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DOI: 10.1055/a-2214-5030
Neue Ansätze in der immunologischen Therapie der Riesenzellarteriitis und Polymyalgia rheumatica
ZUSAMMENFASSUNG
Die Riesenzellarteriitis (RZA) ist eine Autoimmunerkrankung der großen und mittelgroßen Arterien. Sie ist die häufigste primäre systemische Vaskulitis in der westlichen Welt. Eine verzögerte Diagnose kann schwerwiegende Komplikationen wie permanenten Sehverlust zur Folge haben. Der vaskuläre Ultraschall hat sich als schnelle und zuverlässige Methode in der Diagnostik der RZA etabliert. Pathophysiologisch zeigt sich ein Zusammenspiel des angeborenen und adaptiven Immunsystems. Eine häufige Assoziation besteht mit der Polymyalgia rheumatica (PMR). Bei Verdacht auf RZA ist eine sofortige Glukokortikoid-Stoßtherapie, gefolgt von einem Tapering zumeist über 6 Monate, indiziert. Tocilizumab, ein Inhibitor des IL-6-Rezeptors, hat sich als therapeutischer Goldstandard zur Reduktion der kumulativen Steroid-Dosis und Rezidivrate der RZA etabliert. Bei der Behandlung der PMR werden primär Glukokortikoide eingesetzt, wobei ein Tapering über mindestens 1 Jahr empfohlen wird. Bei hohem Risiko für ein Rezidiv kann zusätzlich die Gabe von Methotrexat oder Tocilizumab in Betracht gezogen werden. Derzeit befinden sich zahlreiche Therapieansätze zur Behandlung von RZA und PMR in klinischen Studien.
Schlüsselwörter
Riesenzellarteriitis - Polymyalgia rheumatica - Glukokortikoide - Tocilizumab - Disease-modifying Antirheumatic DrugPublication History
Article published online:
16 April 2024
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Literatur
- 1 Buttgereit F, Dejaco C, Matteson EL. et al Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review. JAMA 2016; 315: 2442-2458
- 2 Hoffman GS. Giant Cell Arteritis. Ann Intern Med 2016; 165: ITC65-ITC80
- 3 Danesh-Meyer H, Savino PJ, Gamble GG. Poor prognosis of visual outcome after visual loss from giant cell arteritis. Ophthalmology 2005; 112: 1098-1103
- 4 Diamantopoulos AP, Haugeberg G, Lindland A. et al The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis?. Rheumatology (Oxford) 2016; 55: 66-70
- 5 Dejaco C, Ramiro S, Duftner C. et al EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018; 77: 636-643
- 6 Ponte C, Grayson PC, Robson JC. et al 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Ann Rheum Dis 2022; 81: 1647-1653
- 7 Schäfer VS, Chrysidis S, Schmidt WA. et al OMERACT definition and reliability assessment of chronic ultrasound lesions of the axillary artery in giant cell arteritis. Semin Arthritis Rheum 2021; 51: 951-956
- 8 Schäfer VS, Chrysidis S, Dejaco C. et al Assessing Vasculitis in Giant Cell Arteritis by Ultrasound: Results of OMERACT Patient-based Reliability Exercises. J Rheumatol 2018; 45: 1289-1295
- 9 Lundberg IE, Sharma A, Turesson C. et al An update on polymyalgia rheumatica. J Intern Med 2022; 292: 717-732
- 10 Burg LC, Karakostas P, Behning C. et al Prevalence and characteristics of giant cell arteritis in patients with newly diagnosed polymyalgia rheumatica – a prospective cohort study. Ther Adv Musculoskelet Dis 2023; 15: 1759720X221149963. doi:10.1177/1759720X221149963
- 11 Dasgupta B, Cimmino MA, Maradit-Kremers H. et al 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012; 71: 484-492
- 12 Schäfer VS, Brossart P, Warrington KJ. et al The role of autoimmunity and autoinflammation in giant cell arteritis: A systematic literature review. Autoimmun Rev 2023; 22: 103328
- 13 Corbera-Bellalta M, Planas-Rigol E, Lozano E. et al Blocking interferon γ reduces expression of chemokines CXCL9, CXCL10 and CXCL11 and decreases macrophage infiltration in ex vivo cultured arteries from patients with giant cell arteritis. Ann Rheum Dis 2016; 75: 1177-1186
- 14 Deng J, Younge BR, Olshen RA. et al Th17 and Th1 T-cell responses in giant cell arteritis. Circulation 2010; 121: 906-915
- 15 Terrier B, Geri G, Chaara W. et al Interleukin-21 modulates Th1 and Th17 responses in giant cell arteritis. Arthritis Rheum 2012; 64: 2001-2011
- 16 Hid Cadena R, Reitsema RD, Huitema MG. et al Decreased Expression of Negative Immune Checkpoint VISTA by CD4 + T Cells Facilitates T Helper 1, T Helper 17, and T Follicular Helper Lineage Differentiation in GCA. Front Immunol 2019; 10: 1638
- 17 Stone JH, Tuckwell K, Dimonaco S. et al Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med 2017; 377: 317-328
- 18 Miyabe C, Miyabe Y, Strle K. et al An expanded population of pathogenic regulatory T cells in giant cell arteritis is abrogated by IL-6 blockade therapy. Ann Rheum Dis 2017; 76: 898-905
- 19 Espígol-Frigolé G, Planas-Rigol E, Lozano E. et al Expression and Function of IL12/23 Related Cytokine Subunits (p35, p40, and p19) in Giant-Cell Arteritis Lesions: Contribution of p40 to Th1- and Th17-Mediated Inflammatory Pathways. Front Immunol 2018; 09: 809
- 20 Hysa E, Gotelli E, Sammorì S. et al Immune system activation in polymyalgia rheumatica: Which balance between autoinflammation and autoimmunity? A systematic review. Autoimmun Rev 2022; 21: 102995
- 21 Florescu MM, Bobircă F, Florescu A. et al Polymyalgia rheumatica: An update (Review). Exp Ther Med 2023: 26
- 22 Carvajal Alegria G, Boukhlal S, Cornec D. et al The pathophysiology of polymyalgia rheumatica, small pieces of a big puzzle. Autoimmun Rev 2020; 19: 102670
- 23 Samson M, Audia S, Fraszczak J. et al Th1 and Th17 lymphocytes expressing CD161 are implicated in giant cell arteritis and polymyalgia rheumatica pathogenesis. Arthritis Rheum 2012; 64: 3788-3798
- 24 Pulsatelli L, Boiardi L, Pignotti E. et al Serum interleukin-6 receptor in polymyalgia rheumatica: a potential marker of relapse/recurrence risk. Arthritis Rheum 2008; 59: 1147-1154
- 25 Weyand CM, Hicok KC, Hunder GG. et al Tissue cytokine patterns in patients with polymyalgia rheumatica and giant cell arteritis. Ann Intern Med 1994; 121: 484-491
- 26 Schirmer JH, Aries PM, Balzer K. et al S2k-Leitlinie Management der Großgefäßvaskulitiden. 2020 Im Internet https://register.awmf.org/de/leitlinien/detail/060-007; Stand: 09.03.2023
- 27 Salvarani C, Macchioni PL, Tartoni PL. et al Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy. Clin Exp Rheumatol 1987; 05: 205-215
- 28 Albrecht K, Huscher D, Buttgereit F. et al Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database. Rheumatol Int 2018; 38: 569-577
- 29 Buttgereit F, Da Silva JAP, Boers M. et al Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002; 61: 718-722
- 30 Villiger PM, Adler S, Kuchen S. et al Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. The Lancet 2016; 387: 1921-1927
- 31 Hoffman GS, Cid MC, Hellmann DB. et al A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum 2002; 46: 1309-1318
- 32 Jover JA, Hernández-García C, Morado IC. et al Combined treatment of giant-cell arteritis with methotrexate and prednisone. a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001; 134: 106-114
- 33 Spiera RF, Mitnick HJ, Kupersmith M. et al A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol 2001; 19: 495-501
- 34 Mahr AD, Jover JA, Spiera RF. et al Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum 2007; 56: 2789-2797
- 35 Silva M de, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study. Ann Rheum Dis 1986; 45: 136-138
- 36 Hočevar A, Ješe R, Rotar Ž. et al Does leflunomide have a role in giant cell arteritis? An open-label study. Clin Rheumatol 2019; 38: 291-296
- 37 Boysson H de, Boutemy J, Creveuil C. et al Is there a place for cyclophosphamide in the treatment of giant-cell arteritis? A case series and systematic review. Semin Arthritis Rheum 2013; 43: 105-112
- 38 Hoffman GS, Cid MC, Rendt-Zagar KE. et al Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial. Ann Intern Med 2007; 146: 621-630
- 39 Martínez-Taboada VM, Rodríguez-Valverde V, Carreño L. et al A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effects. Ann Rheum Dis 2008; 67: 625-630
- 40 Seror R, Baron G, Hachulla E. et al Adalimumab for steroid sparing in patients with giant-cell arteritis: results of a multicentre randomised controlled trial. Ann Rheum Dis 2014; 73: 2074-2081
- 41 Langford CA, Cuthbertson D, Ytterberg SR. et al A Randomized, Double-Blind Trial of Abatacept (CTLA-4Ig) for the Treatment of Takayasu Arteritis. Arthritis Rheumatol 2017; 69: 846-853
- 42 Christ L, Seitz L, Scholz G. et al Tocilizumab monotherapy after ultra-short glucocorticoid administration in giant cell arteritis: a single-arm, open-label, proof-of-concept study. The Lancet Rheumatology 2021; 03: e619-e626
- 43 Deshayes S, Ly K-H, Rieu V. et al Steroid-sparing effect of anakinra in giant-cell arteritis: a case series with clinical, biological and iconographic long-term assessments. Rheumatology (Oxford) 2021; 61: 400-406
- 44 Conway R, O’Neill L, Gallagher P. et al Ustekinumab for refractory giant cell arteritis: A prospective 52-week trial. Semin Arthritis Rheum 2018; 48: 523-528
- 45 Matza MA, Fernandes AD, Stone JH. et al Ustekinumab for the Treatment of Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2021; 73: 893-897
- 46 Venhoff N, Schmidt WA, Bergner R. et al Safety and efficacy of secukinumab in patients with giant cell arteritis (TitAIN): a randomised, double-blind, placebo-controlled, phase 2 trial. The Lancet Rheumatology 2023; 05: e341-e350
- 47 Cid MC, Unizony SH, Blockmans D. et al Efficacy and safety of mavrilimumab in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Ann Rheum Dis 2022; 81: 653-661
- 48 Kreis L, Dejaco C, Schmidt WA. et al The Meteoritics Trial: Efficacy of Methotrexate after Remission-Induction with Tocilizumab and Glucocorticoids in Giant Cell Arteritis: Study Protocol for a Randomized, Double-Blind, Placebo-Controlled, Parallel Group Phase II Study. 2023
- 49 Nesher G, Berkun Y, Mates M. et al Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum 2004; 50: 1332-1337
- 50 Lee MS, Smith SD, Galor A. et al Antiplatelet and anticoagulant therapy in patients with giant cell arteritis. Arthritis Rheum 2006; 54: 3306-3309
- 51 Mollan SP, Sharrack N, Burdon MA. et al Aspirin as adjunctive treatment for giant cell arteritis. Cochrane Database Syst Rev 2014: 2014
- 52 Dejaco C, Singh YP, Perel P. et al 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2015; 74: 1799-1807
- 53 Marsman DE, Bolhuis TE, den Broeder N. et al PolyMyalgia Rheumatica treatment with Methotrexate in Optimal Dose in an Early disease phase (PMR MODE): study protocol for a multicenter double-blind placebo controlled trial. Trials 2022; 23: 318
- 54 Ruediger C, Nguyen L, Black R. et al Efficacy of methotrexate in polymyalgia rheumatica in routine rheumatology clinical care. Intern Med J 2020; 50: 1067-1072
- 55 Caporali R, Cimmino MA, Ferraccioli G. et al Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2004; 141: 493-500
- 56 Spiera RF, Unizony S, Warrington KJ. et al Sarilumab for Relapse of Polymyalgia Rheumatica during Glucocorticoid Taper. N Engl J Med 2023; 389: 1263-1272
- 57 Antiochos B. Tocilizumab as a Novel Therapy for Steroid-Dependent Polymyalgia Rheumatica. JAMA 2022; 328: 1047-1048
- 58 Bonelli M, Radner H, Kerschbaumer A. et al Tocilizumab in patients with new onset polymyalgia rheumatica (PMR-SPARE): a phase 2/3 randomised controlled trial. Ann Rheum Dis 2022; 81: 838-844
- 59 Marsman DE, den Broeder N, van den Hoogen FHJ. et al Efficacy of rituximab in patients with polymyalgia rheumatica: a double-blind, randomised, placebo-controlled, proof-of-concept trial. The Lancet Rheumatology 2021; 03: e758-e766
- 60 Koster MJ, Crowson CS, Giblon RE. et al Baricitinib for relapsing giant cell arteritis: a prospective open-label 52-week pilot study. Ann Rheum Dis 2022; 81: 861-867
- 61 Schmidt WA, Dasgupta B, Luqmani R. et al A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate the Efficacy and Safety of Sirukumab in the Treatment of Giant Cell Arteritis. Rheumatol Ther 2020; 07: 793-810