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Arthritis und Rheuma 2010; 30(04): 199-204
DOI: 10.1055/s-0037-1618022
Vaskulitiden
Schattauer GmbH

Riesenzellarteriitis/Arteriitis temporalis und Polymyalgia rheumatica

Giant cell arteritis (temporal arteritis) and polymyalgia rheumatica
W. A. Schmidt
1   Immanuel Krankenhaus Berlin, Berlin-Buch
› Author Affiliations
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Publication History

Publication Date:
26 December 2017 (online)

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Zusammenfassung

Zu den Vaskulitiden der großen Arterien zählen unter anderem die Arteriitis temporalis/Riesenzellarteriitis (RZA) und die RZA großer Gefäße mit Vaskulitis der proximalen Armarterien. Sie können mit einer Polymyalgia rheumatica (PMR) einhergehen, die jedoch auch isoliert vorkommen kann. Eine RZA sollte durch Temporalarterienbiopsie oder in erfahrenen Zentren mittels Sonografie oder MRT bestätigt werden. An die PMR sollte bei Patienten mit plötzlich aufgetretenen Schulterbeschwerden gedacht werden. Erhöhte BSG und CRP weisen dann auf die Diagnose hin. Bildgebend finden sich in der Regel entzündliche Veränderungen an Schulter- und Hüftgelenken. Glukokortikoide bilden weiterhin den Mittelpunkt der Behandlung. Begonnen wird bei einer RZA mit Augenkomplikationen mit 300–1000 mg Prednisolon täglich, ohne Komplikationen mit 40–70 mg täglich, bei einer PMR mit 15–25 mg täglich. Kontinuierlich sollte dann die Dosis gesenkt werden. Eine feste Erhaltungsdosis ist nicht sinnvoll. Methotrexat kann die Prednisolondosis um ca. 20 Prozent senken.

Summary

Giant cell arteritis (GCA)/temporal arteritis and large-vessel GCA (vasculitis of proximal arm arteries) are large-vessel vasculitides. Symptoms may include polymyalgia rheumatica (PMR). PMR may occur also without vasculitis. The diagnosis of GCA should include temporal artery biopsy, ultrasound or MRI. PMR should be considered in case of sudden onset of bilateral shoulder pain. Elevated CRP and ESR are clues for further diagnosis. Imaging shows inflammation at shoulders and hips. Glucocorticoids are still the mainstay of treatment. The prednisolone starting dose is 300–1000 mg per day intravenously in GCA with eye complications, 40–70 mg in GCA without complications and 15–25 mg in PMR. The dose should be reduced continuously always with the aim to reach lower doses or to finally taper glucocorticoids. Methotrexate may reduce the prednisolone dose by 20 %.

Schlüsselwörter

Polymyalgia rheumatica - Riesenzellarteriitis - MRT - Sonografie

Keywords

Polymyalgia rheumatica - giant cell arteritis - MRI - ultrasonography
 

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