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Polymyalgia rheumatica

Myalgisches Syndrom oder okkulte Vaskulitis?

Polymyalgia rheumatica: myalgic syndrome or occult vasculitis?

  • Schwerpunkt: Muskelschmerz aus internistischer Sicht
  • Published:
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Zusammenfassung

Die Polymyalgia rheumatica (PMR) ist eine entzündlich-rheumatische Erkrankung unbekannter Ätiologie. Typische Leitsymptome sind proximal betonte symmetrische Myalgien mit Betonung des Schulter- und Beckengürtels bei raschem Symptombeginn und Manifestation im fortgeschrittenen Lebensalter. In mehr als 20% der Fälle geht die PMR mit einer Riesenzell- bzw. Temporalarteriitis (RZA) einher. Moderne bildgebende Verfahren zeigen aber, dass weitaus häufiger eine subklinische RZA (z. B. in Form einer Aortitis) vorkommt. In der Regel besteht eine ausgeprägte Erhöhung der serologischen Akutphaseparameter wie der Blutsenkungsgeschwindigkeit oder des C-reaktiven Proteins. Synovitiden und Bursitiden der großen proximalen Gelenke können durch MRT oder Arthrosonographie abgebildet werden. Während die Diagnose einer Riesenzellarteriitis durch Biopsie der befallenen Temporalarterie gesichert werden kann, sind pathognomonische Leitbefunde oder spezifische Autoantikörper der PMR nicht bekannt. Charakteristisch ist das rasche Ansprechen auf eine Kortikosteroidtherapie, die in der Regel für mindestens 2 Jahre erforderlich ist. In vielen Fällen ist eine kortikoideinsparende Therapie, z. B. mit Methotrexat, sinnvoll.

Abstract

Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder of unknown etiology which typically presents with symmetric myalgias in the shoulder and pelvic girdles. Other clinical signs include the rapid onset of symptoms and the almost exclusive manifestation in the elderly population. In around 20% of cases, PMR is associated with giant cell arteritis (GCA). However, new imaging techniques suggest that the prevalence of subclinical GCA (e. g. aortitis) in PMR is probably higher. Acute phase reactants like erythrocyte sedimentation rate and c-reactive protein are usually elevated. Myalgias are accompanied by synovitis and bursitis of the large proximal joints and can be visualized by ultrasound or magnetic resonance imaging. While the diagnosis of GCA can be verified by temporal artery biopsy, pathognomonic findings for PMR like specific autoantibodies are lacking. Typical for PMR is the rapid response to corticosteroids. Usually the therapy needs to be continued for at least 2 years. Due to adverse events in many cases a corticosteroid saving therapy like methotrexate is needed.

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Danksagung.

Die Autoren danken Frau Dr. Konstanze Holl-Ullrich, Institut für Pathologie am Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Herrn Dr. Markus Both, Institut für Radiologie am Universitätsklinikum Schleswig-Holstein, Campus Kiel, sowie Herrn Prof. Dr. Baehre, Institut für Nuklearmedizin am Universitätsklinikum Schleswig-Holstein, Campus Lübeck, für die Überlassung von Bildmaterial.

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  1. Rheumaklinik Bad Bramstedt & Poliklinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    B. Hellmich & W. L. Gross

  2. Poliklinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck

    B. Hellmich

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  1. B. Hellmich
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  2. W. L. Gross
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Correspondence to B. Hellmich.

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Hellmich, B., Gross, W.L. Polymyalgia rheumatica. Internist 46, 1233–1244 (2005). https://doi.org/10.1007/s00108-005-1491-9

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