Morbus Horton (Arteriitis temporalis, Riesenzellarteriitis): Klinik, Diagnostik, Histologie, Therapie

Abstract

Giant cell arteritis can cause diagnostic difficulties due to its heterogeneous symptomatology. Characteristic ophthalmic and systemic symptoms of Horton's disease are discussed. The clinical course is described on the basis of typical patients, which shows that generic symptoms do not have to coexist. The Horton's arteritis potentially represents a systemic vasculitis that requires early diagnosis and treatment in order to avoid dramatic ophthalmic consequences, in worst cases blindness. The erythrocyte sedimentation rate (ESR) represents the most important laboratory parameter. Although temporal artery biopsy remains the only confirmatory procedure for a definite diagnosis, imaging procedures such as sonography, magnetic resonance imaging, ultrasound biomicroscopy are useful in supporting the clinical diagnosis. Highly dosed corticosteroid therapy should always be indicated when suspicious clinical symptoms are present, even without any dramatic laboratory parameter changes. Initial high dosages are indicated up to 1 gram daily depending on the severity of the disease. Subsequently a slow ESR titrated reduction of the dose is necessary under control of inflammation values, symptomatology and side effects. Occasionally a lifelong immunsuppressive therapy is indispensable. The long-term treatment should take place in close cooperation with the general practitioner, rheumatologist, neurologist and if necessary further specialists.

Ophthalmologische Notfälle – was ist wichtig?

“…Riesenzellarteriitis) mit einer möglichen Parästhesie und/oder Druckdolenz, Induration und Pulslosigkeit der Aa. temporales an der Schläfe, Kopfschmerzen, Kieferclaudicatio, unspezifische Nackenschmerzen, auch einhergehend mit erhöhten Entzündungsparametern und Sturzsenkung der BSG, auszuschließen [6].…”

“…Arterienastverschlüssen (AAV) (s. Fallbeispiel 3) kommt es zu einer atherosklerosebedingten Thrombosebildung durch Cholesterinemboli (sog. Hollenhorst-Plaque), kalzifizierte Emboli oder Fibrinthrombozytenemboli [6]. Seltener gehen Zentralarterien-bzw.…”