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

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 (2019) 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Annals of the rheumatic diseases. ISSN 1468-2060. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://ard.bmj.com/

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.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WW Eyes. Ophthalmology
Divisions: Ambulatory Care > Ophthalmology
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Depositing User: Mrs Yolande Brookes
Date Deposited: 05 Jul 2019 11:48
Last Modified: 05 Jul 2019 11:48
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2204

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