Möglichkeiten der Krankheitsaktivitätsmessung bei Vaskulitiden im klinischen Alltag

Zusammenfassung

Zusammenfassung Systemische Vaskulitiden sind eine heterogene Gruppe an Erkrankungen, deren gemeinsames Merkmal die Entzündung von Blutgefäßen ist. Durch Messung der Krankheitsaktivität soll einerseits der Therapieerfolg objektiviert, andererseits die Prognose eines individuellen Patienten mit Vaskulitis abgeschätzt werden. Bei keiner Form der Vaskulitis kann die Krankheitsaktivität mit einem singulären Parameter mit ausreichender Sicherheit bestimmt werden. Krankheitsaktivitätsscores errechnen sich zumeist aus der Bewertung klinischer Symptome, sind aber nicht für alle Vaskulitisformen verfügbar. Die Bestimmung der Entzündungswerte und/oder Autoantikörper sowie bildgebende Verfahren helfen zusätzlich ein umfassendes Bild über die Krankheitsaktivität eines Patienten mit Vaskulitis zu erhalten, um so die Planung der weiteren therapeutischen Schritte zu erleichtern.

Abstract

Systemic vasculitides are a heterogeneous group of diseases with inflammation of blood vessels. The assessment of disease activity is necessary to objectify the success of an ongoing current therapy and to estimate the prognosis for an individual patient. There is no single parameter that can be used to determine the activity of vasculitis disease. Disease activity scores are usually based on the evaluation of clinical symptoms; however, such indices are not available for all types of vasculitis. Laboratory parameters including inflammatory markers and autoantibodies as well as imaging methods provide additional information on disease activity and thus provide a basis for therapeutic decisions.

Schlüsselwörter

Vaskulitis - Behçet Syndrom - Riesenzellarteriitis - Autoantikörper - anti-neutrophile cytoplasmatische Antikörper

Key words

vasculitis - Behçet's syndrome - giant cell arteritis - autoantibodies - antineutrophil cytoplasmic antibodies

Literatur

• 1 Mukhtyar C, Lee R, Brown D. et al . Modification and validation of the Birmingham Vasculitis Activity Score (Version 3).  Ann Rheum Dis. 2008;  , [Epub ahead of print]
• 2 Jennette JC, Falk RJ, Andrassy K. et al . Nomenclature of systemic vasculitides.  Proposal of an international consensus conference. Arthritis Rheum. 1994;  37 187-192
• 3 Wipfler-Freißmuth E, Moosig F, Loock J. et al . Innovative Therapieansätze bei Riesenzellarteritiden.  Z Rheumatol. 2009;  68 132-136
• 4 Weyand CM, Goronzy JJ. Medium- and large-vessel vasculitis.  N Engl J Med. 2003;  349 160-169
• 5 Kerr GS, Hallahan CW, Giordano J. et al . Takayasu arteritis.  Ann Intern Med. 1994;  120 919-929
• 6 Lagneau P, Michel JP, Vuong PN. Surgical treatment of Takayasu's disease.  Ann Surg. 1987;  205 157-166
• 7 Salvarani C, Cantini F, Boiardi L. et al . Polymyalgia rheumatica and giant-cell arteritis.  N Engl J Med. 2002;  347 261-271
• 8 Weyand CM, Goronzy JJ. Arterial wall injury in giant cell arteritis.  Arthritis Rheum. 1999;  42 844-853
• 9 Narvaez J, Clavaguera MT, Nolla-Sole JM. et al . Lack of association between infection and onset of polymyalgia rheumatica.  J Rheumatol. 2000;  27 953-957
• 10 Salvarani C, Cantini F, Boiardi L. et al . Laboratory investigations useful in giant cell arteritis and Takayasu's arteritis.  Clin Exp Rheumatol. 2003;  21 ((6 Suppl 32)) S23-S28
• 11 Hall S, Barr W, Lie JT. et al . Takayasu arteritis: a study of 32 North American patients.  Medicine. 1985;  64 89-99
• 12 Hoffman GS, Ahmed AE. Surrogate markers of disease activity in patients with Takayasu's arteritis. A preliminary report from The International Network for the Study of the Systemic Vasculitides (INSSYS).  Int J Cardiol. 1998;  66 ((Suppl 1)) S191-S194
• 13 Salvarani C, Cantini F, Olivieri I. et al . Proximal bursitis in active polymyalgia rheumatica.  Ann Intern Med. 1997;  127 27-31
• 14 Gabriel SE, O’Fallon MW, Achkar AA. et al . The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis.  J Rheumatol. 1995;  22 93-96
• 15 Noris M, Daina E, Gamba S. et al . Interleukin-6 and RANTES in Takayasu's arteritis.  A guide for therapeutic decisions? Circulation. 1999;  100 55-60
• 16 Karassa FB, Matsagas MI, Schmidt WA. et al . Meta-analysis: test performance of ultrasonography for giant-cell arteritis.  Ann Intern Med. 2005;  142 359-369
• 17 Gotway MB, Araoz PA, Macedo TA. et al . Imaging findings in Takayasu's arteritis.  AJR Am J Roentgenol. 2005;  184 1945-1950
• 18 Yoshida S, Akiba H, Tamakawa M. et al . The spectrum of findings in supra-aortic Takayasu's arteritis as seen on spiral CT angiography and digital subtraction angiography.  Cardiovasc Intervent Radiol. 2001;  24 117-121
• 19 Narváez J, Narváez JA, Nolla JM. et al . Giant cell arteritis and polymyalgia rheumatica: usefulness of vascular magnetic resonance imaging studies in the diagnosis of aortitis.  Rheumatology. 2005;  44 479-483
• 20 Pipitone N, Versari A, Salvarani C. Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update.  Rheumatology. 2008;  47 403-408
• 21 Bley TA, Uhl M, Venhoff N. et al . 3-T MRI reveals cranial and thoracic inflammatory changes in giant cell arteritis.  Clin Rheumatol. 2007;  26 448-450
• 22 Bley TA, Markl M, Schelp M. et al . Mural inflammatory hyperenhancement in MRI of giant cell (temporal) arteritis resolves under corticosteroid treatment.  Rheumatology. 2008;  47 65-67
• 23 Both M, Ahmadi-Simab K, Reuter M. et al . MRI and FDG-PET in the assessment of inflammatory aortic arch syndrome in complicated courses of giant cell arteritis.  Ann Rheum Dis. 2008;  67 1030-1033
• 24 Tso E, Flamm SD, White RD. et al . Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment.  Arthritis Rheum. 2002;  46 1634-1642
• 25 Hara M, Goodman PC, Leder RA. FDG-PET finding in early-phase Takayasu arteritis.  J Comput Assist Tomogr. 1999;  23 16-18
• 26 Meller J, Strutz F, Siefker U. et al . Early diagnosis and follow-up of aortitis with [⁽¹⁸⁾F]FDG PET and MRI.  Eur J Nucl Med Mol Im. 2003;  30 730-736
• 27 Blockmans D, de Ceuninck L, Vanderschueren S. et al . Repetitive ¹⁸F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients.  Arthritis Rheum. 2006;  55 131-137
• 28 Schirmer M, Klauser A, Wenger M. et al . New perspectives of imaging techniques for diagnosis of organ manifestations in Behçet's disease.  Adv Exp Med Biol. 2003;  528 445-448
• 29 Davatchi F, Akbarian M, Shahram F. Iran Behçet's disease Dynamic Activity Measure. Abstracts of the XIIth European Congress of Rheumatology.  Hungarian Rheumatol. 1991;  32 ((Suppl)) S10
• 30 Yazici H, Tüzün Y, Pazarli H. et al . Influence of age of onset and patient's sex on the prevalence and severity of manifestations of Behcets syndrome.  Ann Rheum Dis. 1984;  43 783-789
• 31 Chamberlain MA, Noble BA. the Behçet's U.K. Study Group. Disease Activity in Behçet's disease. In O'Duffy JD, Kokmen E, Hrsg. Behcets Disease, Basic and Clinical Aspects. Marcel Dekker Inc, New York 1991: 299-302
• 32 Bhakta BB, Brennan P, James TE. et al . Behçet's disease: evaluationof a new instrument to measure clinical activity.  Rheumatology. 1999;  38 728-733
• 33 Dejaco C, Duftner C, Calamia KT. et al . Meeting report: 13^th International Conference on Behçet's disease.  J Rheumatol. 2009;  36 1312-1317
• 34 Hamza M, Ouertani A. Proposed evaluation of uveitis in Behçet's disease. In: Wechsler B, Godeau P, Hrsg. Excerpta Medica International Congress Series No. 1037. Amsterdam, Elsevier Science. 1993: 587-590
• 35 James T, Bhakta B, Hamuryudan V. et al .The Behçet's oculopathy index: A new measure of ophthalmic involvement in Behçet's disease. In: Wechsler B, Godeau P, Hrsg. Excerpta Medica International Congress Series No. 1037. Amsterdam, Elsevier Science 1993: 591-593
• 36 Chams H, Shahram F, Davatchi F. et al .Proposed ocular therapeutic scoring and activity/chronicity ratio. In Hamza M Behçet's disease. Tunis 1996: 234-237
• 37 Bang D, Kim HS, Lee ES. The significance of laboratory tests in evaluating the clinical activity of Behçet's disease.  Proceedings of the 9^th International Conference on Behçet's disease. Seoul 2000: 125-128
• 38 Muftuoglu AU, Yazici H, Yurdakul S. et al .Behçet' disease. Relation of serum C-reactive protein and erythrocyte sedimentation rates to disease activity.  Int J Dermatol. 1986 25: 235-239
• 39 Katsantonis J, Adler Y, Orfanos CE. et al . Adamantiades-Behçet's disease: serum IL-8 is a more reliable marker for disease activity than C-reactive protein and erythrocyte sedimentation rate.  Dermatology. 2000;  201 37-39
• 40 Nölle B, Specks U, Ludemann J. et al . Anticytoplasmic autoantibodies: their immunodiagnostic values in Wegener's granulomatosis.  Ann Intern Med. 1989;  111 28-40
• 41 Hellmich B, Flossmann O, Gross WL. et al . EULAR recommendations for conducting clinical studies and/ or clinical trials in systemic vasculitis: focus on anti-neutrophil cytoplasmatic antibody-associated vasculitis.  Ann Rheum Dis. 2007;  66 605-617
• 42 Exley AR, Bacon PA, Luqmani RA. et al . Development and initial validation of the Vasculitis Damage Index for the standardized clinical assessment of damage in the systemic vasculitides.  Arthritis Rheum. 1997;  40 371-380
• 43 Sanders JS, Huitma MG, Kallenberg CG. et al . Prediction of relapses in PR3-ANCA-associated vasculitis by assessing responses of ANCA titres to treatment.  Rheumatology. 2006;  45 724-729
• 44 Finkielman JD, Merkel PA, Schroeder D. et al . Antiproteinase 3 antineutrophil cytoplasmic antibodies and disease activity in Wegener granulomatosis.  Ann Intern Med. 2007;  147 611-619
• 45 Abril A, Calamia KT, Cohen MD. The Churg Strauss syndrome (allergic granulomatous angiitis): review and update.  Semin Arthritis Rheum. 2003;  33 106-114
• 46 Keogh KA, Specks U. Churg-Strauss syndrome.  Semin Respir Crit Care Med. 2006;  27 148-157

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