What are the guideline sources, guidelines and references for Takayasu arteritis ?
Guideline sources The following summarized guidelines for the evaluation and management of takayasu arteritis (TA) are prepared by our editorial team based on guidelines from the American Heart Association (AHA/ACC 2022), the Vasculitis Foundation (VF/ACR 2021), the European League Against Rheumatism (EULAR 2020; 2018), and the Society for Cardiovascular Angiography and Interventions (SCAI/STS/SVM/AATS/SCA/AHA/ACR/ACC/ASA/SIR 2010). 1 2 3 4 5 Calculator Calculator Calculator ACR/EULAR diagnostic criteria f EULAR/PRINTO/PRES criteria for NIH criteri Guidelines 1. Diagnostic investigations Diagnostic imaging: As per ACC 2022 guidelines, obtain prompt evaluation of the entire aorta and branch vessels with MRI or CT, with or without 18F-FDG-positron emission tomography, in patients with large https://web.pathway.md/diseases/recXqwBiutAOUu3sC 1/5 6/24/23, 4:05 PM Takayasu arteritis Pathway vessel vasculitis. B As per ACR 2021 guidelines, consider obtaining noninvasive imaging over catheter-based dye angiography for assessing disease activity in patients with TA. C As per EULAR 2020 guidelines, obtain ultrasound, CT, positron emission tomography-CT or MRI of aorta/extracranial arteries to confirm the diagnosis of suspected TA. B As per EULAR 2018 guidelines, obtain MRI to investigate mural inflammation and/or luminal changes as first-line imaging to make a diagnosis of TA, assuming high expertise and prompt availability of the technique. B Show 4 more As per AHA 2010 guidelines, obtain thoracic CT or MRI of the thoracic aorta and branch vessels to assess for aneurysms or arterial occlusion as part of the initial evaluation of TA. B Assessment of comorbidities: screen patients with large vessel vasculitis for treatment-related and cardiovascular comorbidities. Offer prophylaxis and life-style advice to reduce cardiovascular risk and treatment-related complications. 2. Medical management General principles: As per ACR 2021 guidelines, consider initiating medical management over surgical intervention in patients with TA with renovascular hypertension and renal artery stenosis, or stenosis of a cranial/cervical vessel without clinical symptoms. C As per EULAR 2020 guidelines, offer best care in patients with large vessel vasculitis based on a shared decision between the patient and the rheumatologist, considering efficacy, safety and costs. Corticosteroids: As per ACC 2022 guidelines, initiate high-dose corticosteroids as initial medical therapy in patients with active TA. B As per ACR 2021 guidelines, consider initiating high-dose oral corticosteroids over IV pulse corticosteroids followed by high-dose oral corticosteroids in patients with active, severe TA not receiving immunosuppressive therapy. C Show 3 more As per EULAR 2020 guidelines, initiate high-dose corticosteroids (40-60 mg/day prednisone- equivalent) immediately for induction of remission in patients with active TA. B Show 3 more As per AHA 2010 guidelines, initiate high-dose corticosteroids (prednisone 40-60 mg/day or its equivalent) in patients with active TA. B Other immunosuppressants: As per ACC 2022 guidelines, initiate nonbiological DMARDs in combination with corticosteroids in all patients with TA. B https://web.pathway.md/diseases/recXqwBiutAOUu3sC 2/5 6/24/23, 4:05 PM Takayasu arteritis Pathway As per ACR 2021 guidelines, consider initiating a non-corticosteroid immunosuppressive agent plus corticosteroids over corticosteroids alone in patients with active TA. C Show 5 more As per EULAR 2020 guidelines, initiate non-biologic disease modifying agents in combination with corticosteroids in all patients with TA. B Show 2 more As per AHA 2010 guidelines, consider initiating additional anti-inflammatory agents in patients with TA receiving corticosteroids if there is evidence of progression of vascular disease, recurrence of constitutional symptoms, or re-elevation of inflammatory markers. C Antithrombotics: As per ACR 2021 guidelines, consider initiating aspirin or another antiplatelet therapy in patients with active TA and critical cranial or vertebrobasilar involvement. C As per EULAR 2020 guidelines: Do not initiate routine antiplatelet or anticoagulant therapy for the treatment of patients with large vessel vasculitis unless it is indicated for other reasons (such as coronary heart disease or cerebrovascular disease). D Consider initiating antiplatelet or anticoagulant therapy on an individual basis in special situations such as vascular ischemic complications or high risk of CVD. C 3. Surgical interventions Reconstructive surgery: As per ACC 2022 guidelines, consider performing elective endovascular or open surgical intervention to treat aortic and branch vessel complications in patients with TA in remission. C As per ACR 2021 guidelines, decide on the type and timing of intervention for any patient requiring surgical vascular intervention based on a collaborative decision between the vascular surgeon and rheumatologist. Show 2 more As per EULAR 2020 guidelines, perform elective endovascular interventions or reconstructive surgery in phases of stable remission of large vessel vasculitis. Refer patients with arterial vessel dissection or critical vascular ischemia to a vascular team urgently. B As per AHA 2010 guidelines, delay elective revascularization of patients with TA and giant cell arteritis until the acute inflammatory state is treated and quiescent. B 4. Patient education Patient education: ensure access for patients to education focusing on the impact of large vessel vasculitis, its key warning symptoms and treatment (including treatment-related complications). https://web.pathway.md/diseases/recXqwBiutAOUu3sC 3/5 6/24/23, 4:05 PM Takayasu arteritis Pathway 5. Follow-up and surveillance Indications for referral: refer all patients presenting with signs and symptoms suggestive of TA to a specialist team for multidisciplinary diagnostic work-up and management. B Follow-up assessment: As per ACC 2022 guidelines: Assess treatment efficacy periodically by monitoring clinical symptoms, inflammatory serum markers (CRP and ESR), and imaging (CT, MRI, or 18F-FDG-positron emission tomography) in patients with active TA. B Consider obtaining annual surveillance imaging with CT, MRI, or 18F-FDG-positron emission tomography in patients with TA and aortic involvement in remission. C As per ACR 2021 guidelines, obtain long-term clinical monitoring in patients with TA in apparent clinical remission. B Show 3 more As per EULAR 2020 guidelines, obtain regular follow-up and monitoring of disease activity in patients with large vessel vasculitis, primarily based on symptoms, clinical findings and ESR/V- reactive protein levels. B As per EULAR 2018 guidelines, consider obtaining MRA, CT angiography and/or ultrasound for long-term monitoring of structural damage, particularly to detect stenosis, occlusion, dilatation and/or aneurysms in patients with TA. C Show 2 more As per AHA 2010 guidelines, monitor patients with Takayasu's arteritis with serial physical examinations and measurements of ESR or CRP level. B References 1. Hiratzka LF, Bakris GL, Beckman JA et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010 Apr 6;121 13):e266 369. Open 2. Bernhard Hellmich, Ana Agueda, Sara Monti et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020 Jan;79 1 19 30. Open 3. Mehrdad Maz, Sharon A Chung, Andy Abril et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis. Arthritis Care Res Hoboken). 2021 Aug;73 8 1071 1087. Open 4. Eric M Isselbacher, Ourania Preventza, James Hamilton Black rd et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Nov 2. Open https://web.pathway.md/diseases/recXqwBiutAOUu3sC 4/5 6/24/23, 4:05 PM Takayasu arteritis Pathway 5. Christian Dejaco, Sofia Ramiro, Christina Duftner et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018 May;77 5 636 643. Open 6. Seza Ozen, Angela Pistorio, Silvia M Iusan et al. EULAR/PRINTO/PRES criteria for Henoch-Sch nlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II Final classification criteria. Ann Rheum Dis. 2010 May;69 5 798 806. Open 7. Nienke de Graeff, Noortje Groot, Paul Brogan et al. European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides - the SHARE initiative. Rheumatology Oxford). 2019 Apr 1;58 4 656 671. Open 8. G S Kerr, C W Hallahan, J Giordano et al. Takayasu arteritis. Ann Intern Med. 1994 Jun 1;120 11 919 29. Open 9. Peter C Grayson, Cristina Ponte, Ravi Suppiah et al. 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis. 2022 Dec;81 12 1654 1660. Open https://web.pathway.md/diseases/recXqwBiutAOUu3sC 5/5