Zusammenfassung
Die häufig noch uncharakteristischen Symptome bei Erstmanifestation einer Vaskulitis wie Myalgien, Fieber und Gewichtsverlust führen nicht selten zu Verzögerungen in der Diagnosestellung. Organspezifischere Symptome wie Hämoptysen, Dyspnoe, Epistaxis, Ödeme oder Organinfarkte treten hinzu, wenn als Folge der Vaskulitis bereits eine Funktionsminderung der betroffenen Organsysteme besteht. Eine gezielte serologische Diagnostik, insbesondere die Bestimmung von anti-neutrophilen zytoplasmatischen Antikörpern (ANCA) oder Kryoglobulinen kann eine frühe Diagnosestellung von Kleingefäßvaskulitiden erleichtern. Moderne bildgebende Verfahren wie die Magentresonanztomographie, Computertomographie, Positronenemissionstomographie und Sonographie sind für die Frühdiagnose von Vaskulitiden bedeutsam, da sie eine Diagnose oft noch subklinischer Manifestationen ermöglichen und die Auswahl eines Ortes zur Gewinnung einer Biopsie erleichtern. Die bioptische Sicherung ist immer noch der Goldstandard in der Diagnostik der Vaskulitiden.
Funktionell relevante Spätschäden als Folge einer Vaskulitis können durch eine frühzeitig eingeleitete Therapie in ihrer Schwere deutlich reduziert werden. Voraussetzung hierfür ist die möglichst frühe und präzise Diagnosestellung.
Summary
The often unspecific symptoms like myalgias, fever and weight loss at the onset of vasculitides are a frequent cause for a delay in diagnosis. Organspecific symptoms like hemoptysis, dyspnoea, epistaxis, edema and organ infarcts a present when organ dysfunction occurs as a result of vasculitis. Targeted serologic testing including antineutrophil cytoplasm antibodies (ANCA) and cryoglobulins allows early diagnosis of certain vasculitides. Modern imaging techniques like magnetic resonance imaging, computed tomography, positron-emission tomography and ultrasound are cornerstones for an early diagnosis as they allow the detection of subclinical disease and are helpful in the identification of a site for biopsy. Bioptic proof of vasculitis is still the gold standard for diagnosis.
Functionally relevant damage caused by systemic inflammatory disorders can by reduced or sometimes avoided by early initiation of treatment. This requires a correct diagnosis is made as early as possible.
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Hellmich, B., Lamprecht, P., Aries, P.M. et al. Frühdiagnose von Vaskulitiden. Z. Rheumatol. 64, 538–546 (2005). https://doi.org/10.1007/s00393-005-0794-5
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DOI: https://doi.org/10.1007/s00393-005-0794-5