巨细胞动脉炎和 Takayasu 动脉炎的治疗——现状与未来。
Treatment of Giant Cell Arteritis and Takayasu Arteritis-Current and Future.
机构信息
Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitis-Zentrum Süd, Medius Kliniken, akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim-unter-Teck, Germany.
Department of Rheumatology, Centro Hospitalar e Universitário da Cova da Beira, Covilhã, Portugal.
出版信息
Curr Rheumatol Rep. 2020 Oct 12;22(12):84. doi: 10.1007/s11926-020-00964-x.
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. 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.
目的综述
多个科学协会最近更新了大血管血管炎的治疗指南。我们评估了巨细胞动脉炎（GCA）和 Takayasu 动脉炎（TA）的当前治疗建议，并探讨了潜在的未来治疗策略。
最近的发现
虽然糖皮质激素（GCs）仍然是诱导缓解的金标准，但许多患者会复发并累积接受高剂量的 GC 治疗。因此，对于 GCA 患者中的某些患者和所有 TA 患者，建议使用甲氨蝶呤等 GC 保存疗法。最近的高质量证据表明，托珠单抗是 GCA 中一种有效的 GC 保存药物。非生物和生物免疫调节剂在 TA 中也具有 GC 保存作用。托珠单抗现在被认为是 GCA 标准治疗的一部分，特别是对于复发疾病，但关于其使用的问题，例如治疗时间和疾病活动监测，仍存在争议。指导 TA 治疗的高质量证据仍然缺乏。
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