Holle J U
Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander Str. 26, 24576, Bad Bramstedt, Deutschland,
Internist (Berl). 2015 Jan;56(1):41-50; quiz 51-2. doi: 10.1007/s00108-014-3613-8.
The vasculitides represent one group of the systemic rheumatic diseases. Among the vasculitides we distinguish between large- (i.e. giant cell arteritis), medium- (i.e. polyarteritis nodosa) and small-vessel vasculitides (i.e. ANCA-associated vasculitides). Granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis belong to the ANCA-associated vasculitides. They share the features of vasculitic manifestations in small- to medium-sized vessel beds (which can occur in almost any organ system) and the presence of ANCA, the detection of which, however, is not necessarily mandatory. The treatment of AAV depends on disease stage and activity and is carried out on the basis of randomized controlled trials with an initial regimen aimed at inducing remission followed by maintenance treatment. In addition to glucocorticoids, conventional immunosuppressants (such as methotrexate, azathioprine and cyclophosphamide) form the basis of treatment, whereby rituximab, first licensed for the treatment of severe active GPA and MPA in 2013, has emerged as new treatment option.
血管炎是系统性风湿性疾病中的一类。在血管炎中,我们可区分出大血管性(如巨细胞动脉炎)、中血管性(如结节性多动脉炎)和小血管性血管炎(如抗中性粒细胞胞浆抗体相关性血管炎)。肉芽肿性多血管炎、显微镜下多血管炎和嗜酸性肉芽肿性多血管炎属于抗中性粒细胞胞浆抗体相关性血管炎。它们具有中小血管床血管炎表现的特征(几乎可发生于任何器官系统)以及抗中性粒细胞胞浆抗体的存在,不过抗中性粒细胞胞浆抗体的检测并非必然是必需的。抗中性粒细胞胞浆抗体相关性血管炎的治疗取决于疾病阶段和活动度,基于随机对照试验进行,初始方案旨在诱导缓解,随后进行维持治疗。除糖皮质激素外,传统免疫抑制剂(如甲氨蝶呤、硫唑嘌呤和环磷酰胺)构成治疗基础,而利妥昔单抗于2013年首次获批用于治疗重度活动性肉芽肿性多血管炎和显微镜下多血管炎,已成为一种新的治疗选择。