Neue Ansätze in der immunologischen Therapie der Riesenzellarteriitis und Polymyalgia rheumatica

ZUSAMMENFASSUNG

Die Riesenzellarteriitis (RZA) ist eine Autoimmunerkrankung der großen und mittelgroßen Arterien. Sie ist die häufigste primäre systemische Vaskulitis in der westlichen Welt. Eine verzögerte Diagnose kann schwerwiegende Komplikationen wie permanenten Sehverlust zur Folge haben. Der vaskuläre Ultraschall hat sich als schnelle und zuverlässige Methode in der Diagnostik der RZA etabliert. Pathophysiologisch zeigt sich ein Zusammenspiel des angeborenen und adaptiven Immunsystems. Eine häufige Assoziation besteht mit der Polymyalgia rheumatica (PMR). Bei Verdacht auf RZA ist eine sofortige Glukokortikoid-Stoßtherapie, gefolgt von einem Tapering zumeist über 6 Monate, indiziert. Tocilizumab, ein Inhibitor des IL-6-Rezeptors, hat sich als therapeutischer Goldstandard zur Reduktion der kumulativen Steroid-Dosis und Rezidivrate der RZA etabliert. Bei der Behandlung der PMR werden primär Glukokortikoide eingesetzt, wobei ein Tapering über mindestens 1 Jahr empfohlen wird. Bei hohem Risiko für ein Rezidiv kann zusätzlich die Gabe von Methotrexat oder Tocilizumab in Betracht gezogen werden. Derzeit befinden sich zahlreiche Therapieansätze zur Behandlung von RZA und PMR in klinischen Studien.

Schlüsselwörter

Riesenzellarteriitis - Polymyalgia rheumatica - Glukokortikoide - Tocilizumab - Disease-modifying Antirheumatic Drug

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