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01.02.2009 | CME Weiterbildung • Zertifizierte Fortbildung

Wegener-Granulomatose und mikroskopische Polyangiitis

verfasst von: PD Dr. K. de Groot, E. Reinhold-Keller

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 1/2009

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Zusammenfassung

Die Wegener-Granulomatose (WG) und mikroskopische Polyangiitis (MPA) sind primäre systemische Kleingefäßvaskulitiden, die mit dem Nachweis eines C-ANCA/PR3-ANCA bei der WG und P-ANCA/MPO-ANCA bei der MPA assoziiert sind. Klinisch führend sind Beteiligungen des oberen (nur bei WG) und unteren Respirationstraktes und der Nieren. Die Diagnostik zur Festlegung von Krankheitsausdehnung und -aktivität ist interdisziplinär. Die Therapie erfolgt stadien- und aktivitätsadaptiert. Eine Remissionsinduktion bei der „Early-systemic-WG/MPA“ kann mit Methotrexat (MTX) erfolgen. Bei schwer generalisierten Verläufen ist Cyclophosphamid (CYC) unverzichtbar, bei rapid progressiver Glomerulonephritis (RPGN) mit zusätzlicher Plasmapheresebehandlung. Nach etwa 3- bis 6-monatiger CYC-Therapie wird auf eine remissionserhaltende Therapie mit Azathioprin umgestellt. Alternativen sind Leflunomid, Mycophenolat oder MTX (Kreatinin <150 µmol/l). Alter ≥50 Jahre, Lungenbeteiligung oder Nierenfunktionseinschränkung bei Diagnose sind mit einer erhöhten Mortalität assoziiert. Die Rezidivrate liegt um 50% in 5 Jahren, bei der WG höher als bei der MPA.

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Titel: Wegener-Granulomatose und mikroskopische Polyangiitis
verfasst von: PD Dr. K. de Groot
E. Reinhold-Keller
Publikationsdatum: 01.02.2009
Verlag: Springer-Verlag
Erschienen in: Zeitschrift für Rheumatologie / Ausgabe 1/2009
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI: https://doi.org/10.1007/s00393-008-0425-z

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