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Practice Guideline
. 2021 Aug;73(8):1349-1365.
doi: 10.1002/art.41774. Epub 2021 Jul 8.

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

Mehrdad Maz  1 , Sharon A Chung  2 , Andy Abril  3 , Carol A Langford  4 , Mark Gorelik  5 , Gordon Guyatt  6 , Amy M Archer  7 , Doyt L Conn  8 , Kathy A Full  9 , Peter C Grayson  10 , Maria F Ibarra  11 , Lisa F Imundo  5 , Susan Kim  2 , Peter A Merkel  12 , Rennie L Rhee  12 , Philip Seo  13 , John H Stone  14 , Sangeeta Sule  15 , Robert P Sundel  16 , Omar I Vitobaldi  17 , Ann Warner  18 , Kevin Byram  19 , Anisha B Dua  7 , Nedaa Husainat  20 , Karen E James  21 , Mohamad A Kalot  22 , Yih Chang Lin  23 , Jason M Springer  1 , Marat Turgunbaev  24 , Alexandra Villa-Forte  4 , Amy S Turner  24 , Reem A Mustafa  25
Affiliations
Practice Guideline

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

Mehrdad Maz et al. Arthritis Rheumatol. 2021 Aug.

Abstract

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.

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Conflict of interest statement

Financial Conflict: Forms submitted as required.

Figures

Figure 1.
Figure 1.
Overview of treatment of giant cell arteritis.
Figure 2.
Figure 2.
Overview of treatment of Takayasu arteritis based on clinical and radiographic assessments.
See this image and copyright information in PMC

Comment in

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