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Aktuelle Rheumatologie 2019; 44(04): 245-252
DOI: 10.1055/a-0968-6782
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Riesenzellarteriitis: Aktuelle Erkenntnisse zu Epidemiologie, Pathogenese, Diagnostik und Therapie

Giant Cell Arteritis: Current Insights on Epidemiology, Pathogenesis, Diagnostics and Treatment
Gernot Keyßer
1   Klinik und Poliklinik für Innere Medizin II, Department für Innere Medizin, Universitätsklinikum Halle (Saale), Halle (Saale)
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Publikationsverlauf

Publikationsdatum:
13. August 2019 (online)

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Zusammenfassung

Als Riesenzellarteriitis (RZA, englisch giant cell arteritis, GCA) bezeichnet man eine Vaskulitis der großen Gefäße, also der Aorta sowie der aortennahen Gefäße erster und zweiter Ordnung. RZA sind in Manifestation und Verlauf vielgestaltige Erkrankungen, die häufig hohe Ansprüche an die Diagnostik und die langfristige Betreuung der Patienten stellen. Fortschritte in Ultraschall-, MRT- und Positronen-Emissionstomografie haben die Diagnostik erleichtert und den Blick für seltenere und ungewöhnliche Manifestationsformen geschärft, die früher oft unerkannt geblieben sind. Therapie der ersten Wahl sind auch heute noch Corticoide. Deren langfristige und hochdosierte Anwendung ist bei den meist älteren und oft polymorbiden Patienten nicht unproblematisch. MTX stellt eine sinnvolle Möglichkeit zur Corticoid-Einsparung dar. Die Einführung der Therapie mit Interleukin-6-Rezeptor-Antikörpern hat neue therapeutische Möglichkeiten für Patienten eröffnet, bei denen langfristige Steroidgaben gefährlich oder kontraindiziert sind. Hauptziel der Behandlung ist die Vermeidung von Komplikationen wie Erblindung, Gefäßverschlüssen oder Aneurysmata sowie die Verhinderung von Therapiekomplikationen.

Abstract

The term “giant cell arteritis” (GCA) refers to large vessel vasculitides of the aorta and its associated first and second order vessels. GCA is complex with respect to manifestation and course of the disease, with diagnosis and long-term care for GCA patients often being demanding tasks. Progress achieved in ultrasonography, MRI and positron emission tomography has facilitated the diagnostic workup and has allowed the detection of rare and uncommon cases that went unrecognised in the past. Corticosteroids are still considered the treatment of first choice. However, their long-term application may be problematic in the mostly elderly patients, who frequently suffer from various other diseases. Methotrexate is considered a reasonable, steroid-sparing alternative. The introduction of antibodies against the receptor of interleukin-6 has offered new therapeutic options for patients in whom corticosteroids are contraindicated. The main goal of treatment is the avoidance of complications (such as blindness, vessel occlusion or the formation of aneurysms) as well as the prevention of treatment-related complications.

Schlüsselwörter

giant cell arteritis - temporal arteritis - corticosteroids - methotrexate - tocilizumab

Key words

Riesenzell-Arteriitis - Arteriitis temporalis - Corticosteroide - Methotrexat - Tocilizumab
 

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