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Vaskulitiden der großen Gefäße

Large vessel vasculitis

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Zusammenfassung

Großgefäßvaskulitiden manifestieren sich an der Aorta und ihren Ästen erster und zweiter Ordnung durch umschriebene Entzündungen der Gefäßwand, in denen regelhaft Riesenzellen nachweisbar sind. In der Folge können Stenosen und Verschlüsse ebenso entstehen wie aneurysmatische Aufweitungen. Fortschritte in der bildgebenden Diagnostik (Farbduplex, MRT/MRA und PET) lassen die Diagnose bei der Takayasu-Arteriitis früher als bisher stellen und decken bei der Arteriitis temporalis (Riesenzellarteriitis, RZA) den Befall auch größerer Arterien auf. Zunehmend häufig wird bei jüngeren, überwiegend weiblichen Patienten mit RZA eine weitgehend extrakraniale Variante diagnostiziert, die vor allem die A. subclavia, teilweise auch die Aorta befällt. Letztere kann auch isoliert betroffen sein. Die Initialbehandlung erfolgt mit Steroiden, als weiteres Immunsuppressivum hat sich bei der RZA nur Methotrexat bewährt. Die Krankheitsaktivität wird anhand serologischer Entzündungsparameter, aber auch anhand der Gefäßmorphologie überwacht.

Abstract

Large vessel vasculitis is characterized by local inflammation of the vessel wall of the aorta and its first and second degree branches. Giant cells are found regularly. The process leads to stenoses and occlusions as well as to aneurysmatic dilatation. Recent progress in vascular imaging (colour Doppler ultrasound, MRI and PET) allows to detect Takayasu arteritis at an earlier stage and to reveal the involvement of larger arteries in temporal arteritis (giant cell arteritis, GCA). With increasing frequency, a subtype of predominantly female and less aged GCA patients without cranial symptoms is noticed in whom obstructions are prevailing in the proximal arm vessels or in the aorta. The latter may be affected exclusively. Initial therapy is based on corticosteroids. In GCA, methotrexate hitherto is the only other immunosuppressive drug that has proved to be helpful. Disease activity has to be controlled both by laboratory parameters and vascular imaging.

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Literatur

  1. Andrews J, Mason JC (2007) Takayasu’s arteritis – recent advances in imaging offer promise. J Rheumatol 46: 6–15

    Article  CAS  Google Scholar 

  2. Arend WP, Michel BA, Block DA et al. (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33: 1129–1134

    Article  PubMed  CAS  Google Scholar 

  3. Bird HA, Esselincks W, Dixon AS et al. (1979) An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 38: 434–439

    Article  PubMed  CAS  Google Scholar 

  4. Blockmans D, Bley T, Schmidt W (2009) Imaging for large-vessel vasculitis. Curr Opin Rheumatol 21: 19–28

    Article  PubMed  Google Scholar 

  5. Bongartz T, Matteson EL (2006) Large-vessel involvement in giant cell arteritis. Curr Opin Rheumatol 18: 10–17

    Article  PubMed  Google Scholar 

  6. Brack A, Martinez-Taboada V, Stanson A et al. (1999) Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum 42: 311–317

    Article  PubMed  CAS  Google Scholar 

  7. Dasgupta B, Salvarani C, Schirmer M et al. (2008) Developing classification criteria for polymyalgia rheumatica: comparison of views from an expert panel and wider survey. J Rheumatol 35: 270–277

    PubMed  Google Scholar 

  8. Evans JM, O’Fallon WM, Hunder GG (1995) Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis. A population-based study. Ann Intern Med 122: 502–50

    PubMed  CAS  Google Scholar 

  9. Hoffmann GS, Leavitt RY, Kerr GS et al. (1994) Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum 36: 568–582

    Google Scholar 

  10. Hoffman GS, Cid MC, Rendt-Zagar KE et al. (2007) Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial. Ann Intern Med 146: 621–630

    PubMed  Google Scholar 

  11. Hunder GG, Bloch DA, Michel BA et al. (1990) The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 33: 1122–1128

    PubMed  CAS  Google Scholar 

  12. Jennette JC, Falk RJ, Andrassy K et al. (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 36: 186–192

    Google Scholar 

  13. Kerr GS, Hallahan CW, Giordano J et al. (1994) Takayasu arteritis. Ann Intern Med 120: 919–929

    PubMed  CAS  Google Scholar 

  14. Mahr AD, Jover JA, Spiera RF et al. (2007) Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum 56: 2789–2797

    Article  PubMed  CAS  Google Scholar 

  15. Mazlumzadeh M, Hunder GG, Easley KA et al. (2006) Treatment of giant cell arteritis using induction therapy with high-dose glucocorticoids: a double-blind, placebo-controlled, randomized prospective clinical trial. Arthritis Rheum 54: 3310–3318

    Article  PubMed  CAS  Google Scholar 

  16. Molloy ES, Langford CA, Clark TM et al. (2008) Anti-tumour necrosis factor therapy in patients with refractory Takayasu arteritis: long-term follow-up. Ann Rheum Dis 67: 1567–1569

    Article  PubMed  CAS  Google Scholar 

  17. Moriwaki R, Noda M, Yajima M (1997) Clinical manifestations of Takayasu arteritis in India and Japan – new classification of angiographic findings. Angiology 48: 369–379

    PubMed  CAS  Google Scholar 

  18. Mukhtyar C, Guillevin L, Cid MC (2009) EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 68: 318–323

    Article  PubMed  CAS  Google Scholar 

  19. Myklebust G, Gran JT (1996) A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. Br J Rheumatol 35: 1161–1168

    Article  PubMed  CAS  Google Scholar 

  20. Pryshchep O, Ma-Krupa W, Younge BR et al. (2008) Vessel-specific Toll-like receptor profiles in human medium and large arteries. Circulation 118: 1276–1284

    Article  PubMed  CAS  Google Scholar 

  21. Rodríguez-Pla A, Rosselló-Urgell J, Bosch-Gil JA et al. (2007) Proposal to decrease the number of negative temporal artery biopsies. Scand J Rheumatol 36: 111–118

    Article  PubMed  Google Scholar 

  22. Salvarani C, Cantini F, Hunder GG (2008) Polymyalgia rheumatica and giant-cell arteritis. Lancet 372: 234–245

    Article  PubMed  Google Scholar 

  23. Schmidt WA, Kraft HE, Vorpahl K et al. (1997) Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 337: 1336–1342

    Article  PubMed  CAS  Google Scholar 

  24. Schmidt WA, Nerenheim A, Seipelt E et al. (2002) Diagnosis of early Takayasu arteritis by colour Doppler ultrasonography. Rheumatology 41: 496–502

    Article  PubMed  CAS  Google Scholar 

  25. Tatò F, Hoffmann U (2008) Giant cell arteritis: a systemic vascular disease. Vascular Med 13: 127–140

    Article  Google Scholar 

  26. Weyand CM, Goronzy JJ (2003) Mechanisms of disease: Medium- and large-vessel vasculitis. N Engl J Med 349: 160–169

    Article  PubMed  CAS  Google Scholar 

  27. Zehr KJ, Mathur A, Orszulak TA et al. (2005) Surgical treatment of ascending aortic aneurysms in patients with giant cell aortitis. Ann Thorac Surg 79: 1512–1517

    Article  PubMed  Google Scholar 

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  1. Angiologische Praxis Luisenstraße und Klinikum Oststadt-Heidehaus, Luisenstraße 10/11, 30159, Hannover, Deutschland

    L. Caspary

  2. Städtisches Klinikum Friedrichstadt, Dresden, Deutschland

    S. Schellong

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  1. L. Caspary
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  2. S. Schellong
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Correspondence to L. Caspary.

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Caspary, L., Schellong, S. Vaskulitiden der großen Gefäße. Internist 50, 958–963 (2009). https://doi.org/10.1007/s00108-009-2363-5

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