University of Kansas Medical Center, Kansas City.
University of California, San Francisco.
Arthritis Care Res (Hoboken). 2021 Aug;73(8):1071-1087. doi: 10.1002/acr.24632. Epub 2021 Jul 8.
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.
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.
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.
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.
为巨细胞动脉炎（GCA）和 Takayasu 动脉炎（TAK）的管理提供循证建议和专家指导，这两种疾病是大血管血管炎的代表。
以 GCA 和 TAK 为例，采用人群、干预、比较和结局（PICO）格式制定了与诊断性检查、治疗和管理相关的临床问题。对每个 PICO 问题进行了系统文献综述。采用推荐评估、制定与评价（GRADE）方法对证据质量进行评级。推荐意见由包含成人和儿科风湿病学家和患者的投票小组制定。每个推荐意见需要获得投票小组成员≥70%的共识。
我们提出了 22 条 GCA 推荐意见和 2 条未分级立场声明，以及 20 条 TAK 推荐意见和 1 条未分级立场声明。这些推荐意见和声明涉及与 GCA 和 TAK 中诊断性检查的使用有关的临床问题，包括影像学、治疗和手术干预。GCA 的推荐意见包括支持使用糖皮质激素保留免疫抑制剂以及使用影像学来识别大血管受累。TAK 的推荐意见包括在初始治疗中使用非糖皮质激素免疫抑制剂与糖皮质激素联合应用。仅有 2 条强烈推荐意见；其余推荐意见是有条件的，因为大多数 PICO 问题的证据质量较低。
这些建议为 GCA 和 TAK 患者的评估和管理提供了指导，包括诊断策略、药物治疗的选择和手术干预。
