British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis

McDermott, Michael; Dejaco, Christian; Appenzeller, Simone; Camellino, Dario; Duftner, Christina; Gonzalez-Chiappe, Solange; Mahr, Alfred; Mukhtyar, Chetan; Reynolds, Gary; Souza, Alexandre Wagner Silva de; Brouwer, Elisabeth; Bukhari, Marwan; Buttgereit, Frank; Byrne, Dorothy; Cid, María C.; Cimmino, Marco A.; Direşkeneli, Haner; Gilbert, Kate; Kermani, Tanaz A.; Khan, Abdullah; Lanyon, Peter; Luqmani, Raashid; Mallen, Christian; Mason, Justin C.; Matteson, Eric L.; Merkel, Peter A.; Mollan, Susan P; Neill, Lorna; Sullivan, Eoin O’; Sandovici, Maria; Schmidt, Wolfgang A.; Watts, Richard A.; Whitlock, Madeline; Yacyshyn, Elaine; Ytterberg, Steven R.; Dasgupta, Bhaskar

doi:10.1093/rheumatology/kez672

Cited by 152 publications

(175 citation statements)

References 96 publications

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“…Pre-emptive therapy should (a) not delay early referral, should (b) be limited to a few days duration at the most, and should (c) be stopped once GCA is ruled out [10]. Blood should be taken for full blood cell count, CRP, and ESR (preferably) before or immediately after starting high-dose GCs [11].…”

Section: General Approachmentioning

confidence: 99%

“…EULAR and BSR recommend starting treatment of GCA with GC at a dose of 40-60 mg prednisolone-equivalent per day [10,11]. The initial dose is continued until GCA-related symptoms resolve and CRP and ESR decrease, which is the case in the vast majority of patients after a few days of treatment.…”

Section: Glucocorticoidsmentioning

confidence: 99%

“…No GC-sparing effect of intravenous GCs after 12 months was observed in a larger (N = 164) but lower quality open RCT, where patients received either intravenous methylprednisolone at a single dose of 240 mg followed by 0.7 mg/kg oral prednisone or oral prednisone at 0.7 mg/kg alone, or a single dose of 240 mg intravenous methylprednisolone followed by 0.5 mg/kg oral prednisone. Current guidelines do not recommend alternate day administration of oral GC, splitting the GC dose in two or more daily doses or modified-release prednisone [10,11], because there is no evidence of improved outcomes compared to using GCs once daily [4].…”

Section: Glucocorticoidsmentioning

confidence: 99%

“…However, at least one of the studies that enrolled only 21 patients and used a low methotrexate dose of 7.5 mg per week was underpowered to exclude or demonstrate a treatment effect of MTX [38]. A recent pooled analysis of the two larger studies [39,40] revealed that MTX reduced the relapse rate at 12-24 months (RR 3.20 (95% CI 1.49, 6.87)) [11].…”

Section: Indications For Gc-sparing Therapiesmentioning

confidence: 99%

“…Conventional and biologic immunosuppressive drugs have been studied for their potential to reduce the GC exposure and maintain remission [8•, 9]. In view of these and other new data, the European League Against Rheumatism (EULAR) as well as the British, Swedish and French Societies of Rheumatology have recently updated their recommendations for the management of LVV [10][11][12][13]. In this review, we aim to summarize current guidelines for drug therapy of GCA and TA.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Treatment of Giant Cell Arteritis and Takayasu Arteritis—Current and Future

Hellmich¹,

Águeda

Monti

et al. 2020

Curr Rheumatol Rep

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Purpose of Review Guidelines for the management of large vessel vasculitides have been recently updated by several scientific societies. We have evaluated the current recommendations for treatment of giant cell arteritis (GCA) and Takayasu arteritis (TA) and addressed potential future therapeutic strategies. Recent Findings While glucocorticoids (GCs) remain the gold standard for induction of remission, many patients relapse and acquire high cumulative GC exposure. Thus, GC-sparing therapies such as methotrexate are recommended for selected patients with GCA and all patients with TA. Recent high-quality evidence shows that tocilizumab is an effective GC-sparing agent in GCA. Non-biologic and biologic immunomodulators also appear to have GC-sparing properties in TA. Summary Tocilizumab is now considered to be part of the standard treatment for GCA, particularly with relapsing disease, but questions on its use such as length of treatment and monitoring of disease activity remain open. High-quality evidence to guide treatment of TA is still lacking.

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Section: General Approachmentioning

confidence: 99%

Section: Glucocorticoidsmentioning

confidence: 99%