うつ症状が先行したリウマチ性多発筋痛症の1例

A Case of Polymyalgia Rheumatica (PMR) with Prodromal Depressive State

　リウマチ性多発筋痛症（polymyalgia rheumatica；PMR）は側頭動脈炎（temporal arteritis；TA）の1症状とも考えられている^2,4,8）。臨床上は近位筋痛を主症状とし，血沈値は高度亢進しCRPも強陽性であるが，RAやRFといったリウマチ性疾患を示す検査は陰性で関節症状も伴わないのが特徴とされており，副腎皮質ホルモンが有効である^3,4,10）。

　筆者は76歳女性でうつ症状が先行していた典型的なPMRの1例を経験した。PMRの報告は多いものの，精神症状としてのうつ症状を伴ったPMRの症例^7,9,11）は極めて少ないので，若干の文献考察を加え報告する。

　A case of polymyalgia rheumatica (PMR) with prodromal depressive state was presented. A 76-year-old woman was admitted to our hospital with complaints of sleep disturbance, depressive mood, and feelings of hopelessness. Physical examinations showed nothing remarkable except for a body temperature that reached 38.8℃. Routine laboratory studies revealed no marked abnormalities. Antidepressants were administered for the depressive state but the mental picture remained unchanged. After 4 weeks in the hospital, the patient complainted of severe muscular pain in the pelvic girdle and thighs. Two days later, the pain spread to the shoulder girdle, neck, and upper arms. The temporal artery was not found to be thickened. No muscle weakness and no synovitis was found. At that time, laboratory tests showed an erythrocyte sedimentation rate (ESR) of 88mm/lhr, a serum fibrinogen content (FIB) of 638mg/dl, and a strongly positive C-reactive protein (CRP). Tests for rheumatoid factors were negative and other laboratory data were all normal. Within a few days after treatment with 20mg per day of prednisolone, the pain was dramatically relieved and the depressive state disappeared completely. ESR, CRP, and FIB returned to normal levels. The final diagnosis of PMR with prodromal depressive state was made.