Therapie mit Glukokortikoiden bei Polymyalgia rheumatica und Riesenzellarteriitis

Zusammenfassung

Glukokortikoide (GC) sind die unabdingbare Basis der Therapie der Polymyalgia rheuma­tica (PMR) und Riesenzellarteriitis (RZA). Durch ihren schnellen Wirkeintritt und die effektive Unterdrückung der Entzündung sind sie in der Therapie dieser beiden Erkrankungen unverzichtbar. Verschiedene Untersuchungen haben gezeigt, dass initiale Dosen von 15–25 mg Prednisonäquivalent/d bei der überwiegenden Zahl der Patienten mit PMR ausreicht um die Erkrankung zu kontrollieren. Bei der RZA wird dagegen eine initiale Dosis von 1 mg/kg Körpergewicht Prednisonäquivalent empfohlen. Weniger Evidenz gibt es dagegen für die richtige Form der Dosisreduktion der GC-Therapie. Dabei muss ein Dosierungsschema gewählt werden, welches eine andauernde ausreichende Kontrolle der Entzündung gewährleistet, gleichzeitig aber auch Nebenwirkungen vermeidet. Diese treten bei ca. 80% der Patienten mit RZA und 65% der Patienten mit PMR auf und die häufigsten davon sind Katarakt, osteoporotische Frakturen und arterielle Hypertension. Die Gesamtdauer der GC-Therapie muss bei der PMR 1–1,5 Jahre und bei der RZA noch länger, manchmal auch lebenslang sein.

Abstract

Glucocorticoids (GC) are an essential basis of the treatment for polymyalgia rheumatica (PMR) and giant-cell arteriitis (GCA). Due to their fast and effective suppression of inflammation, they are indispensable for this indication. Various investigations have shown that initial doses of 15–25 mg prednisone equivalent per day are sufficient to control disease in the majority of patients with PMR. In GCA, however, doses of 1 mg/kg body weight prednisone equivalent are advised. Less evidence exists for the best method of dose reduction. For this, a schedule has to be chosen which guarantees sufficient control of inflammation but at the same time prevents side effects of GC treatment. These are found in about 80% of patients with RZA and 65% of patients with PMR. The most frequent ones are cataract, osteoporotic fractures and arterial hypertension. The overall duration of therapy has to be 1–1.5 years for PMR and longer time periods for RZA, sometimes even life-long.

SchlüsselwÖrter

Glukokortikoide - Polymyalgia rheumatica - Riesenzellarteriitis

Key words

glucocorticoids - polymyalgia rheumatica - giant-cell arteriitis

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