2018 Update of the EULAR recommendations for the management of large vessel vasculitis.
- Hellmich B Department of Internal Medicine, Rheumatology and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany b.hellmich@medius-kliniken.de.
- Agueda A Rheumatology Department, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, Portugal.
- Monti S Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
- Buttgereit F Department of Rheumatology and Immunology, University Hospital Charité, Berlin, Germany.
- de Boysson H Internal Medicine, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France.
- Brouwer E Rheumatology and Clinical Immunology, UMCG, Groningen, The Netherlands.
- Cassie R Leicester, UK.
- Cid MC Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Dasgupta B Rheumatology, Southend Hospital NHS Trust, Westcliff-on-sea, UK.
- Dejaco C Rheumatology, Medical University Graz, Graz, Austria.
- Hatemi G Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
- Hollinger N Department of Internal Medicine, Rheumatology and Immunology, Medus Klinken, Karl-Albrechts-Universität Tübingen, Kirchheim-Teck, Germany.
- Mahr A Hospital Saint-Louis, University Paris Diderot, Paris, France.
- Mollan SP Ophthalmology, University Hospitals Birmingham, Birmingham, UK.
- Mukhtyar C Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK.
- Ponte C Rheumatology, Hospital de Santa Maria - CHLN, Lisbon Academic Medical Centre, Lisbon, Portugal.
- Salvarani C Arcispedale S Maria Nuova, Reggio Emilia, Italy.
- Sivakumar R Stroke and Neurocritical Care, GLB Hospitals and Acute Stroke Centers, Chennai, India.
- Tian X Rheumatology, Peking Union Medical College Hospital, Beijing, China.
- Tomasson G University of Iceland, Reykjavik, Iceland.
- Turesson C Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
- Schmidt W Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany.
- Villiger PM Rheumatology and Clinical Immunology / Allerg, University Hospital (Inselspital), Bern, Switzerland.
- Watts R Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, UK.
- Young C Steyning, UK.
- Luqmani RA Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK.
- 2019-07-05
Published in:
- Annals of the rheumatic diseases. - 2020
Eular recommendations
Takayasu arteritis
giant cell arteritis
large vessel vasculitis
management
Antibodies, Monoclonal, Humanized
Antirheumatic Agents
Aortitis
Giant Cell Arteritis
Glucocorticoids
Humans
Methotrexate
Takayasu Arteritis
English
BACKGROUND
Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations.
METHODS
Using EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations.
RESULTS
Three overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40-60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons.
CONCLUSIONS
We have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.
Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations.
METHODS
Using EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations.
RESULTS
Three overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40-60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons.
CONCLUSIONS
We have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1136/annrheumdis-2019-215672
- PMID 31270110
- Persistent URL
- https://sonar.ch/global/documents/45285
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