„Gender Aspects“ bei Vaskulitiden und der Polymyalgia rheumatica

Zusammenfassung

Bislang gibt es nur wenige Untersuchungen zu geschlechtsspezifischen Aspekten bei Vaskulitiden. In ihrem Vorkommen zeigen die Riesenzellarteriitis (RZA) und die Polymyalgia rheumatica (PMR) eine eindeutige Präferenz des weiblichen Geschlechts. Inzidenz und Prävalenz der RZA und PMR sind bei Frauen ab dem 50. Lebensjahr ca. 3–5 fach höher als in der männlichen Vergleichspopulation. Unterschiede gibt es möglicherweise auch im Krankheitsverlauf der PMR. Frauen mit einer PMR haben eine längere Krankheitsdauer, häufiger Rezidive und benötigen eine höhere kumulative Prednisolon-Dosis als Männer. ANCA-assoziierte Vaskulitiden (AAV) kommen bei Männern und Frauen gleich häufig vor. Während sich das Gesamt-Outcome für Patienten mit AAV in den letzten Jahrzehnten deutlich verbessert hat mit vergleichbarer Mortalität bei jüngeren AAV-Patientinnen mit der Normalbevölkerung, besteht für Männer mit einer Wegenerschen Granulomatose nach wie vor eine Übersterblichkeit, die bei jüngeren Männern sogar das fast 9-fache im Vergleich zur Normalbevölkerung beträgt. Bei den sozioökonomischen Krankheitsfolgen gibt es deutliche Nachteile für jüngere Frauen mit einer Vaskulitis, sie haben ein fast 3-fach höheres Risiko für den Verlust des Arbeitsplatzes als Männer.

Abstract

Little data exist on gender differences in vasculitides. Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) have a marked predominance in women. The incidence and prevalence rates of the GCA and PMR are 3- to 5-fold higher in women aged 50 years and older compared to the older male population. The course of PMR is more severe in women. Women with PMR have longer disease duration vs. male patients. Women are treated with a higher cumulative dosage of prednisone and suffer more frequently from relapses, leading to a higher number of therapy-related side effects. In the epidemiology of ANCA-associated vasculitides no differences were found between men and women. Whereas the overall outcome of ANCA-associated vasculitides has improved dramatically, young males have a considerably higher standardised mortality rate (nearly 9-fold) compared with the general population (and young females). Considering also the effects of vasculitides on work disability, younger employed women with Wegener’s granulomatosis at diagnose had a nearly 3-fold higher risk of losing their jobs compared with men.

Schlüsselwörter

Vaskulitis - Riesenzellarteriitis - Polymyalgia rheumatica - ANCA-assoziierte Vaskulitiden - Outcome

Key words

vasculitis - giant cell arteritis - polymyalgia rheumatica - ANCA-associated vasculitis - outcome

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