Skip to main content

Advertisement

SpringerLink
Log in

Glukokortikoide in der Therapie der Riesenzellarteriitis

Wie viel und wie lange und womit einsparen?

Glucocorticoids in the treatment of giant cell arteritis

How much, how long and how to spare?

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Eine Therapie einer Riesenzellarteriitis (RZA) mit hoch dosierten Glukokortikoiden (GC) führt regelhaft zu einer Kontrolle der entzündlichen Aktivität, sodass hoch dosierte GC in den aktuellen Leitlinien weiterhin als Therapiestandard empfohlen werden. Allerdings kommt es nach Beendigung der GC-Therapie bzw. Reduktion der GC-Dosis bei bis zu 70 % der Patienten im weiteren Krankheitsverlauf zu Rezidiven, die eine Wiederaufnahme der Therapie bzw. eine Dosiserhöhung erforderlich machen. In der Konsequenz müssen daher viele Patienten über mehrere Jahre mit teils höher dosierten GC behandelt werden, was eine hohe kumulative GC-Exposition zur Folge hat. Das Risiko für GC-assoziierte Erkrankungen wie Diabetes, Glaukom, Osteoporose oder schwere Infektion ist daher für Patienten mit einer Riesenzellarteriitis deutlich erhöht. Für Patienten mit GC-assoziierten Komorbiditäten bzw. erhöhtem Risiko, diese zu entwickeln, oder Patienten mit einem Rezidiv empfehlen aktuelle Leitlinien daher eine GC-sparende Therapie mit Tocilizumab oder alternativ Methotrexat. Unklar ist derzeit, über welchen Zeitraum Patienten mit einer RZA mit GC und auch GC-sparenden Therapien behandelt werden sollten, da hochwertige Studiendaten zu Deeskalationsstrategien für die RZA derzeit noch fehlen. Entscheidungen zu Therapiedauer und -intensität müssen daher patientenindividuell unter Abwägung von allgemeinen und patientenspezifischen Risikofaktoren für einen GC-abhängigen Verlauf, RZA-assoziierten Gefäßschäden (Stenosen, Aneurysmen, Visusverlust) und therapieassoziierten Komplikationen getroffen werden.

Abstract

Treatment of giant cell arteritis (GCA) with high-dose glucocorticoids (GC) regularly leads to a control of the inflammatory activity, so that high-dose GC is still the recommended standard treatment in the current guidelines; however, after discontinuation of GC treatment or reduction of the GC dosage, relapses occur in up to 70% of patients in the further course of the disease, making it necessary to resume treatment or increase the dosage. As a consequence many patients therefore have to be treated with GC often in high doses over several years, which results in a high cumulative exposure to GC. The risk for GC-associated diseases, such as diabetes, glaucoma, osteoporosis or severe infections is therefore significantly increased for patients with giant cell arteritis. For patients with GC-associated comorbidities or increased risk of developing them or patients with a relapse, the current guidelines therefore recommend GC-sparing treatment with tocilizumab or alternatively methotrexate. It is currently unclear over what period of time patients should be treated with GC and GC-sparing treatment, since high-quality study data on de-escalation strategies for GCA are currently still lacking. Decisions on treatment duration and intensity must therefore be made individually for each patient, taking into account general and patient-specific risk factors for a GC-dependent course, GCA-associated vascular damage (stenoses, aneurysms, visual loss) and treatment-associated complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Adler S, Reichenbach S, Gloor A et al (2019) Risk of relapse after discontinuation of tocilizumab therapy in giant cell arteritis. Rheumatology (Oxford) 58:1639–1643

    Article  CAS  Google Scholar 

  2. Agueda AF, Monti S, Luqmani RA et al (2019) Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis. RMD Open 5:e1020

    Article  PubMed  PubMed Central  Google Scholar 

  3. Alba MA, Garcia-Martinez A, Prieto-Gonzalez S et al (2014) Relapses in patients with giant cell arteritis: prevalence, characteristics, and associated clinical findings in a longitudinally followed cohort of 106 patients. Medicine 93:194–201

    Article  PubMed  PubMed Central  Google Scholar 

  4. Alsolaimani RS, Bhavsar SV, Khalidi NA et al (2016) Severe intracranial involvement in giant cell arteritis: 5 cases and literature review. J Rheumatol 43:648–656

    Article  PubMed  Google Scholar 

  5. Banerjee S, Quinn KA, Gribbons KB et al (2020) Effect of treatment on imaging, clinical, and serologic assessments of disease activity in large-vessel vasculitis. J Rheumatol 47:99–107

    Article  CAS  PubMed  Google Scholar 

  6. Berger CT, Daikeler T (2020) Longitudinal versus cross-sectional IL‑6 measurements in tocilizumab-treated GCA response to: ‘Analysis of IL‑6 measurement in GCA patients treated with tocilizumab should consider concomitant treatment with prednisone’ by Samson and Bonnotte. Ann Rheum Dis 79(8):e103. https://doi.org/10.1136/annrheumdis-2019-215729

    Article  PubMed  Google Scholar 

  7. Breuer GS, Poltorak V, Nesher G (2020) Survival of patients with giant cell arteritis: a controversial issue. Clin Exp Rheumatol 38(124):210–213

    PubMed  Google Scholar 

  8. Broder MS, Sarsour K, Chang E et al (2016) Corticosteroid-related adverse events in patients with giant cell arteritis: a claims-based analysis. Semin Arthritis Rheum 46:246–252

    Article  PubMed  Google Scholar 

  9. Buttgereit F, Da Silva JA, Boers M et al (2002) Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 61:718–722

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Camellino D, Matteson EL, Buttgereit F et al (2020) Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica. Nat Rev Rheumatol 16:481–495

    Article  CAS  PubMed  Google Scholar 

  11. Chandran A, Udayakumar PD, Kermani TA et al (2015) Glucocorticoid usage in giant cell arteritis over six decades (1950 to 2009). Clin Exp Rheumatol 33:S-98–102

    Google Scholar 

  12. Chevalet P, Barrier JH, Pottier P et al (2000) A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a one year followup study of 164 patients. J Rheumatol 27:1484–1491

    CAS  PubMed  Google Scholar 

  13. Christ L, Seitz L, Buetikofer L et al (2020) A proof of concept study to assess the efficacy of tocilizumab in combination with ultra-short glucocorticoid administration to treat newly diagnosed giant cell arteritis—a 24 week analysis. https://acrabstracts.org/abstract/a-proof-of-concept-study-to-assess-the-efficacy-of-tocilizumab-in-combination-with-ultra-short-glucocorticoid-administration-to-treat-newly-diagnosed-giant-cell-arteritis-a-24-week-analysis/. Zugegriffen: 10. Nov. 2020

  14. de Boysson H, Daumas A, Vautier M et al (2018) Large-vessel involvement and aortic dilation in giant-cell arteritis. A multicenter study of 549 patients. Autoimmun Rev 17:391–398

    Article  PubMed  Google Scholar 

  15. de Boysson H, Liozon E, Espitia O et al (2019) Different patterns and specific outcomes of large-vessel involvements in giant cell arteritis. J Autoimmun 103:102283

    Article  PubMed  Google Scholar 

  16. Delecoeuillerie G, Joly P, Cohen De Lara A et al (1988) Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients). Ann Rheum Dis 47:733–739

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Dumont A, Parienti JJ, Delmas C et al (2020) Factors associated with relapse and dependence on glucocorticoids in giant cell arteritis. J Rheumatol 47:108–116

    Article  CAS  PubMed  Google Scholar 

  18. Gloor AD, Yerly D, Adler S et al (2018) Immuno-monitoring reveals an extended subclinical disease activity in tocilizumab-treated giant cell arteritis. Rheumatology (Oxford) 57:1795–1801

    Article  CAS  Google Scholar 

  19. Gonzalez-Gay MA, Blanco R, Rodriguez-Valverde V et al (1998) Permanent visual loss and cerebrovascular accidents in giant cell arteritis: predictors and response to treatment. Arthritis Rheum 41:1497–1504

    Article  CAS  PubMed  Google Scholar 

  20. Graham E, Holland A, Avery A et al (1981) Prognosis in giant-cell arteritis. Br Med J (Clin Res Ed) 282:269–271

    Article  CAS  Google Scholar 

  21. Grayson PC, Alehashemi S, Bagheri AA et al (2018) (18) F‑Fluorodeoxyglucose-positron emission tomography as an imaging biomarker in a prospective, longitudinal cohort of patients with large vessel vasculitis. Arthritis Rheumatol 70:439–449

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hachulla E, Boivin V, Pasturel-Michon U et al (2001) Prognostic factors and long-term evolution in a cohort of 133 patients with giant cell arteritis. Clin Exp Rheumatol 19:171–176

    CAS  PubMed  Google Scholar 

  23. Hayreh SS, Zimmerman B, Kardon RH (2002) Visual improvement with corticosteroid therapy in giant cell arteritis. Report of a large study and review of literature. Acta Ophthalmol Scand 80:355–367

    Article  PubMed  Google Scholar 

  24. Hellmich B (2020) So behandle ich: ANCA-assoziierte Vaskulitiden nach Erreichen einer Remission. Z Rheumatol 79:696–701

    Article  CAS  PubMed  Google Scholar 

  25. Hellmich B, Agueda A, Monti S et al (2020) 2018 update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 79:19–30

    Article  PubMed  Google Scholar 

  26. Hellmich B, Águeda AF, Monti S et al (2020) Treatment of giant cell arteritis and Takayasu arteritis-current and future. Curr Rheumatol Rep 22:84

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Herlyn K, Buckert F, Gross WL et al (2014) Doubled prevalence rates of ANCA-associated vasculitides and giant cell arteritis between 1994 and 2006 in northern Germany. Rheumatology 53:882–889

    Article  PubMed  Google Scholar 

  28. Hernandez-Rodriguez J, Garcia-Martinez A, Casademont J et al (2002) A strong initial systemic inflammatory response is associated with higher corticosteroid requirements and longer duration of therapy in patients with giant-cell arteritis. Arthritis Rheum 47:29–35

    Article  CAS  PubMed  Google Scholar 

  29. Hoffman GS, Cid MC, Hellmann DB et al (2002) A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum 46:1309–1318

    Article  CAS  PubMed  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. Holle JU, Moosig F (2020) Therapie der Riesenzellarteriitis. Was ist in der Pipeline? Z Rheumatol 79:516–522

    Article  CAS  PubMed  Google Scholar 

  32. Jamilloux Y, Liozon E, Pugnet G et al (2013) Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study. PLoS One 8:e68713

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Jover JA, Hernandez-Garcia C, Morado IC et al (2001) Combined treatment of giant-cell arteritis with methotrexate and prednisone. a randomized, double-blind, placebo-controlled trial. Ann Intern Med 134:106–114

    Article  CAS  PubMed  Google Scholar 

  34. Karras A, Pagnoux C, Haubitz M et al (2017) Randomised controlled trial of prolonged treatment in the remission phase of ANCA-associated vasculitis. Ann Rheum Dis 76:1662–1668

    Article  CAS  PubMed  Google Scholar 

  35. Kermani TA, Warrington KJ, Crowson CS et al (2013) Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis 72:1989–1994

    Article  PubMed  Google Scholar 

  36. Kermani TA, Warrington KJ, Cuthbertson D et al (2015) Disease relapses among patients with giant cell arteritis: a prospective, longitudinal cohort study. J Rheumatol 42:1213–1217

    Article  PubMed  PubMed Central  Google Scholar 

  37. Koster MJ, Yeruva K, Crowson CS et al (2019) Efficacy of methotrexate in real-world management of giant cell arteritis: a case-control study. J Rheumatol 46:501–508

    Article  CAS  PubMed  Google Scholar 

  38. Kyle V, Hazleman BL (1989) Treatment of polymyalgia rheumatica and giant cell arteritis. I. Steroid regimens in the first two months. Ann Rheum Dis 48:658–661

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Labarca C, Koster MJ, Crowson CS et al (2016) Predictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study. Rheumatology 55:347–356

    Article  PubMed  Google Scholar 

  40. Langford CA, Cuthbertson D, Ytterberg SR et al (2017) A randomized, double-blind trial of abatacept (CTLA-4Ig) for the treatment of giant cell arteritis. Arthritis Rheumatol 69:837–845

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Les I, Pijoan JI, Rodriguez-Alvarez R et al (2015) Effectiveness and safety of medium-dose prednisone in giant cell arteritis: a retrospective cohort study of 103 patients. Clin Exp Rheumatol 33:S-90–97

    Google Scholar 

  42. Liozon E, Roblot P, Paire D et al (2000) Anticardiolipin antibody levels predict flares and relapses in patients with giant-cell (temporal) arteritis. A longitudinal study of 58 biopsy-proven cases. Rheumatology (Oxford) 39:1089–1094

    Article  CAS  Google Scholar 

  43. Mackie SL, Dasgupta B, Hordon L et al (2011) Ischaemic manifestations in giant cell arteritis are associated with area level socio-economic deprivation, but not cardiovascular risk factors. Rheumatology (Oxford) 50:2014–2022

    Article  Google Scholar 

  44. Mackie SL, Dejaco C, Appenzeller S et al (2020) British society for rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology (Oxford) 59:e1–e23

    Article  Google Scholar 

  45. 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  CAS  PubMed  Google Scholar 

  46. Martinez-Lado L, Calvino-Diaz C, Pineiro A et al (2011) Relapses and recurrences in giant cell arteritis: a population-based study of patients with biopsy-proven disease from northwestern Spain. Medicine 90:186–193

    Article  PubMed  Google Scholar 

  47. Martinez-Taboada VM, Rodriguez-Valverde V, Carreno L et al (2008) A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effects. Ann Rheum Dis 67:625–630

    Article  CAS  PubMed  Google Scholar 

  48. 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  CAS  PubMed  Google Scholar 

  49. Monti S, Agueda AF, Luqmani RA et al (2019) Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis: focus on giant cell arteritis. RMD Open 5:e1003

    Article  PubMed  PubMed Central  Google Scholar 

  50. Muratore F, Boiardi L, Restuccia G et al (2020) Relapses and long-term remission in large vessel giant cell arteritis in northern Italy: characteristics and predictors in a long-term follow-up study. Semin Arthritis Rheum 50:549–558

    Article  CAS  PubMed  Google Scholar 

  51. Muratore F, Crescentini F, Spaggiari L et al (2019) Aortic dilatation in patients with large vessel vasculitis: a longitudinal case control study using PET/CT. Semin Arthritis Rheum 48:1074–1082

    Article  PubMed  Google Scholar 

  52. Nesher G, Nesher R, Mates M et al (2008) Giant cell arteritis: intensity of the initial systemic inflammatory response and the course of the disease. Clin Exp Rheumatol 26:S30–34

    CAS  PubMed  Google Scholar 

  53. Prieto-Gonzalez S, Terrades-Garcia N, Corbera-Bellalta M et al (2017) Serum osteopontin: a biomarker of disease activity and predictor of relapsing course in patients with giant cell arteritis. Potential clinical usefulness in tocilizumab-treated patients. RMD Open 3:e570

    Article  PubMed  PubMed Central  Google Scholar 

  54. Proven A, Gabriel SE, Orces C et al (2003) Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 49:703–708

    Article  CAS  PubMed  Google Scholar 

  55. Restuccia G, Boiardi L, Cavazza A et al (2016) Flares in biopsy-proven giant cell arteritis in northern Italy: characteristics and predictors in a long-term follow-up study. Medicine 95:e3524

    Article  PubMed  PubMed Central  Google Scholar 

  56. Saito S, Okuyama A, Okada Y et al (2020) Tocilizumab monotherapy for large vessel vasculitis: results of 104-week treatment of a prospective, single-centre, open study. Baillieres Clin Rheumatol 59(7):1617–1621. https://doi.org/10.1093/rheumatology/kez511

    Article  CAS  Google Scholar 

  57. Salvarani C, Cimino L, Macchioni P et al (2005) Risk factors for visual loss in an Italian population-based cohort of patients with giant cell arteritis. Arthritis Rheum 53:293–297

    Article  PubMed  Google Scholar 

  58. Salvarani C, Della Bella C, Cimino L et al (2009) Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis. Rheumatology (Oxford) 48:250–253

    Article  CAS  Google Scholar 

  59. Samson M, Bonnotte B (2020) Analysis of IL‑6 measurement in patients with GCA treated with tocilizumab should consider concomitant treatment with prednisone. Ann Rheum Dis 79(8):e102. https://doi.org/10.1136/annrheumdis-2019-215697

    Article  PubMed  Google Scholar 

  60. Samson M, Jacquin A, Audia S et al (2015) Stroke associated with giant cell arteritis: a population-based study. J Neurol Neurosurg Psychiatry 86:216–221

    Article  PubMed  Google Scholar 

  61. Schirmer JH, Aries PM, Balzer K et al (2020) S2k Leitlinie: Management der Großgefäßvaskulitiden. Z Rheumatol 79:67–95

    Article  CAS  PubMed  Google Scholar 

  62. Schmidt J, Smail A, Roche B et al (2016) Incidence of severe infections and infection-related mortality during the course of giant cell arteritis: a multicenter, prospective, double-cohort study. Arthritis Rheumatol 68:1477–1482

    Article  CAS  PubMed  Google Scholar 

  63. Seror R, Baron G, Hachulla E et al (2014) Adalimumab for steroid sparing in patients with giant-cell arteritis: results of a multicentre randomised controlled trial. Ann Rheum Dis 73:2074–2081

    Article  CAS  PubMed  Google Scholar 

  64. Smeeth L, Cook C, Hall AJ (2006) Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990–2001. Ann Rheum Dis 65:1093–1098

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Spiera RF, Mitnick HJ, Kupersmith M et al (2001) A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol 19:495–501

    CAS  PubMed  Google Scholar 

  66. Stahn C, Buttgereit F (2008) Genomic and nongenomic effects of glucocorticoids. Nat Clin Pract Rheumatol 4:525–533

    Article  CAS  PubMed  Google Scholar 

  67. Stone J, Bao M, Han J et al (2019) Long-term outcome of tocilizumab for patients with giant cell arteritis: results from part 2 of a randomized controlled phase 3 trial. https://acrabstracts.org/abstract/long-term-outcome-of-tocilizumab-for-patients-with-giant-cell-arteritis-results-from-part-2-of-a-randomized-controlled-phase-3-trial/. Zugegriffen: 16. Febr. 2021

  68. Stone JH, Tuckwell K, Dimonaco S et al (2017) Trial of tocilizumab in giant-cell arteritis. N Engl J Med 377:317–328

    Article  CAS  PubMed  Google Scholar 

  69. Stone JH, Tuckwell K, Dimonaco S et al (2019) Glucocorticoid dosages and acute-phase reactant levels at giant cell arteritis flare in a randomized trial of tocilizumab. Arthritis Rheumatol 71:1329–1338

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Strehl C, Buttgereit F (2013) Optimized glucocorticoid therapy: teaching old drugs new tricks. Mol Cell Endocrinol 380:32–40

    Article  CAS  PubMed  Google Scholar 

  71. Turesson C, Borjesson O, Larsson K et al (2019) Swedish society of rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis. Scand J Rheumatol 48:259–265

    Article  CAS  PubMed  Google Scholar 

  72. Uddhammar A, Eriksson AL, Nystrom L et al (2002) Increased mortality due to cardiovascular disease in patients with giant cell arteritis in northern Sweden. J Rheumatol 29:737–742

    PubMed  Google Scholar 

  73. Villiger PM, Adler S, Kuchen S et al (2016) Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 387:1921–1927

    Article  CAS  PubMed  Google Scholar 

  74. Wilson JC, Sarsour K, Collinson N et al (2017) Incidence of outcomes potentially associated with corticosteroid therapy in patients with giant cell arteritis. Semin Arthritis Rheum 46:650–656

    Article  CAS  PubMed  Google Scholar 

  75. Wilson JC, Sarsour K, Collinson N et al (2017) Serious adverse effects associated with glucocorticoid therapy in patients with giant cell arteritis (GCA): a nested case-control analysis. Semin Arthritis Rheum 46:819–827

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken – Akademisches Lehrkrankenhaus der Universität Tübingen, Eugenstr. 3, 73230, Kirchheim unter Teck, Deutschland

    Bernhard Hellmich

Authors
  1. Bernhard Hellmich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernhard Hellmich.

Ethics declarations

Interessenkonflikt

B. Hellmich war federführend bzw. koordinativ an der Erstellung der EULAR-Recommendations 2018 und der DGRh-Leitlinie zum Management der Großgefäßvaskulitiden beteiligt und hat folgende Zuwendungen von der Industrie erhalten: Vortragshonorare: AbbVie, BMS, Celgene, Novartis, Orgentec, Pfizer, Roche, Sifor. Honorare für Beratungsleistungen: Boehringer, BMS, InflaRx, GSK, Roche.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

C. Fiehn, Baden-Baden

J. Holle, Neumünster

F. Moosig, Neumünster

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hellmich, B. Glukokortikoide in der Therapie der Riesenzellarteriitis. Z Rheumatol 80, 322–331 (2021). https://doi.org/10.1007/s00393-021-00975-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-021-00975-8

Schlüsselwörter

Keywords

Search

Navigation