Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

Abstract

ObjectivesTo develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).MethodsA systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously.ResultsFive overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment.ConclusionThese are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.

Giant cell arteritis and innovative treatments

“…The treatment targets are achieving and maintaining remission and preventing tissue ischemia and vascular damage. Comorbidities must be considered when assessing disease activity and selecting treatment [14 ▪▪ ].…”

Patient-reported outcomes provide evidence for increased depressive symptoms and increased mental impairment in giant cell arteritis

“…A GCA-PMR-specific PRO could refine the course of treatment by better understanding patients’ concerns. Perhaps we could find out whether there are different subgroups in the spectrum of GCA and PMR in relation to the recognition that both diseases belong to a spectrum of inflammatory diseases with different clinical manifestations ( 2 ). Robson and colleagues recently published a first draft for a GCA specific PRO-set, that now has to be further evaluated ( 42 ).…”

“…Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are rheumatic diseases of people of older age ( 1 ). Both entities belong to a common spectrum of highly inflammatory diseases and are closely related ( 2 , 3 ). While GCA is primarily a vasculitis of the large vessels, PMR is a mostly symmetrical inflammation of the extracapsular structures, primarily of the shoulders and pelvic girdle ( 4 ).…”

“…While GCA is primarily a vasculitis of the large vessels, PMR is a mostly symmetrical inflammation of the extracapsular structures, primarily of the shoulders and pelvic girdle ( 4 ). Both conditions can occur isolated, overlapping or sequential ( 2 , 5 , 6 ). Patients frequently experience severe pain and also report unspecific symptoms such as disturbed night sleep, weakness, and malaise, lowering quality of life ( 7 , 8 ).…”

The importance of defining which Janus kinases are activated in giant cell arteritis

“…The mainstay of therapy is based on glucocorticoids, however about half to two third of patients experience flares during glucocorticoid tapering or after glucocorticoid withdrawn. Moreover, up to 85% of patients can have glucocorticoid-related side effects (6). Glucocorticoids did not appear capable of dampening IFNγ-producing Th1 cells, that play a key role in vascular inflammation and remodelling (7).…”