Empfehlungen der European League Against Rheumatism (EULAR) zur Behandlung von „Großgefäßvaskulitiden“

Wipfler-Freißmuth, E.; Moosig, Frank; Schirmer, Michael

doi:10.1007/s00393-008-0387-1

Cited by 5 publications

(3 citation statements)

References 12 publications

(12 reference statements)

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“…In den EULAR-Empfehlungen von 2009 wird eine initiale GK-Dosis von 1 mg/kg/d (maximal 60 mg/d) empfohlen, welche für einen Monat beibehalten und bis zum 3. Monat auf 10-15 mg/d reduziert werden soll [27,28]. Orientierend kann auch eine Reduktion um 10 % der täglichen Dosis alle 1-2 Wochen erfolgen [29].…”

Section: Empfehlungen Zurunclassified

Prophylaxe und Therapie der Glukokortikoid-induzierten Osteoporose

Oelzner

Wolf

2017

Akt Rheumatol

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ZusammenfassunGDie Glukokortikoid-induzierte Osteoporose (GK-OP) ist eine der häufigsten Formen der Osteoporose. Epidemiologischen Untersuchungen zufolge nehmen 0,5-0,9 % der Bevölkerung Glukokortikoide (GK) ein, bei den über 50-jährigen liegt diese Zahl bei ca. 3 %. Das Frakturrisiko ist unter chronischer GKTherapie auf das Doppelte erhöht und liegt auf Grund der bevorzugten Wirkung von GK auf den trabekulären Knochen für Wirbelkörperfrakturen noch höher. Pathogenetisch liegt der GK-OP eine Verminderung von Knochenmasse und -qualität zugrunde, welche aus suppressiven Effekten von GK auf die Zahl Übersichtsarbeit abstr ac t Glucocorticoid-induced osteoporosis (GC-OP) is one of the most frequent forms of osteoporosis. Based on epidemiological investigations, 0.5-0.9 % of the community population use oral glucocorticoids (GC); in persons aged 50 or more, the number of GC users is about 3 %. The fracture risk is increased twofold in patients with chronic GC treatment and is even higher for vertebral fractures because GCs predominantly affect trabecular bone. The pathogenetic origin of GC-OP is a loss of bone mass and quality resulting from the suppressive effects of GC on the number and function of osteoblasts and osteocytes and an increase in bone resorption. Systemic effects inducing sarcopenia with an increased risk of falls, hormonal changes and a negative calcium balance may further amplify the unfavourable effects of GCs on bone. Basic diagnostic evaluation for osteoporosis including osteodensitometry is indicated when GC treatment with a minimum daily dose of 2.5 mg/d prednisolone equivalent is planned for more than 3 months. The fracture risk is already increased in the first 3 months of GC treatment. Therefore an early intervention to prevent GC-induced loss of bone mass is necessary. The guidelines given by the umbrella organisation of the German osteology societies provide the foundation for prophylaxis and treatment of GC-OP based on the calculated fracture risk. General measures include the prevention of falls and improvement of muscle mass and coordination as well as a sufficient supply of calcium and vitamin D. The indication for specific drug treatment exceeding these basic measures depends on the individual fracture risk, which is determined by daily GC dose, duration of GC treatment, age, gender and other risk factors including the underlying disease that is treated with GC. For the implementation of the recommendations, particularly in the prophylactic approach, the calculation of the duration and dose of planned GC treatment is essential. In this context the guidelines for treatment of the different inflammatory rheumatic diseases provide crucial orientation. Treatment with GC doses of ≥ 7.5 mg/d prednisolone equivalent for more than 3 months requires specific drug treatment if T scores are < − 1.5 or if low-traumatic vertebral fractures or multiple peripheral fractures are present. GC doses between 2.5 und 7.5 mg/d require a lowering of the treatment threshold, which is determined by age, gende...

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Section: Empfehlungen Zurunclassified

Prophylaxe und Therapie der Glukokortikoid-induzierten Osteoporose

Oelzner

Wolf

2017

Akt Rheumatol

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“…Die medikamentöse Behandlung der Takayasu-Arteriitis sollte sich nach den 7 EULAR-("European League Against Rheumatism"-) Empfehlungen richten. Zur Glukokortikoid-Einsparung wird eine additive immunsuppressive Therapie angeraten, vorzugsweise mit Methotrexat [70]. Gefäßchir-urgische Bypass-Operationen sollten ebenso wie die minimal-invasive interventionelle Therapie vorzugsweise in einer Phase ohne Entzündungsaktivität durchgeführt werden [8,9].…”

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Imaging techniques in the evaluation of primary large vessel vasculitides

et al. 2009

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Imaging methods have become indispensable for the diagnosis and follow-up of giant cell arteritis and Takayasu's arterititis, in addition to physical examination and laboratory parameters. The choice of method is predominantly determined by clinical presentation and localization of the vascular territory to be examined. Furthermore, aspects of radiation protection, contrast media intolerance and other contraindications, as well as the varying costs of the different procedures need to be considered. This article reviews the clinical and morphological features of primary large vessel vasculitides which are fundamental to the identification of the disease and the assessment of inflammatory activity using imaging modalities. Angiography is the gold standard for the evaluation of stenotic lesions and can be combined with interventional treatment. Vessel wall thickening as a defining diagnostic criterion is outlined only by cross-sectional imaging. In addition to MR angiography, MRI techniques in particular enable vizualization of inflammatory processes in central as well as in peripheral arteries.

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“…TA predominantly affects young females during the second or third decades of life and mainly involves the aortic arch and its primary branches, ascending aorta, thoracic descending aorta and abdominal aorta [9,22]. In the initial stage of the disease, non-specific constitutional symptoms such as fever, malaise and weight loss may occur [23]. Later, inflammation of the involved arteries progresses, resulting in segmental stenosis, occlusion, dilatation and/or aneurysm [12].…”

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confidence: 99%

Principles of Diagnostics and Treatment of Patients with Takayasu Arteritis

FG¹,

As²,

FSh³

et al. 2017

AJCTS

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Urgency of problem: Many types of vasculitis syndromes are rare and intractable diseases with unknown etiology and pathogenesis; these vasculitis are relatively prevalent and difficult to treat, among such diseases Takayasu Arteritis (TA). Takayasu Arteritis is a nonspecific large vessel vasculitis characterized by granulomatous inflammation of the vessel wall, predominantly with the damage of aorta, aortic arch and its major branches [Toyoshima S, et al. 2008; Keser G, et al. 2014]. In the initial stage of the disease, non-specific constitutional symptoms such as fever, malaise and weight loss may occur. Later, inflammation of the involved arteries progresses, resulting in segmental stenosis, occlusion, dilatation and/ or aneurysm. TA can show different patterns of arterial involvement, disease expression and prognosis in different regions of the world [Brunner J, et al. 2010]. So, there are no universal clinical recommendations and protocols of the TA managing. The purpose of our work was to evaluate results of medical and surgical treatment of TA in Uzbekistan (Asia) and offer algorithms of diagnostics, clinical management and treatment of TA. There were analyzed 210 patients with TA, young female patients were predominant (male/female ratio = 1:7.3; middle age = 32.1 ± 1.3 years); brachio-cephal arteries damage (100%). Combined lesion (aortic arch + thoracic or abdominal or renal arteries) was in 58% of patients. The coronary, renal arteries and pulmonary arteries also be involved in some patients. Many studies use a combination of clinical symptoms sometimes linked to changes in acute-phase reactants. We believe, that Duplex Scan (DS) is very important for detection of stenosis/occlusion of arteries and useful for evaluation of inflammation intensity in the complex with biochemical inflammatory markers such as C-reactive protein, leucocytes-count, RBS sedimentation velocity. To reach the main purpose of the medical treatment of TA-conversion of the acute phase of TA to morphological remission, glucocorticoid treatment is necessary. The typical initial dose is approximately 20 to 30 mg/day prednisolone (PSL), though the dose should be adjusted according to the age and constitution of the patient. Our investigation shows that in acute and subacute phase of TA disease prolonged using of glucocorticoid in "small" doses (10-30 mg/day) is less effective. We have received good results from pulse-therapy. Scheme of medical treatment is 1000 mg of cyclophosphamide and 1000 mg PSL intravenous at the first day, then, at the second and third days-1000 mg PSL per day. After this treatment level of the CRP, RBC sedimentation decreased (p < 0.05) in contrast pretreatment level. After pulse-therapy we used methotrexate. Surgical treatments have been performed after full programme of medical treatment and normalization of inflammation markers and ultrasound signs. Conclusion: The most informative imaging methods of TA diagnostics are DS, RA and MSCT-angiography. On the base of the DS, MSCT-angiography and laboratory tests da...

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Empfehlungen der European League Against Rheumatism (EULAR) zur Behandlung von „Großgefäßvaskulitiden“

Cited by 5 publications

References 12 publications

Prophylaxe und Therapie der Glukokortikoid-induzierten Osteoporose

Prophylaxe und Therapie der Glukokortikoid-induzierten Osteoporose

Imaging techniques in the evaluation of primary large vessel vasculitides

Principles of Diagnostics and Treatment of Patients with Takayasu Arteritis

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