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2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis
Author(s) -
Maz Mehrdad,
Chung Sharon A.,
Abril Andy,
Langford Carol A.,
Gorelik Mark,
Guyatt Gordon,
Archer Amy M.,
Conn Doyt L.,
Full Kathy A.,
Grayson Peter C.,
Ibarra Maria F.,
Imundo Lisa F.,
Kim Susan,
Merkel Peter A.,
Rhee Rennie L.,
Seo Philip,
Stone John H.,
Sule Sangeeta,
Sundel Robert P.,
Vitobaldi Omar I.,
Warner Ann,
Byram Kevin,
Dua Anisha B.,
Husainat Nedaa,
James Karen E.,
Kalot Mohamad A.,
Lin Yih Chang,
Springer Jason M.,
Turgunbaev Marat,
VillaForte Alexandra,
Turner Amy S.,
Mustafa Reem A.
Publication year - 2021
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24632
Subject(s) - medicine , giant cell arteritis , guideline , grading (engineering) , psychological intervention , evidence based medicine , systematic review , vasculitis , intensive care medicine , medline , physical therapy , pathology , alternative medicine , disease , civil engineering , psychiatry , political science , law , engineering
Objective To provide evidence‐based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis. Methods Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel. Results We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid‐sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions. Conclusion These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions.