Download PDF
Aktuelle Rheumatologie 2014; 39(04): 252-255
DOI: 10.1055/s-0034-1383660
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Therapie mit Glukokortikoiden bei Polymyalgia rheumatica und Riesenzellarteriitis

Treatment with Glucocorticoids for Polymyalgia Rheumatica and Giant-Cell Arteriitis
C. Fiehn
1   ACURA-Kliniken, Rheumazentrum Baden-Baden, Baden-Baden
› Author Affiliations
Further Information

Publication History

Publication Date:
15 August 2014 (online)

Also available at
    Permissions and Reprints

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
 

  • Literatur

  • 1 Hernandez-Rodriguez J, Cid MC, Lopez-Soto A et al. Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med 2009; 169: 1839-1850
    CrossrefPubMedGoogle Scholar
  • 2 Fiehn C, Peter HH. Immunmodulation durch Medikamente. In: Peter HH, Pichler WJ, Müller-Ladner U. eds. Klinische Immunologie. München: Elsevier; 2012: 145-154
    Google Scholar
  • 3 Märker-Hermann E, Schmidt WA. [Polymyalgia rheumatica]. Dtsch Med Wochenschr 2009; 134: 135-142
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Dasgupta B, Borg FA, Hassan N et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford) 2010; 49: 186-190
    CrossrefPubMedGoogle Scholar
  • 5 Salvarani C, Cantini F, Boiardi L et al. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 2002; 347: 261-271
    CrossrefPubMedGoogle Scholar
  • 6 Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008; 372: 234-245
    CrossrefPubMedGoogle Scholar
  • 7 Kremers HM, Reinalda MS, Crowson CS et al. Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol 2005; 32: 65-73
    PubMedGoogle Scholar
  • 8 Mackie SL, Hensor EM, Haugeberg G et al. Can the prognosis of polymyalgia rheumatica be predicted at disease onset? Results from a 5-year prospective study. Rheumatology (Oxford) 2010; 49: 716-722
    CrossrefPubMedGoogle Scholar
  • 9 Gabriel SE, Sunku J, Salvarani C et al. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 1997; 40: 1873-1878
    CrossrefPubMedGoogle Scholar
  • 10 Delecoeuillerie G, Joly P, Cohen de LA et al. Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients). Ann Rheum Dis 1988; 47: 733-739
    CrossrefPubMedGoogle Scholar
  • 11 Kyle V, Hazleman BL. Treatment of polymyalgia rheumatica and giant cell arteritis. I. Steroid regimens in the first two months. Ann Rheum Dis 1989; 48: 658-661
    CrossrefPubMedGoogle Scholar
  • 12 Cimmino MA, Parodi M, Caporali R et al. Is the course of steroid-treated polymyalgia rheumatica more severe in women?. Ann N Y Acad Sci 2006; 1069: 315-321
    CrossrefPubMedGoogle Scholar
  • 13 Dasgupta B, Dolan AL, Panayi GS et al. An initially double-blind controlled 96 week trial of depot methylprednisolone against oral prednisolone in the treatment of polymyalgia rheumatica. Br J Rheumatol 1998; 37: 189-195
    CrossrefPubMedGoogle Scholar
  • 14 Hutchings A, Hollywood J, Lamping DL et al. Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica. Arthritis Rheum 2007; 57: 803-809
    CrossrefPubMedGoogle Scholar
  • 15 Behn AR, Perera T, Myles AB. Polymyalgia rheumatica and corticosteroids: how much for how long?. Ann Rheum Dis 1983; 42: 374-378
    CrossrefPubMedGoogle Scholar
  • 16 Duftner C, Dejaco C, Schirmer M. [Polymyalgia rheumatica]. Internist (Berl) 2009; 50: 51-57
    CrossrefPubMedGoogle Scholar
  • 17 Borchers AT, Gershwin ME. Giant cell arteritis: A review of classification, pathophysiology, geoepidemiology and treatment. Autoimmun Rev. 2012
    PubMedGoogle Scholar
  • 18 Mukhtyar C, Guillevin L, Cid MC et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2009; 68: 318-23
    CrossrefPubMedGoogle Scholar
  • 19 Hayreh SS, Zimmerman B. Visual deterioration in giant cell arteritis patients while on high doses of corticosteroid therapy. Ophthalmology 2003; 110: 1204-1215
    CrossrefPubMedGoogle Scholar
  • 20 Dasgupta B, Borg FA, Hassan N et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford) 2010; 49: 1594-1597
    CrossrefPubMedGoogle Scholar
  • 21 Liozon E, Herrmann F, Ly K et al. Risk factors for visual loss in giant cell (temporal) arteritis: a prospective study of 174 patients. Am J Med 2001; 111: 211-217
    CrossrefPubMedGoogle Scholar
  • 22 Cid MC, Font C, Oristrell J et al. Association between strong inflammatory response and low risk of developing visual loss and other cranial ischemic complications in giant cell (temporal) arteritis. Arthritis Rheum 1998; 41: 26-32
    CrossrefPubMedGoogle Scholar
  • 23 Hunder GG, Sheps SG, Allen GL et al. Daily and alternate-day corticosteroid regimens in treatment of giant cell arteritis: comparison in a prospective study. Ann Intern Med 1975; 82: 613-618
    CrossrefPubMedGoogle Scholar
  • 24 Martinez-Lado L, Calvino-Diaz C, Pineiro A et al. Relapses and recurrences in giant cell arteritis: a population-based study of patients with biopsy-proven disease from northwestern Spain. Medicine (Baltimore) 2011; 90: 186-193
    CrossrefPubMedGoogle Scholar
  • 25 Liu GT, Glaser JS, Schatz NJ et al. Visual morbidity in giant cell arteritis. Clinical characteristics and prognosis for vision. Ophthalmology 1994; 101: 1779-1785
    CrossrefPubMedGoogle Scholar
  • 26 Kupersmith MJ, Langer R, Mitnick H et al. Visual performance in giant cell arteritis (temporal arteritis) after 1 year of therapy. Br J Ophthalmol 1999; 83: 796-801
    CrossrefPubMedGoogle Scholar
  • 27 Danesh-Meyer H, Savino PJ, Gamble GG. Poor prognosis of visual outcome after visual loss from giant cell arteritis. Ophthalmology 2005; 112: 1098-1103
    CrossrefPubMedGoogle Scholar
  • 28 Chevalet P, Barrier JH, Pottier P et al. A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a one year followup study of 164 patients. J Rheumatol 2000; 27: 1484-1491
    PubMedGoogle Scholar
  • 29 Mazlumzadeh M, Hunder GG, Easley KA et al. Treatment of giant cell arteritis using induction therapy with high-dose glucocorticoids: a double-blind, placebo-controlled, randomized prospective clinical trial. Arthritis Rheum 2006; 54: 3310-3318
    CrossrefPubMedGoogle Scholar
  • 30 Lee MS, Smith SD, Galor A et al. Antiplatelet and anticoagulant therapy in patients with giant cell arteritis. Arthritis Rheum 2006; 54: 3306-3309
    CrossrefPubMedGoogle Scholar
  • 31 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
    CrossrefPubMedGoogle Scholar
  • 32 Proven A, Gabriel SE, Orces C et al. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 2003; 49: 703-708
    CrossrefPubMedGoogle Scholar
  • 33 Mazzantini M, Torre C, Miccoli M et al. Adverse Events During Longterm Low-dose Glucocorticoid Treatment of Polymyalgia Rheumatica: A Retrospective Study. J Rheumatol 2012;
    PubMedGoogle Scholar
  • 34 Maradit KH, Reinalda MS, Crowson CS et al. Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica. Arthritis Rheum 2007; 57: 279-286
    CrossrefPubMedGoogle Scholar