The Italian Society of Rheumatology clinical practice guidelines for the management of large vessel vasculitis

Abstract

Objective: Since of the last publication of last recommendations on primary large-vessel vasculitis (LVV) endorsed by the Italian Society of Rheumatology (SIR) in 2012, new evidence emerged regarding the diagnosis and the treatment with conventional and biologic immunosuppressive drugs. The associated potential change of clinical care supported the need to update the original recommendations. Methods: Using the grading of recommendations assessment, development and evaluation (GRADE)-ADOLOPMENT framework, a systematic literature review was performed to update the evidence supporting the European Alliance of Associations for Rheumatology (EULAR) guidelines on LVV as reference. A multidisciplinary panel of 12 expert clinicians, a trained nurse, and a patients’ representative discussed the recommendation in cooperation with an Evidence Review Team. Sixty-one stakeholders were consulted to externally review and rate the recommendations. Results: Twelve recommendations were formulated. A suspected diagnosis of LVV should be confirmed by imaging or histology. In active GCA or TAK, the prompt commencement of high dose of oral glucocorticoids (40-60 mg prednisone-equivalent per day) is strongly recommended to induce clinical remission. In selected patients with GCA (e.g., refractory or relapsing disease or patients at risk of glucocorticoid related adverse effects) the use of an adjunctive therapy (tocilizumab or methotrexate) is recommended. In all patients diagnosed with TAK, adjunctive therapies, such as conventional synthetic or biological immunosuppressants, should be given in combination with glucocorticoids. Conclusions: The new set of SIR recommendations was formulated in order to provide a guidance on both diagnosis and treatment of patients suspected of or with a definite diagnosis of LVV.

EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update

“…The American College of Rheumatology (ACR) has recently published management guidelines for GCA expressing their preference for TAB over ultrasound and MRI of cranial arteries in the diagnosis of GCA, which contrasts with the 2018 EULAR recommendations12 and other recommendations 13–16. The ACR clarifies that these recommendations relate in part to the lack of technical expertise of clinicians in the USA with these modalities 12…”

“…11 The American College of Rheumatology (ACR) has recently published management guidelines for GCA expressing their preference for TAB over ultrasound and MRI of cranial arteries in the diagnosis of GCA, which contrasts with the 2018 EULAR recommendations 12 and other recommendations. [13][14][15][16] The ACR clarifies that these recommendations relate in part to the lack of technical expertise of clinicians in the USA with these modalities. 12 These and other developments have prompted us to re-evaluate and update the original EULAR recommendations, particularly addressing uncertainties about the choice of the imaging technique for diagnosis and assessment of patients with GCA Recommendation and TAK.…”

Chinese guideline for the diagnosis and treatment of Takayasu’s arteritis (2023)

“…Relapse may lead to progression of organ damage. As there are currently no studies on patients with relapsed TAK, EULAR / ACR/ Italian guideline recommended to ( i.e ., no symptoms of major relapse), increase the dose of GC to at least the previous effective dose [ 4 , 5 , 76 ] and adjust DMARD for patients with minor relapse. For TAK patients with major relapse (clinical manifestations or signs of ischemia, or progression of vasculitis, etc .…”

“…The modalities and frequency of image examinations should be based on the patient’s condition. [ 62 , 76 ] Some adverse reactions are caused by long-term use of GC and DMARDs. Therefore, during each follow-up visit, patient should be monitored for the adverse reactions and complications caused by GCs or csDMARDs, including infection, diabetes, hypertension and osteoporosis.…”

Fever Correlation with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Concentrations in Patients with Isolated Polymyalgia Rheumatica (PMR): A Retrospective Comparison Study between Hospital and Out-of-Hospital Local Registries

“…On the other hand, fever or low-grade fever can be the onset manifestation in some PMR-mimicking diseases, such as infections and malignancies [ 11 , 12 , 13 , 14 , 15 ], or can be a warning signal for an association with a large-vessel vasculitis, named giant cell arteritis [GCA]). GCA, a granulomatous vasculitis affecting the aorta and its branches, may be associated with PMR in up to 20% of cases [ 16 , 17 , 18 , 19 , 20 ].…”