the patient and the presence of symptoms characteristic of polymyalgia rheumatica, it was decided to start therapy with prednisolone at a dose of 15 mg/dey. The effect of the therapy during the day (to normal body temperature), allowed to stay on the diagnosis of polymyalgia rheumatica. Furher pablyudenie rheumatologist with the correction of the dherapy led to remission. In this clinical example demonstrates that in elderly patients with prolonged fever, arthralgias symmetrical, increasing weakness, loss of weight should be aware of the possible presence have polymyalgia rheumatica.

 

1. Bunchuk N.V., Nikitin S.S. Diagnostika revmaticheskojj polimialgii // Klinicheskaja medicina. 1986. № 5. S. 80-86.
2. Bunchuk N.V., Rytikova M.I. Klinicheskie projavlenija revmaticheskojj polimialgii // Terapevticheskijj arkhiv. 1991. № 4. S. 106-109.
3. Efimenko I.S., Mikhajjlova I.A., Bagrova JI.O. Revmaticheskaja polimialgija // Terapevticheskijj arkhiv. 1995. № 11. S. 71-73.
4. Nutrikhina N.N. Raspoznavanie i lechenie revmaticheskojj polimialgii // Revmatologija. 1985. № 4. S. 55-57.
5. Armstrong R.D., Behn A., Myles A. et al. Histocompatibility antigens in polymyalgia rheumatica and giant cell arteritis // J. Rheum. 1983. V. 10. P. 659-661.
6. Otteva EH.N., Zotkin E.G. Revmaticheskaja polimialgija: klinicheskaja kartina i monitoring // Rossijjskijj semejjnyjj vrach. 2012. № 1. S. 42-46.
7. Cantini F., Niccoli L., Storri L. et al. Are polymyalgia rheumatica and giant cell arteritis the same disease - // Arthritis Rheum. 2004. V. 33. №. 5. P. 294-301.
8. Cenac A., Sparfel A., Amiel-Lebigre F. et al. Effect of stressful life events on clinical development of temporal arteritis and/or polymyalgia rheumatica // Presse Med. 2002. V. 31. № 19. P. 873-879.
9. http://www.lvrach.ru/2011/07/15435233/ 20.04.2016 g.
10. http://www.rusmedserv.com/rheumatology/polym.htm 20.04.2016 g.