2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis

• Published in: Arthritis & rheumatology (Hoboken, N.J.) Vol. 73; no. 8; pp. 1349 - 1365
• Main Authors: 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, Villa‐Forte, Alexandra, Turner, Amy S., Mustafa, Reem A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2021
• Subjects: Arteritis; Diagnostic systems; Diagnostic tests; Disease Management; Evaluation; Evidence-Based Medicine - standards; Giant Cell Arteritis - diagnosis; Giant Cell Arteritis - drug therapy; Glucocorticoids; Humans; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Literature reviews; Medical imaging; Patients; Pediatrics; Questions; Rheumatology - standards; Takayasu Arteritis - diagnosis; Takayasu Arteritis - drug therapy; Takayasu's disease; United States; Vasculitis; Vein & artery diseases; Voting; United States
• ISSN: 2326-5191; 2326-5205; 2326-5205
• DOI: 10.1002/art.41774

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.