Riesenzellarteriitis

Zusammenfassung

Die Riesenzellarteriitis (RZA) ist die häufigste primäre Vaskulitis und geht mit potenziell bilateraler Erblindungsgefahr einher. Weder klinisch noch laborchemisch gibt es einen einfachen und eindeutigen Beweis für diese Erkrankung, die i. d. R. eine schnelle und sichere Diagnose und Therapie erfordert. Bei folgenden Augensymptomen sollte der Augenarzt an eine RZA denken: Sehverschlechterung oder Gesichtsfeldausfälle, vorübergehende Sehstörungen (Amaurosis fugax), Doppelbilder, Augenschmerzen sowie neu aufgetretene Kopf- oder Kauschmerzen. Es sollte umgehend eine augenärztliche Untersuchung mit Spaltlampe, Ophthalmoskopie und Gesichtsfeld sowie eine Farbduplexsonografie der A. temporalis erfolgen. Bei hinreichendem klinischem Verdacht auf RZA sollte unverzüglich unter Kortisontherapie eine zeitnahe Vorstellung beim Rheumatologen/Internisten und ggf. eine Temporalarterienbiospie organisiert werden. Zahlreiche Entwicklungen der modernen Bildgebung mit Farb-Duplex-Sonografie, MRT und PET-CT können mit der klassischen, bewährten Biopsie einer Temporalarterie konkurrieren. Eine frühzeitige Bestimmung von BSG und CRP kann die RZA-Diagnose untermauern. Therapeutisch kann eine steroidersetzende bzw. steroidreduzierende Immunsuppression mit IL-6-Blockade oder Methotrexat erwogen werden. Diese Entwicklungen haben zu einer Überarbeitung sowohl der Klassifikationskriterien als auch der Diagnostik- und Therapieempfehlungen von American College of Rheumatologists und European League against Rheumatism geführt, die hier für die Augenheilkunde zusammengestellt sind.

Schlüsselwörter

Riesenzellarteriitis - AION - Duplexsonografie - EULAR - MRT

• References/Literatur

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