Premium
2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Polyarteritis Nodosa
Author(s) -
Chung Sharon A.,
Gorelik Mark,
Langford Carol A.,
Maz Mehrdad,
Abril Andy,
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,
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.24633
Subject(s) - medicine , polyarteritis nodosa , intensive care medicine , guideline , rheumatology , disease , grading (engineering) , position paper , evidence based medicine , physical therapy , vasculitis , pathology , alternative medicine , civil engineering , engineering
Objective To provide evidence‐based recommendations and expert guidance for the management of systemic polyarteritis nodosa (PAN). Methods Twenty‐one clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for systemic, non–hepatitis B–related PAN. Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel. Results We present 16 recommendations and 1 ungraded position statement for PAN. Most recommendations were graded as conditional due to the paucity of evidence. These recommendations support early treatment of severe PAN with cyclophosphamide and glucocorticoids, limiting toxicity through minimizing long‐term exposure to both treatments, and the use of imaging and tissue biopsy for disease diagnosis. These recommendations endorse minimizing risk to the patient by using established therapy at disease onset and identify new areas where adjunctive therapy may be warranted. Conclusion These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and imaging for patients with PAN.