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

Hellmich, Bernhard ; Agueda, Ana ; Monti, Sara ; Buttgereit, Frank ; De Boysson, Hubert ; Brouwer, Elisabeth ; Cassie, Rebecca ; Cid, Maria Cinta ; Dasgupta, Bhaskar and Dejaco, Christian , et al. (2019) In Annals of the Rheumatic Diseases
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... (More)

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.

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@article{f87a26fd-18a9-43d2-b3c8-d911796af654,
  abstract     = {<p>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.</p>},
  author       = {Hellmich, Bernhard and Agueda, Ana and Monti, Sara and Buttgereit, Frank and De Boysson, Hubert and Brouwer, Elisabeth and Cassie, Rebecca and Cid, Maria Cinta and Dasgupta, Bhaskar and Dejaco, Christian and Hatemi, Gulen and Hollinger, Nicole and Mahr, Alfred and Mollan, Susan P. and Mukhtyar, Chetan and Ponte, Cristina and Salvarani, Carlo and Sivakumar, Rajappa and Tian, Xinping and Tomasson, Gunnar and Turesson, Carl and Schmidt, Wofgang and Villiger, Peter M. and Watts, Richard and Young, Chris and Luqmani, Raashid Ahmed},
  issn         = {0003-4967},
  language     = {eng},
  month        = {07},
  publisher    = {British Medical Association},
  series       = {Annals of the Rheumatic Diseases},
  title        = {2018 Update of the EULAR recommendations for the management of large vessel vasculitis},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2019-215672},
  doi          = {10.1136/annrheumdis-2019-215672},
  year         = {2019},
}