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Internistische und serologische Befunde der Riesenzellarteriitis

Clinical and serological findings of giant-cell arteritis

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Zusammenfassung

Die Riesenzellarteriitis (RZA) manifestiert sich häufig als kraniale Arteriitis (z. B. Temporalarteriitis) mit Kopf- und Kauschmerzen sowie Sehstörungen. Nicht selten besteht jedoch auch eine extrakranielle Beteiligung, sodass die RZA gehäuft zu Aortenaneurysmen, Aortendissektionen und zu Stenosen der großen thorakalen, abdominellen oder der Extremitätenarterien führen kann. Begleitet wird die vaskulitische Symptomatik von unspezifischen Allgemeinbeschwerden (Malaise, erhöhte Temperaturen, Gewichtsabnahme, Depressionen), die bei älteren Menschen (>50 Jahre) an eine RZA denken lassen müssen. Die Polymyalgia rheumatica (PMR) stellt die häufigste rheumatische Manifestation der RZA dar, kann aber auch unabhängig von ihr auftreten. Als strukturelles Korrelat der PMR-Beschwerden kommen in erster Linie extraartikuläre Entzündungen (Tenosynovitis, Bursitis) großer Gelenke und der Wirbelsäule (interspinale Bursitis) in Betracht. Bei hoher Entzündungsaktivität der PMR muss zusätzlich an vaskulitische Entzündungen großer Gefäße gedacht werden. Während spezifische Laborparameter für die RZA und die PMR fehlen, haben erhöhte BSG- und CRP-Werte bei der Erstdiagnose eine hohe Sensitivität dieser relativ häufigen, Kortison-sensitiven Erkrankung des älteren Menschen. Neben der Klinik stellt die serologische Akute-Phase-Reaktion den wesentlichen Verlaufsparameter unter der Therapie dar.

Abstract

Giant cell arteritis (GCA) frequently appears as cranial arteritis (eg. temporal arteritis) with headache, pain on chewing and visual disturbances. In addition, extracranial manifestations are often observed leading to aneurysmatic dilatations and dissections of the aorta as well as stenoses of large thoracic, abdominal or limb arteries. The vascular signs are accompanied by general disease symptoms, e.g. malaise, elevated temperatures, weight loss and depression. Polymyalgia rheumatica (PMR) is the most frequent rheumatic manifestation of GCA but also occurs independently from GCA. The structural correlate for the PMR symptoms is first and foremost extra-articular inflammation (tenosynovitis, bursitis) of large joints and the vertebral column (interspinal bursitis). In addition, vasculitis of large arteries in PMR must be considered particularly in the presence of high inflammatory activity. While specific laboratory markers for GCA and PMR are lacking elevated values for the erythrocyte sedimentation rate and C-reactive protein are present in almost all patients at disease onset. Besides the clinical evaluation, the serological acute phase reaction represents the main parameter for the course during therapy of this relatively frequent disease in elderly people.

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Abb. 1

Notes

  1. Bei Vorliegen von mindestens 3 Kriterien kann die Diagnose einer RZA gestellt werden. Die dargestellten Kriterien haben gegenüber anderen Vaskulitiden eine Sensitivität von 93,5% und eine Spezifität von 91,2%.

  2. Wahrscheinliche PMR: 3 Kriterien oder Koexistenz von einem Kriterium plus Temporalarteriitis.

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  1. Abteilung Rheumatologie und Klinische Immunologie, Medizinische Klinik, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland

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Vaith, P., Warnatz, K. Internistische und serologische Befunde der Riesenzellarteriitis. Z. Rheumatol. 68, 124–131 (2009). https://doi.org/10.1007/s00393-008-0377-3

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