Häufigkeit, Diagnose und Therapie von Rezidiven bei der Polymyalgia rheumatica

Zusammenfassung

Allgemein akzeptierte Kriterien zur Feststellung eines Rezidivs der Polymyalgia rheumatica (PMR) sind bisher nicht verfügbar. In klinischen Studien wurde meist ein „Aufflammen PMR typischer Symptome“ mit oder ohne Anstieg der Akut-Phase Parameter als Rezidiv definiert. Circa 50% der PMR Patienten erleiden im Verlauf der Erkrankung mindestens ein Rezidiv. Ein hohes Alter zum Zeitpunkt der Diagnose, weibliches Geschlecht, eine hohe Blutsenkungsgeschwindigkeit (BSG) zu Erkrankungsbeginn, gesteigerte Plasmaviskosität, erhöhte Serumwerte an solublem Interleukin (IL)-6 Rezeptor und anhaltend erhöhtes C-reaktives Protein wurden in Studien mit einem erhöhten Rezidivrisiko assoziiert. Die eingesetzte Glukokortikoid-Anfangsdosis und das nachfolgende Abstufungsprotokoll scheinen ebenso relevant zu sein. Generell wird bei einem PMR Rezidiv die Kortikosteroiddosis auf die zuletzt wirksame Dosis erhöht. Bei häufigen Schüben trotz langsamer Therapiereduktion kann den Empfehlungen der British Society of Rheumatology zufolge die zusätzliche Gabe von Methotrexat in Betracht gezogen werden.

Abstract

There are no generally accepted criteria for the classification of a relapse in polymyalgia rheumatica (PMR). In clinical studies, a relapse was defined as “recurrence of PMR characteristic symptoms” with or without increment of acute phase reactants. Around 50% of PMR patients suffer at least one relapse episode during their disease course. Advanced age, female sex, elevated erythrocyte sedimentation rate, increased plasma viscosity, high serum levels of soluble interleukin (IL)-6 receptor and persistently elevated C-reactive protein levels were associated with a higher relapse risk. The initial glucocorticoid dose as well as the subsequent tapering regimen also seem to play a role. A relapse of PMR is treated with an increment of corticosteroids to the pre-relapse dose. According to the British Society of Rheumatology guidelines, the addition of methotrexate may be considered in patients with frequent recurrences.

Schlüsselwörter

Polymyalgia rheumatica - Immunsuppressiva - TNF-α Blocker - Therapie

Key words

polymyalgia rheumatic - disease modifying ­antirheumatic drugs - TNF-α inhibitors - drug therapy

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