Villiger P M
Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Universität Bern, 3010, Bern, Schweiz.
Internist (Berl). 2019 Oct;60(10):1059-1073. doi: 10.1007/s00108-019-00666-2.
Large-vessel vasculitis includes giant cell arteritis (GCA) and Takayasu arteritis (TA). GCA can affect persons from the age of 50 years and is more frequent among women. The disease course generally begins with an acute phase, with patients feeling very unwell and experiencing temporal headaches. Rapid diagnosis and treatment are necessary to reduce the risk of blindness. A suspected diagnosis must be confirmed by imaging, histology is optional. Initial treatment comprises oral prednisone. Recent studies have demonstrated inhibition of interleukin‑6 with tocilizumab (TCZ) to be highly effective. Alternatively, methotrexate can be administered in a steroid-sparing approach. In contrast, TA onset is generally during childhood or adolescence, and begins with moderate systemic inflammation. The aorta and its main branches are affected. Treatment comprises steroids, disease-modifying antirheumatic drugs, and the tumor necrosis factor inhibitor infliximab or TCZ.
大血管血管炎包括巨细胞动脉炎（GCA）和大动脉炎（TA）。GCA可累及50岁及以上人群，女性更为常见。病程通常始于急性期，患者感觉非常不适并出现颞部头痛。为降低失明风险，必须进行快速诊断和治疗。疑似诊断必须通过影像学检查确诊，组织学检查为可选项目。初始治疗包括口服泼尼松。最近的研究表明，用托珠单抗（TCZ）抑制白细胞介素-6非常有效。或者，可采用甲氨蝶呤进行激素减量治疗。相比之下，TA通常在儿童期或青春期发病，始于中度全身炎症。主动脉及其主要分支会受到影响。治疗包括使用类固醇、改善病情的抗风湿药物以及肿瘤坏死因子抑制剂英夫利昔单抗或TCZ。
