2018 Update of the EULAR recommendations for the management of large vessel vasculitis

Bernhard Hellmich*, Ana Agueda, Sara Monti, Frank Buttgereit, Hubert de Boysson, Elisabeth Brouwer, Rebecca Cassie, Maria Cinta Cid, Bhaskar Dasgupta, Christian Dejaco, Gulen Hatemi, Nicole Hollinger, Alfred Mahr, Susan P Mollan, Chetan Mukhtyar, Cristina Ponte, Carlo Salvarani, Rajappa Sivakumar, Xinping Tian, Gunnar TomassonCarl Turesson, Wofgang Schmidt, Peter M Villiger, Richard Watts, Chris Young, Raashid Ahmed Luqmani

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

109 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)19-30
Number of pages12
JournalAnnals of the Rheumatic Diseases
Volume79
Issue number1
Early online date3-Jul-2019
DOIs
Publication statusPublished - Jan-2020

Keywords

  • GIANT-CELL ARTERITIS
  • REFRACTORY TAKAYASU ARTERITIS
  • QUALITY-OF-LIFE
  • SEVERE ISCHEMIC COMPLICATIONS
  • PLACEBO-CONTROLLED TRIAL
  • ERYTHROCYTE SEDIMENTATION-RATE
  • NECROSIS FACTOR THERAPY
  • FACTOR-ALPHA INHIBITORS
  • C-REACTIVE PROTEIN
  • DOUBLE-BLIND TRIAL

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