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DOI: 10.1055/s-0029-1243165
© Georg Thieme Verlag KG Stuttgart · New York
Notfall Rheumatologie: Riesenzellarteriitis mit Sehstörungen, vertebrobasilärer oder anderweitiger akuter arterieller Insuffizienz
Emergencies in Rheumatology: Giant Cell Arteritis with Visual Symptoms, Vertebrobasilar Insufficiency or Other Ischaemic ComplicationsPublication History
Publication Date:
25 February 2010 (online)
![](https://www.thieme-connect.de/media/rheuma/201001/lookinside/thumbnails/10.1055-s-0029-1243165-1.jpg)
Zusammenfassung
Die Riesenzellarteriits (RZA) ist die häufigste systemische Vaskulitis im Erwachsenenalter, und betrifft die großen und mittelgroßen Arterien. Im Rahmen der RZA können rheumatologische Notfallsituationen auftreten, da es durch die Entzündung der Gefäßwand zu arteriellen Verschlüssen und/oder zur Aneurysmabildung kommen kann. Der häufigste Notfall bei der RZA ist die anteriore ischämische Optikusneuropathie, welche unbehandelt zur Erblindung führen kann. Gefürchtete Komplikationen sind aber auch die Dissektion eines Aortenaneurysmas, zerebrale Ischämien, Ischämien von Extremitäten oder viszeralen Organen sowie die Zungennekrose. Die diagnostische Abklärung mit Entnahme einer Biopsie der Temporalarterien sollte bei Verdacht auf das Vorliegen einer RZA zwar so schnell wie möglich erfolgen, andererseits darf die Einleitung einer Kortikosteroid Therapie durch eine noch ausstehende Biopsie keinesfalls verzögert werden. Die RZA zeichnet sich durch ein promptes Ansprechen auf Kortikosteroide aus. Die Rolle von Immunsuppressiva ist noch nicht vollständig geklärt, die meisten Daten liegen derzeit zu Methotrexat als kortikosteroidsparende Therapie vor.
Abstract
Giant cell arteritis (GCA) is the most common systemic vasculitis and affects large and medium-sized vessels. Emergencies can occur in the course of GCA because the disease may cause arterial stenosis and/or aneurysm formation. The most common complication of GCA is ischaemia of the optic nerve causing irreversible blindness. Besides, dissection of aortic aneurysm, cerebral ischaemia, ischaemia of limbs or organs as well as tongue necrosis may occur. Diagnosis of GCA including biopsy of the temporal artery should be performed as soon as possible; however, therapy should not be delayed due to a lacking biopsy result. Corticosteroids are the therapy of choice in the treatment of GCA, disease-modifying drugs, particularly methotrexate, may have a corticosteroid-sparing effect.
Schlüsselwörter
Vaskulitis - Arteritis temporalis - Notfall - Ischiämie
Key words
vasculitis - giant cell arteritis - emergencies - ischaemic complications
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Korrespondenzadresse
PD Dr. med. Annette D. Wagner
Hannover Medical School
Department of Nephrology
Carl Neuberg Straße 1
30625 Hannover
Email: Wagner.Annette@mh-hannover.de