Mehrdad Maz1, Sharon A Chung2, Andy Abril3, Carol A Langford4, Mark Gorelik5, Gordon Guyatt6, Amy M Archer7, Doyt L Conn8, Kathy A Full9, Peter C Grayson10, Maria F Ibarra11, Lisa F Imundo5, Susan Kim2, Peter A Merkel12, Rennie L Rhee12, Philip Seo13, John H Stone14, Sangeeta Sule15, Robert P Sundel16, Omar I Vitobaldi17, Ann Warner18, Kevin Byram19, Anisha B Dua7, Nedaa Husainat20, Karen E James21, Mohamad A Kalot22, Yih Chang Lin23, Jason M Springer1, Marat Turgunbaev24, Alexandra Villa-Forte4, Amy S Turner24, Reem A Mustafa25. 1. University of Kansas Medical Center, Kansas City. 2. University of California, San Francisco. 3. Mayo Clinic, Jacksonville, Florida. 4. Cleveland Clinic Foundation, Cleveland, Ohio. 5. Columbia University, New York, New York. 6. McMaster University, Hamilton, Ontario, Canada. 7. Northwestern University, Chicago, Illinois. 8. Emory University, Atlanta, Georgia. 9. Springfield, Illinois. 10. National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland. 11. Children's Mercy Hospital, Kansas City, Missouri. 12. University of Pennsylvania, Philadelphia. 13. Johns Hopkins University, Baltimore, Maryland. 14. Massachusetts General Hospital, Boston. 15. Children's National Hospital, Washington, DC. 16. Boston Children's Hospital, Boston, Massachusetts. 17. Chicago, Illinois. 18. Saint Luke's Health System, Kansas City, Missouri. 19. Vanderbilt University, Nashville, Tennessee. 20. SSM Health-St. Mary's Hospital, St. Louis. Missouri. 21. University of Utah, Salt Lake City. 22. State University of New York at Buffalo. 23. University of South Florida, Tampa. 24. American College of Rheumatology, Atlanta, Georgia. 25. University of Kansas Medical Center, Kansas City, and McMaster University, Hamilton, Ontario, Canada.
Abstract
OBJECTIVE: To provide evidence-based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis. METHODS: Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel. RESULTS: We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid-sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions. CONCLUSION: These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions.
OBJECTIVE: To provide evidence-based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis. METHODS: Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel. RESULTS: We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid-sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions. CONCLUSION: These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions.
Authors: Dan Pugh; Maira Karabayas; Neil Basu; Maria C Cid; Ruchika Goel; Carl S Goodyear; Peter C Grayson; Stephen P McAdoo; Justin C Mason; Catherine Owen; Cornelia M Weyand; Taryn Youngstein; Neeraj Dhaun Journal: Nat Rev Dis Primers Date: 2022-01-06 Impact factor: 65.038
Authors: Hélène Greigert; André Ramon; Georges Tarris; Laurent Martin; Bernard Bonnotte; Maxime Samson Journal: J Clin Med Date: 2022-01-05 Impact factor: 4.241