Klinische Charakteristika und Laborbefunde von Polymyalgia rheumatica (PMR) und Riesenzellarteriitis (RZA)

Zusammenfassung

Die PMR ist überwiegend eine klinische Diagnose: Stammnahe Muskelschmerzen bei älteren Patienten, die häufig rasch progredient einsetzen, eine ausgeprägte Morgensteifigkeit, sowie das überzeugende Ansprechen auf eine Steroidtherapie lassen oft wenig Zweifel an der Diagnose.

Die Manifestationen der RZA können variabler sein und werden vom betroffenen Gefäßgebiet beeinflusst. Die AT geht in mehr als zwei Dritteln der Fälle mit Kopfschmerzen einher, diagnostisch richtungsweisend können Schmerzen beim Kauen sein, die sog. Kiefer-Claudicatio. Die schmerzhaft verdickte Schläfenarterie ist ein klassisches Merkmal des Krankheitsbildes.

Für PMR und AT gibt es keine richtungsweisenden Laborbefunde. Erhöhte Entzündungswerte sind bei beiden Entitäten die Regel, zu der es nur wenige Ausnahmen gibt.

Abstract

The diagnosis of polymyalgia rheumatica can often be made based on symptoms and signs only. Aching muscle pain in the shoulder girdle, gluteal region and thighs may occur with a rapid onset, accompanied by lasting morning stiffness. The immediate pain relief after the initiation of the treatment with corticosteroids is a helpful diagnostic sign as well.

The clinical image of giant cell arteritis is more variable and depends on the vascular region affected by the inflammatory process. Headache is a typical sign of temporal arteritis, as well as jaw claudication. A prominent, painful temporal artery is a classical sign.

There are no pathognomonic laboratory abnormalities for both polymyalgia rheumatica and temporal arteritis. Both are accompanied by elevated acute phase reactants, although few exceptions exist to this rule.

Schlüsselwörter

Polymyalgia rheumatica - Arteriitis temporalis - Riesenzellarteriitis - Laborbefunde

Key words

polymyalgia rheumatica - temporal arteritis - giant cell arteritis - laboratory values

• Literatur

• 1 Hunder GG. Clinical features of GCA/PMR. Clinical and experimental rheumatology 2000; 18: S6-S8
• 2 Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008; 372: 234-245
• 3 Weyand CM, Goronzy JJ. Giant-cell arteritis and polymyalgia rheumatica. Annals of internal medicine 2003; 139: 505-515
• 4 Myklebust G, Gran JT. A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. British journal of rheumatology 1996; 35: 1161-1168
• 5 Fietta P, Manganelli P. Steroid-reversible parkinsonism as presentation of polymyalgia rheumatica. Clinical rheumatology 2006; 25: 564-565
• 6 Malone CB, McCarthy GM. Polymyalgia rheumatica as an unusual cause of pleural and pericardial effusion. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 2005; 11: 59-60
• 7 Kimura M, Tokuda Y, Oshiawa H et al. Clinical characteristics of patients with remitting seronegative symmetrical synovitis with pitting edema compared to patients with pure polymyalgia rheumatica. The Journal of rheumatology 2012; 39: 148-153 DOI: 10.3899/jrheum.110558.
• 8 Gran JT, Myklebust G, Wilsgaard T et al. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology (Oxford) 2001; 40: 1238-1242
• 9 Proven A, Gabriel SE, O’Fallon WM et al. Polymyalgia rheumatica with low erythrocyte sedimentation rate at diagnosis. The Journal of rheumatology 1999; 26: 1333-1337
• 10 Duhaut P, Pinede L, Bornet H et al. Biopsy proven and biopsy negative temporal arteritis: differences in clinical spectrum at the onset of the disease. Groupe de Recherche sur l’Arterite a Cellules Geantes. Annals of the rheumatic diseases 1999; 58: 335-341
• 11 Cunha BA, Parchuri S, Mohan S. Fever of unknown origin: temporal arteritis presenting with persistent cough and elevated serum ferritin levels. Heart & lung: the journal of critical care 2006; 35: 112-116
• 12 Horton BT. Headache and intermittent claudication of the jaw in temporal arteritis. Headache 1962; 2: 29-40
• 13 Nir-Paz R, Gross A, Chajek-Shaul T. Reduction of jaw opening (trismus) in giant cell arteritis. Annals of the rheumatic diseases 2002; 61: 832-833
• 14 Schmidt D, Loffler KU. Temporal arteritis. Comparison of histological and clinical findings. Acta ophthalmologica 1994; 72: 319-325
• 15 Smetana GW, Shmerling RH. Does this patient have temporal arteritis?. JAMA: the journal of the American Medical Association 2002; 287: 92-101
• 16 Weyand CM, Goronzy JJ. Medium- and large-vessel vasculitis. The New England journal of medicine 2003; 349: 160-169
• 17 Salvarani C, Cimino L, Macchioni P et al. Risk factors for visual loss in an Italian population-based cohort of patients with giant cell arteritis. Arthritis and rheumatism 2005; 53: 293-297
• 18 Liu GT, Glaser JS, Schatz NJ et al. Visual morbidity in giant cell arteritis. Clinical characteristics and prognosis for vision. Ophthalmology 1994; 101: 1779-1785
• 19 Brack A, Martinez-Taboada V, Stanson A et al. Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis and rheumatism 1999; 42: 311-317
• 20 Liang KP, Chowdhary VR, Michet CJ et al. Noninfectious ascending aortitis: a case series of 64 patients. The Journal of rheumatology 2009; 36: 2290-2297 DOI: 10.3899/jrheum.090081.
• 21 Gonzalez-Gay MA, Lopez-Diaz MJ, Barros S et al. Giant cell arteritis: laboratory tests at the time of diagnosis in a series of 240 patients. Medicine 2005; 84: 277-290
• 22 Kermani TA, Schmidt J, Crowson CS et al. Utility of Erythrocyte Sedimentation Rate and C-Reactive Protein for the Diagnosis of Giant Cell Arteritis. Semin Arthritis Rheum. 2011
• 23 Hazleman B. Laboratory investigations useful in the evaluation of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). Clinical and experimental rheumatology 2000; 18: S29-S31