ACR/VF Guidance Strongly Recommends Monitoring Patients in Remission From Large Vessel Arteritis

New guidance for the management of giant cell arthritis (GCA) and Takayasu arteritis (TAK) from the American College of Rheumatology and the Vasculitis Foundation strongly recommends long-term clinical monitoring for patients in apparent clinical remission. The recommendations were published online ahead of print in Arthritis & Rheumatology.

In all, the guidance includes 22 recommendations and 2 ungraded position statements for patients with GCA and 20 recommendations and 1 ungraded position statement for patients with TAK.

“There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO [population, intervention, comparator, and outcome] questions,” the authors explained.

The pair of strong recommendations are nearly identical and call for long-term clinical monitoring, over no clinical monitoring, of patients with GCA and patients with TAK who appear to be in remission.

Monitoring frequency will depend on the duration of remission, sites of involvement, risk of disease progression, and the patient’s immunosuppressive regimen, if any, the authors advised. The patient’s ability and likelihood to reliably report new signs or symptoms should also factor in to how often monitoring occurs, according to the recommendations.

Monitoring could include history taking, exams, and laboratory or imaging studies, the guidance stated.

“This is a strong recommendation,” the authors wrote, “given the minimal risks and potential catastrophic outcomes if monitoring is not performed.”

—Jolynn Tumolo

Reference

Maz M, Chung SA, Abril A, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Rheumatol. Published online ahead of print, July 8, 2021.  DOI: https://doi.org/10.1002/art.41774