CC BY-NC-ND 4.0 · Dtsch Med Wochenschr 2019; 144(09): 587-594
DOI: 10.1055/a-0831-0812
Dossier
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Empfehlungen zur Diagnostik der Riesenzellarteriitis

Current Recommendations for Diagnostics in Giant Cell Arteritis
Thorsten Bley
,
Michael Zänker
,
Claudia Dechant
,
Nils Venhoff
Further Information

Publication History

Publication Date:
26 April 2019 (online)

Abstract

In Giant Cell Arteritis (GCA), a timely diagnosis is required to avoid severe complications such as blindness or structural vascular damage. The heterogeneous symptoms are mainly due to local and systemic inflammatory processes. Diagnostics are based on increased inflammation parameters in the laboratory, imaging, in which color-coded duplex sonography (FKDS), high-resolution magnetic resonance imaging (MRI), computer tomography (CT) or CT angiography (CTA) and 18F fluorodeoxyglucose-positron emission tomography with CT (FDG-PET-CT) have become established, as well as histopathological findings in temporal artery biopsy.

Um schwere komplikative Verläufe wie Erblindung oder strukturelle Gefäßschäden bei der Riesenzellarteriitis (RZA) zu vermeiden, bedarf es einer zeitnahen Diagnostik. Dabei haben sich die Überwachung der Entzündungsparameter im Labor und verschiedene bildgebende Verfahren sowie die histopathologische Beurteilung einer Schläfenarterienbiopsie etabliert. Auf Basis aktueller Empfehlungen werden die diagnostischen Verfahren im Folgenden diskutiert.

 
  • Literatur

  • 1 Mohammad AJ, Nilsson JA, Jacobsson LT. et al. Incidence and mortality rates of biopsy-proven giant cell arteritis in southern Sweden. Ann Rheum Dis 2015; 74: 993-997
  • 2 Ness T, Bley TA, Schmidt WA. et al. Diagnose und Therapie der Riesenzellarteriitis. Dtsch Ärzeblatt 2014; 111: 1-12
  • 3 Hoffman GS. Giant Cell Arteritis. Ann Intern Med 2016; 165: 65-80
  • 4 Hellmich B. Management der Polymyalgia rheumatica und der Großgefäßvaskulitiden. Internist 2016; 57: 1069-1078
  • 5 Kermani TA, Warrington KJ, Crowson CS. et al. Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis 2013; 72: 1989-1994
  • 6 Hernández-Rodríguez J, Murgia G, Villar I. et al. Description and Validation of Histological Patterns and Proposal of a Dynamic Model of Inflammatory Infiltration in Giant-cell Arteritis. Medicine (Baltimore) 2016; 95: e2368 . doi:10.1097/MD.0000000000002368
  • 7 Narváez J, Bernad B, Roig-Vilaseca D. et al. Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis. Semin Arthritis Rheum 2007; 37: 13-19
  • 8 Luqmani R, Lee E, Singh S. et al. The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 2016; 20: 1-238
  • 9 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: 636-664
  • 10 de Boysson H, Daumas A, Vautier M. et al. Large-vessel involvement and aortic dilation in giant-cell arteritis. A multicenter study of 549 patients. Autoimmun Rev 2018; 17: 391-398
  • 11 Schmidt WA, Kraft HE, Vorpahl K. et al. Color Duplex Ultrasonography in the Diagnosis of Temporal Arteritis. N Engl J Med 1997; 337: 1336-1342
  • 12 Chrysidis S, Duftner C, Dejaco C. et al. Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: a study from the OMERACT large Vessel Vasculitis Ultrasound Working group. RMD Open 2018; 4: e000598 . doi:10.1136/ rmdopen-2017-000598
  • 13 Arida A, Kyprianou M, Kanakis M. et al. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord 2010; 11: 44
  • 14 Karassa FB, Matsagas MI, Schmidt WA. et al. Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med 2005; 142: 359-369
  • 15 Schäfer VS, Juche A, Ramiro S. et al. Ultrasound cut-off values for intima-media thickness of temporal, facial and axillary arteries in giant cell arteritis. Rheumatoly (Oxford) 2017; 56: 479-1483
  • 16 Schmidt WA, Seifert A, Gromnica-Ihle E. et al. Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis. Rheumatology 2008; 47: 96-101
  • 17 Muratore F, Boiardi L, Restuccia G. et al. Comparison between colour duplex sonography findings and different histological patterns of temporal artery. Rheumatoly (Oxford) 2013; 52: 2268-2274
  • 18 Pérez López J, Solans Laqué R, Bosch Gil JA. et al. Colour-duplex ultrasonography of the temporal and ophthalmic arteries in the diagnosis and follow-up of giant cell arteritis. Clin Exp Rheumatol 2009; 27: 77-82
  • 19 De Miguel E, Roxo A, Castillo C. et al. The utility and sensitivity of colour Doppler ultrasound in monitoring changes in giant cell arteritis. Clin Exp Rheumatol 2012; 30 (70) S34-S38
  • 20 Schinkel AFL, van den Oord SCH, van der Steen AFW. et al. Utility of contrast-enhanced ultrasound for the assessment of the carotid artery wall in patients with Takayasu or giant cell arteritis. Eur Heart J Cardiovasc Imaging 2014; 15: 541-546
  • 21 Bley TA, Uhl M, Carew J. et al. Diagnostic value of high-resolution MR imaging in giant cell arteritis. AJNR Am J Neuroradiol 2007; 28: 1722-1727
  • 22 Klink T, Geiger J, Both M. et al. Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis-results from a multicenter trial. Radiology 2014; 273: 844-852
  • 23 Bley TA, Wieben O, Uhl M. et al. High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. Am J Roentgenol 2005; 84: 283-287
  • 24 Bley TA, Weiben O, Uhl M. et al. Assessment of the cranial involvement pattern of giant cell arteritis with 3T magnetic resonance imaging. Arthritis Rheum 2005; 52: 2470-2477
  • 25 Geiger J, Bley T, Uhl M. et al. Diagnostic value of T2-weighted imaging for the detection of superficial cranial artery inflammation in giant cell arteritis. J Magn Reson Imaging 2010; 31: 470-474
  • 26 Bley TA, Markl M, Schelp M. et al. Mural inflammatory hyperenhancement in MRI of giant cell (temporal) arteritis resolves under corticosteroid treatment. Rheumatology (Oxford) 2008; 47: 65-67
  • 27 Siemonsen S, Brekenfeld C, Holst B. et al. 3T MRI reveals extra- and intracranial involvement in giant cell arteritis. AJNR Am J Neuroradio 2015; 36: 91-97
  • 28 Salvarani C, Soriano A, Muratore F. et al. Is PET/CT essential in the diagnosis and follow-up of temporal arteritis?. Autoimmun Rev 2017; 16: 1125-1130
  • 29 Soussan M, Nicolas P, Schramm C. et al. Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis.. Medicine (Baltimore) 2015; 94: e622 . doi:10.1097/MD.0000000000000622
  • 30 Prieto-González S, Depetris M, García-Martínez A. et al. Positron emission tomography assessment of large vessel inflammation in patients with newly diagnosed, biopsy-proven giant cell arteritis: a prospective, case-control study. Ann Rheum Dis 2014; 73: 1388-1392