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Arteriitis temporalis (Riesenzellarteriitis)

Klinik, Histologie und Therapie

Temporal arteritis (giant cell arteritis)

Clinical picture, histology, and treatment

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Zusammenfassung

Die Riesenzellarteriitis (Arteriitis temporalis) ist die häufigste Form einer systemischen Vaskulitis bei über 50-Jährigen. Eine Reihe von klassischen Symptomen, wie neuaufgetretene Kopfschmerzen, Kauschmerzen, Schulterschmerzen, Gewichtsverlust, Fieber und Anämie weisen auf eine Riesenzellarteriitis hin. Es gibt aber auch stille oder okkulte Formen mit nur geringen oder gar fehlenden Allgemeinsymptomen, insbesondere ohne Kopfschmerzen. Eine Reihe von Laborparametern wie erhöhte Blutsenkungsgeschwindigkeit, CRP, Fibrinogen, Thrombozyten sowie Anticardiolipinantikörper sprechen für das Vorliegen einer Riesenzellarteriitis. Beweisend ist keiner dieser Laborwerte. Der Goldstandard für die Diagnose der Riesenzellarteriitis ist der histologische Nachweis in der Biopsie der A. temporalis. Eine negative Biopsie ist aber kein Ausschluss, da es zwischen entzündeten Arterienabschnitten normale Abschnitte, sog. „skip lesions“, geben kann. Eine häufige und schwerwiegende Folge einer Riesenzellarteriitis ist die okuläre Beteiligung in Form einer AION oder eines retinalen Arterienverschlusses mit meistens irreversibler Erblindung oder starker Sehminderung an einem oder beiden Augen. Die Therapie besteht aus initial hochdosierten Kortikosteroiden, die langsam, meist über Jahre, unter Kontrolle der Entzündungsparameter (vor allem BSG und CRP) und der Symptomatik reduziert werden sollten.

Abstract

Giant cell arteritis (arteritis temporalis) is the most common form of systemic vasculitis in the elderly. A series of symptoms such as new-onset headache, jaw claudication, proximal myalgia, weight loss, and fever may lead to the diagnosis. However, there is also a silent or occult presentation with minor or no systemic symptoms, especially no headache. A number of laboratory values (erythrocyte sedimentation rate, CRP, fibrinogen, thrombocytes, and cardiolipin antibodies) indicate giant cell arteritis, but none of this proves the diagnosis. Temporal artery biopsy is the gold standard for diagnosis of giant cell arteritis. Due to skip lesions, a negative result does not exclude the diagnosis. The most important complication of giant cell arteritis is visual loss in one or both eyes due to AION or retinal artery occlusion. Usually, visual loss is irreversible even with therapy. Corticosteroids are the drug of choice to treat giant cell arteritis. Therapy is required for a long time, monitored by parameters of inflammation (ESR, CRP).

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  1. Universitäts-Augenklinik Freiburg, Killianstraße 5, 79106 , Freiburg

    T. Neß, C. Auw-Hädrich & D. Schmidt

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Neß, T., Auw-Hädrich, C. & Schmidt, D. Arteriitis temporalis (Riesenzellarteriitis). Ophthalmologe 103, 296–301 (2006). https://doi.org/10.1007/s00347-006-1324-9

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