08:39 AM

Three new ACR guidelines recommend treatment for six forms of vasculitis

MDedge reports new guidelines from the American College of Rheumatology (ACR), in partnership with the Vasculitis Foundation, offer evidence-based recommendations for managing and treating six different forms of systemic vasculitis and includes commentary from Robert F. Spiera, MD, rheumatologist at HSS.

Dr. Spiera discussed the conditional recommendation of noninvasive vascular imaging of the large vessels in patients with newly diagnosed Giant cell arteritis (GCA).

He explained, “It is well recognized that a substantial portion of patients with GCA have unrecognized evidence of large vessel involvement, and patients with GCA in general are at higher risk of aneurysms later in the disease course. These guidelines suggest screening even patients with purely cranial presentations for large vessel involvement with imaging to possibly identify the patients at higher risk for those later complications.”

He continued, “What they didn’t offer were recommendations on how to follow up on that imaging,” adding, “which is an important and as-yet-unanswered question.”

Regarding the ANCA-associated vasculitis (AAV) guidelines, Dr. Spiera said, “The literature supports that in patients with relapsing disease, rituximab works better than cyclophosphamide for remission induction. But in these guidelines, even in new disease, rituximab is suggested as the agent of choice to induce remission. I would say that that is reasonable, but you could make an argument that it’s maybe beyond what the literature supports, particularly in patients with advanced renal insufficiency attributable to that initial vasculitis flare.”

He concluded, “There has been progress in terms of well-done clinical trials to inform our decision-making, particularly for ANCA-associated vasculitis, both in terms of how to induce and maintain remission. Though the recommendations were conditional, I think there’s very strong data to support many of them.”

Read the full article at MDedge.com.