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

Gernot Keyßer

doi:10.1055/a-0968-6782

Aktuelle Rheumatologie, Table of Contents

Aktuelle Rheumatologie 2019; 44(04): 245-252
DOI: 10.1055/a-0968-6782

Übersichtsarbeit

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

Giant Cell Arteritis: Current Insights on Epidemiology, Pathogenesis, Diagnostics and Treatment

Authors

Gernot Keyßer

¹Klinik und Poliklinik für Innere Medizin II, Department für Innere Medizin, Universitätsklinikum Halle (Saale), Halle (Saale)

Abstract

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

Full Text

References

Literatur
1 Jennette JC, Falk RJ, Bacon PA. et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis and rheumatism 2013; 65: 1-11 doi 10.1002/art.37715
2 Hunder GG, Bloch DA, Michel BA. et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis and rheumatism 1990; 33: 1122-1128
3 Dejaco C, Duftner C, Buttgereit F. et al. The spectrum of giant cell arteritis and polymyalgia rheumatica: Revisiting the concept of the disease. Rheumatology (Oxford) 2017; 56: 506-515 doi 10.1093/rheumatology/kew273
4 Borchers AT, Gershwin ME. Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmunity reviews 2012; 11: A544-A554 doi 10.1016/j.autrev.2012.01.003
5 Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis research & therapy 2009; 11: 229 doi 10.1186/ar2669
6 Brekke LK, Diamantopoulos AP, Fevang BT. et al. Incidence of giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis research & therapy 2017; 19: 278 doi 10.1186/s13075-017-1479-6
7 Berti A, Dejaco C. Update on the epidemiology, risk factors, and outcomes of systemic vasculitides. Best practice & research Clinical rheumatology 2018; 32: 271-294 doi 10.1016/j.berh.2018.09.001
8 Crowson CS, Matteson EL. Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015. Seminars in arthritis and rheumatism 2017; 47: 253-256 doi 10.1016/j.semarthrit.2017.04.001
9 Crowson CS, Matteson EL, Myasoedova E. et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis and rheumatism 2011; 63: 633-639 doi 10.1002/art.30155
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 Carmona FD, Vaglio A, Mackie SL. et al. A Genome-wide Association Study Identifies Risk Alleles in Plasminogen and P4HA2 Associated with Giant Cell Arteritis. American journal of human genetics 2017; 100: 64-74 doi 10.1016/j.ajhg.2016.11.013
12 Duhaut P, Bosshard S, Calvet A. et al. Giant cell arteritis, polymyalgia rheumatica, and viral hypotheses: a multicenter, prospective case-control study. Groupe de Recherche sur l'Arterite a Cellules Geantes. The Journal of rheumatology 1999; 26: 361-369
13 Cimmino MA, Grazi G, Balistreri M. et al. Increased prevalence of antibodies to adenovirus and respiratory syncytial virus in polymyalgia rheumatica. Clinical and experimental rheumatology 1993; 11: 309-313
14 Wagner AD, Gerard HC, Fresemann T. et al. Detection of Chlamydia pneumoniae in giant cell vasculitis and correlation with the topographic arrangement of tissue-infiltrating dendritic cells. Arthritis and rheumatism 2000; 43: 1543-1551 doi: 10.1002/1529-0131(200007)43:7<1543::AID-ANR19>3.0.CO;2-8
15 Bhatt AS, Manzo VE, Pedamallu CS. et al. In search of a candidate pathogen for giant cell arteritis: Sequencing-based characterization of the giant cell arteritis microbiome. Arthritis Rheumatol 2014; 66: 1939-1944 doi 10.1002/art.38631
16 England BR, Mikuls TR, Xie F. et al. Herpes Zoster as a Risk Factor for Incident Giant Cell Arteritis. Arthritis Rheumatol 2017; 69: 2351-2358 doi 10.1002/art.40236
17 Rhee RL, Grayson PC, Merkel PA. et al. Infections and the risk of incident giant cell arteritis: a population-based, case-control study. Annals of the rheumatic diseases 2017; 76: 1031-1035 doi 10.1136/annrheumdis-2016-210152
18 Zoller B, Li X, Sundquist J. et al. Occupational and socio-economic risk factors for giant cell arteritis: A nationwide study based on hospitalizations in Sweden. Scandinavian journal of rheumatology 2013; 42: 487-497 doi 10.3109/03009742.2013.793777
19 Ungprasert P, Upala S, Sanguankeo A. et al. Patients with giant cell arteritis have a lower prevalence of diabetes mellitus: A systematic review and meta-analysis. Modern rheumatology 2016; 26: 410-414 doi 10.3109/14397595.2015.1081722
20 Singh JA, Cleveland JD. The association of gout with incident giant cell arteritis in older adults. Joint, bone, spine : Revue du rhumatisme 2019; 86: 219-224 doi 10.1016/j.jbspin.2018.05.011
21 Duhaut P, Pinede L, Demolombe-Rague S. et al. Giant cell arteritis and polymyalgia rheumatica: Are pregnancies a protective factor? A prospective, multicentre case-control study. GRACG (Groupe de Recherche sur l'Arterite a Cellules Geantes). Rheumatology (Oxford) 1999; 38: 118-123
22 Weyand CM, Goronzy JJ. Immune mechanisms in medium and large-vessel vasculitis. Nature reviews Rheumatology 2013; 9: 731-740 doi 10.1038/nrrheum.2013.161
23 Ma-Krupa W, Kwan M, Goronzy JJ. et al. Toll-like receptors in giant cell arteritis. Clin Immunol 2005; 115: 38-46 doi 10.1016/j.clim.2005.02.009
24 Corbera-Bellalta M, Planas-Rigol E, Lozano E. et al. Blocking interferon gamma reduces expression of chemokines CXCL9, CXCL10 and CXCL11 and decreases macrophage infiltration in ex vivo cultured arteries from patients with giant cell arteritis. Annals of the rheumatic diseases 2016; 75: 1177-1186 doi 10.1136/annrheumdis-2015-208371
25 Wagner AD, Bjornsson J, Bartley GB. et al. Interferon-gamma-producing T cells in giant cell vasculitis represent a minority of tissue-infiltrating cells and are located distant from the site of pathology. The American journal of pathology 1996; 148: 1925-1933
26 Ninan J, Lester S, Hill C. Giant cell arteritis. Best practice & research Clinical rheumatology 2016; 30: 169-188 doi 10.1016/j.berh.2016.05.001
27 Dejaco C, Wagner AD. Ätiologie und Pathogenese der Polymyalgie rheumatica und Riesenzellarteritis. Aktuelle Rheumatologie 2014; 39: 256-260
28 Spath-Schwalbe E, Born J, Schrezenmeier H. et al. Interleukin-6 stimulates the hypothalamus-pituitary-adrenocortical axis in man. The Journal of clinical endocrinology and metabolism 1994; 79: 1212-1214 doi 10.1210/jcem.79.4.7962296
29 Pacheco MJ, Amado JA, Lopez-Hoyos M. et al. Hypothalamic-pituitary-adrenocortical axis function in patients with polymyalgia rheumatica and giant cell arteritis. Seminars in arthritis and rheumatism 2003; 32: 266-272 doi 10.1053/sarh.2003.49993
30 Patil P, Williams M, Maw WW. et al. Fast track pathway reduces sight loss in giant cell arteritis: Results of a longitudinal observational cohort study. Clinical and experimental rheumatology 2015; 33 S- 103-106
31 Keyßer G. Klinische Charakteristika und Laborbefunde von Polymyalgia rheumatica (PMR) und Riesenzellarteriitis (RZA). Aktuelle Rheumatologie 2014; 39: 223-226
32 Dejaco C, Brouwer E, Mason JC. et al. Giant cell arteritis and polymyalgia rheumatica: current challenges and opportunities. Nature reviews Rheumatology 2017; 13: 578-592 doi 10.1038/nrrheum.2017.142
33 Weyand CM, Goronzy JJ. Giant-cell arteritis and polymyalgia rheumatica. Annals of internal medicine 2003; 139: 505-515
34 Hall JK, Volpe NJ, Galetta SL. et al. The role of unilateral temporal artery biopsy. Ophthalmology 2003; 110: 543-548 discussion 548 doi 10.1016/S0161-6420(02)01758-X
35 Karahaliou M, Vaiopoulos G, Papaspyrou S. et al. Colour duplex sonography of temporal arteries before decision for biopsy: A prospective study in 55 patients with suspected giant cell arteritis. Arthritis research & therapy 2006; 8: R116 doi 10.1186/ar2003
36 Dejaco C, Ramiro S, Duftner C. et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Annals of the rheumatic diseases 2018; 77: 636-643 doi 10.1136/annrheumdis-2017-212649
37 Schmidt WA. Ultrasound in the diagnosis and management of giant cell arteritis. Rheumatology (Oxford) 2018; 57: ii22-ii31 doi 10.1093/rheumatology/kex461
38 Schmidt WA. Ultrasound in vasculitis. Clinical and experimental rheumatology 2014; 32: S71-S77
39 Prieto-Gonzalez S, Arguis P, Garcia-Martinez A. et al. Large vessel involvement in biopsy-proven giant cell arteritis: Prospective study in 40 newly diagnosed patients using CT angiography. Annals of the rheumatic diseases 2012; 71: 1170-1176 doi 10.1136/annrheumdis-2011-200865
40 Pelletier-Galarneau M, Ruddy TD. PET/CT for Diagnosis and Management of Large-Vessel Vasculitis. Current cardiology reports 2019; 21: 34 doi 10.1007/s11886-019-1122-z
41 Schmidt WA, Blockmans D. Investigations in systemic vasculitis - The role of imaging. Best practice & research. Clinical rheumatology 2018; 32: 63-82 doi 10.1016/j.berh.2018.08.009
42 Prieto-Gonzalez S, Garcia-Martinez A, Tavera-Bahillo I. et al. Effect of glucocorticoid treatment on computed tomography angiography detected large-vessel inflammation in giant-cell arteritis. A prospective, longitudinal study. Medicine 2015; 94: e486 doi 10.1097/MD.0000000000000486
43 Keyßer G, Lupatsch F. Histologische Sicherung der Arteriitis temporalis (AT) mittels Biopsie: Indikation, Durchführung, Interpretation. Aktuelle Rheumatologie 2014; 39: 267-269
44 Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008; 372: 234-245 doi 10.1016/S0140-6736(08)61077-6
45 Matteson EL, Buttgereit F, Dejaco C. et al. Glucocorticoids for Management of Polymyalgia Rheumatica and Giant Cell Arteritis. Rheumatic diseases clinics of North America 2016; 42: 75-90 viii. doi 10.1016/j.rdc.2015.08.009
46 Buttgereit F, Dejaco C, Matteson EL. et al. Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review. Jama 2016; 315: 2442-2458 doi 10.1001/jama.2016.5444
47 Pfeil A, Oelzner P, Hellmann P. The Treatment of Giant Cell Arteritis in Different Clinical Settings. Frontiers in immunology 2018; 9: 3129 doi 10.3389/fimmu.2018.03129
48 Mukhtyar C, Guillevin L, Cid MC. et al. EULAR recommendations for the management of large vessel vasculitis. Annals of the rheumatic diseases 2009; 68: 318-323 doi 10.1136/ard.2008.088351
49 Proven A, Gabriel SE, Orces C. et al. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis and rheumatism 2003; 49: 703-708 doi 10.1002/art.11388
50 Wilson JC, Sarsour K, Collinson N. et al. Serious adverse effects associated with glucocorticoid therapy in patients with giant cell arteritis (GCA): A nested case-control analysis. Seminars in arthritis and rheumatism 2017; 46: 819-827 doi 10.1016/j.semarthrit.2016.11.006
51 Restuccia G, Boiardi L, Cavazza A. et al. Long-term remission in biopsy proven giant cell arteritis: A retrospective cohort study. Journal of autoimmunity 2017; 77: 39-44 doi 10.1016/j.jaut.2016.10.002
52 Leon L, Rodriguez-Rodriguez L, Freites D. et al. Long-term continuation of methotrexate therapy in giant cell arteritis patients in clinical practice. Clinical and experimental rheumatology 2017; 35 (Suppl 103): 165-170
53 Leon L, Rodriguez-Rodriguez L, Morado I. et al. Treatment with methotrexate and risk of relapses in patients with giant cell arteritis in clinical practice. Clinical and experimental rheumatology 2018; 36 (Suppl 111): 121-128
54 Carbonella A, Berardi G, Petricca L. et al. Immunosuppressive Therapy (Methotrexate or Cyclophosphamide) in Combination with Corticosteroids in the Treatment of Giant Cell Arteritis: Comparison with Corticosteroids Alone. Journal of the American Geriatrics Society 2016; 64: 672-374 doi 10.1111/jgs.14004
55 Seitz M, Reichenbach S, Bonel HM. et al. Rapid induction of remission in large vessel vasculitis by IL-6 blockade. A case series. Swiss medical weekly 2011; 141: w13156 doi 10.4414/smw.2011.13156
56 Villiger PM, Adler S, Kuchen S. et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2016; 387: 1921-1927 doi 10.1016/S0140-6736(16)00560-2
57 Stone JH, Klearman M, Collinson N. Trial of Tocilizumab in Giant-Cell Arteritis. The New England journal of medicine 2017; 377: 1494-1495 doi 10.1056/NEJMc1711031
58 Tuckwell K, Collinson N, Dimonaco S. et al. Newly diagnosed vs. relapsing giant cell arteritis: Baseline data from the GiACTA trial. Seminars in arthritis and rheumatism 2017; 46: 657-664 doi 10.1016/j.semarthrit.2016.11.002
59 Calderon-Goercke M, Loricera J, Aldasoro V. et al. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Seminars in arthritis and rheumatism 2019;
60 Reichenbach S, Adler S, Bonel H. et al. Magnetic resonance angiography in giant cell arteritis: results of a randomized controlled trial of tocilizumab in giant cell arteritis. Rheumatology (Oxford) 2018; 57: 982-986 doi 10.1093/rheumatology/key015
61 Unizony S, Arias-Urdaneta L, Miloslavsky E. et al. Tocilizumab for the treatment of large-vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica. Arthritis care & research 2012; 64: 1720-1729 doi 10.1002/acr.21750
62 Turesson C, Borjesson O, Larsson K. et al. Swedish Society of Rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis. Scandinavian journal of rheumatology 2019; 1-7 doi 10.1080/03009742.2019.1571223
63 Mainbourg S, Addario A, Samson M. et al. Prevalence of giant cell arteritis relapse in patients treated with glucocorticoids: a meta-analysis. Arthritis care & research 2019;
64 Adler S, Reichenbach S, Gloor A. et al. Risk of relapse after discontinuation of tocilizumab therapy in giant cell arteritis. Rheumatology (Oxford). 2019.
65 Schäfer C. Komplikationen und Prognose der Polymyalgia rheumatica. Aktuelle Rheumatologie 2014; 39: 261-266
66 Soriano A, Muratore F, Pipitone N. et al. Visual loss and other cranial ischaemic complications in giant cell arteritis. Nature reviews Rheumatology 2017; 13: 476-484 doi 10.1038/nrrheum.2017.98
67 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 doi 10.1002/art.21075
68 Saleh M, Turesson C, Englund M. et al. Visual Complications in Patients with Biopsy-proven Giant Cell Arteritis: A Population-based Study. The Journal of rheumatology 2016; 43: 1559-1565 doi 10.3899/jrheum.151033
69 Gonzalez-Gay MA, Blanco R, Rodriguez-Valverde V. et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis: predictors and response to treatment. Arthritis and rheumatism 1998; 41: 1497-1504 doi: 10.1002/1529-0131(199808)41:8<1497::AID-ART22>3.0.CO;2-Z
70 Ungprasert P, Wijarnpreecha K, Koster MJ. et al. Cerebrovascular accident in patients with giant cell arteritis: A systematic review and meta-analysis of cohort studies. Seminars in arthritis and rheumatism 2016; 46: 361-366 doi 10.1016/j.semarthrit.2016.07.005
71 Mestre-Torres J, Simo-Perdigo M, Martinez-Valle F. et al. Risk of ischaemic events at giant cell arteritis diagnosis according to PET/CT findings. European journal of nuclear medicine and molecular imaging 2019; 46: 1626-1632 doi 10.1007/s00259-019-04339-y
72 Ungprasert P, Thongprayoon C, Kittanamongkolchai W. et al. Peripheral arterial disease in patients with giant cell arteritis: a meta-analysis. International journal of rheumatic diseases 2016; 19: 819-825 doi 10.1111/1756-185X.12631
73 Kermani TA, Diab S, Sreih AG. et al. Arterial lesions in giant cell arteritis: A longitudinal study. Seminars in arthritis and rheumatism 2019; 48: 707-713 doi 10.1016/j.semarthrit.2018.05.002
74 Lai LYH, Harris E, West RM. et al. Association between glucocorticoid therapy and incidence of diabetes mellitus in polymyalgia rheumatica and giant cell arteritis: a systematic review and meta-analysis. RMD open 2018; 4: e000521 doi 10.1136/rmdopen-2017-000521
75 Mohammad AJ, Englund M, Turesson C. et al. Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study. The Journal of rheumatology 2017; 44: 84-90 doi 10.3899/jrheum.160249
76 Mohammad AJ, Nilsson JA, Jacobsson LT. et al. Incidence and mortality rates of biopsy-proven giant cell arteritis in southern Sweden. Annals of the rheumatic diseases 2015; 74: 993-997 doi 10.1136/annrheumdis-2013-204652