2018 Update of the EULAR recommendations for the management of large vessel vasculitis
BackgroundSince 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 the...
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| Published in | Annals of the rheumatic diseases Vol. 79; no. 1; pp. 19 - 30 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group Ltd and European League Against Rheumatism
01.01.2020
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0003-4967 1468-2060 1468-2060 |
| DOI | 10.1136/annrheumdis-2019-215672 |
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| Abstract | BackgroundSince 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.MethodsUsing 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.ResultsThree 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.ConclusionsWe 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. |
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| AbstractList | 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. BackgroundSince 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.MethodsUsing 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.ResultsThree 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.ConclusionsWe 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.BACKGROUNDSince 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.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.METHODSUsing 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.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.RESULTSThree 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.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.CONCLUSIONSWe 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. 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. 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. 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. |
| Author | Hollinger, Nicole Young, Chris Mukhtyar, Chetan Mollan, Susan P Tomasson, Gunnar Cid, Maria C Mahr, Alfred Cassie, Rebecca Brouwer, Elisabeth Sivakumar, Rajappa Monti, Sara de Boysson, Hubert Hellmich, Bernhard Luqmani, Raashid Ahmed Agueda, Ana Watts, Richard Hatemi, Gulen Ponte, Cristina Schmidt, Wolfgang Tian, Xinping Villiger, Peter M Buttgereit, Frank Salvarani, Carlo Dejaco, Christian Turesson, Carl Dasgupta, Bhaskar |
| Author_xml | – sequence: 1 givenname: Bernhard orcidid: 0000-0002-8014-1801 surname: Hellmich fullname: Hellmich, Bernhard email: b.hellmich@medius organization: Department of Internal Medicine, Rheumatology and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany – sequence: 2 givenname: Ana surname: Agueda fullname: Agueda, Ana organization: Rheumatology Department, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, Portugal – sequence: 3 givenname: Sara surname: Monti fullname: Monti, Sara organization: Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy – sequence: 4 givenname: Frank surname: Buttgereit fullname: Buttgereit, Frank organization: Department of Rheumatology and Immunology, University Hospital Charité, Berlin, Germany – sequence: 5 givenname: Hubert surname: de Boysson fullname: de Boysson, Hubert organization: Internal Medicine, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France – sequence: 6 givenname: Elisabeth surname: Brouwer fullname: Brouwer, Elisabeth organization: Rheumatology and Clinical Immunology, UMCG, Groningen, The Netherlands – sequence: 7 givenname: Rebecca surname: Cassie fullname: Cassie, Rebecca organization: Leicester, UK – sequence: 8 givenname: Maria C surname: Cid fullname: Cid, Maria C organization: Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain – sequence: 9 givenname: Bhaskar surname: Dasgupta fullname: Dasgupta, Bhaskar organization: Rheumatology, Southend Hospital NHS Trust, Westcliff-on-sea, UK – sequence: 10 givenname: Christian orcidid: 0000-0002-0173-0668 surname: Dejaco fullname: Dejaco, Christian organization: Rheumatology, Hospital of Bruneck, Bruneck, Italy – sequence: 11 givenname: Gulen orcidid: 0000-0002-1952-1135 surname: Hatemi fullname: Hatemi, Gulen organization: Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey – sequence: 12 givenname: Nicole surname: Hollinger fullname: Hollinger, Nicole organization: Department of Internal Medicine, Rheumatology and Immunology, Medus Klinken, Karl-Albrechts-Universität Tübingen, Kirchheim-Teck, Germany – sequence: 13 givenname: Alfred surname: Mahr fullname: Mahr, Alfred organization: Hospital Saint-Louis, University Paris Diderot, Paris, France – sequence: 14 givenname: Susan P surname: Mollan fullname: Mollan, Susan P organization: Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK – sequence: 15 givenname: Chetan orcidid: 0000-0002-9771-6667 surname: Mukhtyar fullname: Mukhtyar, Chetan organization: Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK – sequence: 16 givenname: Cristina surname: Ponte fullname: Ponte, Cristina organization: Rheumatology Research Unit; Instituto de Medicina Molecular, Instituto de Medicina Molecular, Lisboa, Portugal – sequence: 17 givenname: Carlo surname: Salvarani fullname: Salvarani, Carlo organization: Arcispedale S Maria Nuova, Reggio Emilia, Italy – sequence: 18 givenname: Rajappa surname: Sivakumar fullname: Sivakumar, Rajappa organization: Stroke and Neurocritical Care, GLB Hospitals and Acute Stroke Centers, Chennai, India – sequence: 19 givenname: Xinping surname: Tian fullname: Tian, Xinping organization: Rheumatology, Peking Union Medical College Hospital, Beijing, China – sequence: 20 givenname: Gunnar surname: Tomasson fullname: Tomasson, Gunnar organization: University of Iceland, Reykjavik, Iceland – sequence: 21 givenname: Carl surname: Turesson fullname: Turesson, Carl organization: Department of Rheumatology, Skåne University Hospital, Malmö, Sweden – sequence: 22 givenname: Wolfgang surname: Schmidt fullname: Schmidt, Wolfgang organization: Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany – sequence: 23 givenname: Peter M surname: Villiger fullname: Villiger, Peter M organization: Rheumatology and Clinical Immunology / Allerg, University Hospital (Inselspital), Bern, Switzerland – sequence: 24 givenname: Richard surname: Watts fullname: Watts, Richard organization: Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, UK – sequence: 25 givenname: Chris surname: Young fullname: Young, Chris organization: Steyning, UK – sequence: 26 givenname: Raashid Ahmed surname: Luqmani fullname: Luqmani, Raashid Ahmed organization: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31270110$$D View this record in MEDLINE/PubMed https://lup.lub.lu.se/record/f87a26fd-18a9-43d2-b3c8-d911796af654$$DView record from Swedish Publication Index oai:portal.research.lu.se:publications/f87a26fd-18a9-43d2-b3c8-d911796af654$$DView record from Swedish Publication Index |
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| Keywords | giant cell arteritis large vessel vasculitis Takayasu arteritis management Eular recommendations |
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| PublicationDecade | 2020 |
| PublicationPlace | England |
| PublicationPlace_xml | – name: England – name: Kidlington |
| PublicationTitle | Annals of the rheumatic diseases |
| PublicationTitleAbbrev | Ann Rheum Dis |
| PublicationTitleAlternate | Ann Rheum Dis |
| PublicationYear | 2020 |
| Publisher | BMJ Publishing Group Ltd and European League Against Rheumatism Elsevier Limited |
| Publisher_xml | – name: BMJ Publishing Group Ltd and European League Against Rheumatism – name: Elsevier Limited |
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| Snippet | BackgroundSince the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009,... Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several... Background: Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in... |
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| SubjectTerms | Antibodies, Monoclonal, Humanized - therapeutic use Anticoagulants Antirheumatic Agents - therapeutic use Aortitis - diagnostic imaging Aortitis - drug therapy Aortitis - pathology Arteritis Autoimmune diseases Biopsy Clinical Medicine Clinical trials Eular recommendations giant cell arteritis Giant Cell Arteritis - diagnostic imaging Giant Cell Arteritis - drug therapy Giant Cell Arteritis - pathology Glucocorticoids Glucocorticoids - therapeutic use Humans Immunomodulators Klinisk medicin large vessel vasculitis Literature reviews Management Medical and Health Sciences Medicin och hälsovetenskap Methotrexate Methotrexate - therapeutic use Monoclonal antibodies Patients Prednisone Recommendation Remission Stroke Systematic review Takayasu arteritis Takayasu Arteritis - diagnostic imaging Takayasu Arteritis - drug therapy Takayasu Arteritis - pathology Takayasu's disease Task forces Vasculitis Vein & artery diseases Veins & arteries |
| Title | 2018 Update of the EULAR recommendations for the management of large vessel vasculitis |
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