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Riesenzellarteritis

Update: Diagnose und Therapie

Giant-cell arteritis

Update: diagnosis and therapy

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Zusammenfassung

Die Riesenzellarteritis (RZA) ist die häufigste Vaskulitis bei den über 50-Jährigen. Sehverlust ist die häufigste schwerwiegende Komplikation, eine Beteiligung der extrakraniellen Arterien inklusive der Aorta ist häufiger als bisher angenommen. Die Rolle der dendritischen und der T-Zellen lässt auf das Vorhandensein eines Antigens schließen, aber eindeutige Assoziationen mit zugrunde liegenden Infekten wurden bisher nicht nachgewiesen. Auch wenn die Entzündungsparameter im Blut bei der Diagnose der RZA meist erhöht sind, ist eine spezifische Labordiagnostik für die Diagnose der RZA derzeit nicht verfügbar. Unter den bildgebenden Verfahren kann der Ultraschall neben der Magnetresonanztomographie und der 18F-Fluorodeoxyglukose-Positronenemissionstomographie hilfreich sein, um Lokalisation und Ausmaß der Gefäßbeteiligung zu beurteilen. Glukokortikoide sind nach wie vor Standard in der Therapie der RZA, wobei möglicherweise die kumulative Dosis durch zusätzliches Methotrexat verringert wird. Zudem werden Azetylsalizylsäure als Prophylaxe gegen kardio- und zerebrovaskuläre Ereignisse und eine Prophylaxe bzw. Therapie einer begleitenden Osteoporose empfohlen.

Abstract

Giant-cell arteritis (GCA) is the most common form of vasculitis in patients over 50 years old. Loss of vision is the most common severe complication but involvement of extracranial arteries including the aorta is more frequent than previously assumed. The role of dendritic and T-cells indicates the presence of an antibody but a clear association with underlying infections has not yet been demonstrated. Even if the inflammation parameters in blood are mostly increased in the diagnosis of GCA, specific laboratory tests for the diagnosis of GCA are not available. Of the imaging procedures ultrasonography, magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography can be useful to localize and estimate the extent of vascular involvement. Glucocorticoids are still the standard therapy of GCA, whereby the cumulative dose can possibly be reduced by additional methotrexate. In addition acetylsalicylic acid is recommended as prophylaxis against cardiovascular and cerebrovascular events as well as prophylaxis and therapy of accompanying osteoporosis.

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Schirmer, M., Dejaco, C. & Schmidt, W. Riesenzellarteritis. Z. Rheumatol. 71, 754–759 (2012). https://doi.org/10.1007/s00393-012-0983-y

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