Vasculitis Guidelines in Focus, Part 1: The Guideline Project

I would surmise that these guidelines will be re-evaluated in a few years. New PICO questions may be developed and old PICO questions taken away, the literature review will be supplemented with the new articles that have been published and the entire process will be repeated with another voting panel. Thus, there is a definite expectation that these guidelines will be revised in the future.

Q: That makes sense—actually specifying how you’re going to update, especially for moving things forward and as things progress. My last question for you: What have you learned from all this?

Dr. Chung: First and foremost, I think, is how far we have come. When I started training, the only options for treating vasculitis were prednisone and cyclophosphamide. It was during my training that the first articles were published looking at remission maintenance therapy in ANCA-associated vasculitis. Now we’re developing multiple alternative therapies. We’re learning more about how to use prednisone and how to minimize prednisone. We’re learning more about the pathogenesis of these diseases. It’s really exciting to see how much the field has moved forward, the new alternatives available to our patients for therapy, and how much better our patients are doing. In the past, our goal was to keep patients alive. We’re far beyond that now.

Working on these guidelines has been a really fun experience because of the vasculitis community. It’s all volunteer—people giving up their weekends and their evenings and doing things in a rush fashion at times for paper reviews—and they’re doing this because we all believe this is important for the field. The community that we have here is astounding.

---

Michael Putman, MD (@EBRheum), is an assistant professor at the Medical College of Wisconsin, Wauwatosa, where he is the associate fellowship program director and the medical director of the vasculitis program.

 

 

 

References

1. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for theManagement of Antineutrophil CytoplasmicAntibody–Associated Vasculitis. Arthritis Rheumatol and Arthritis Care Res (Hoboken). 2021 Jul 8. Online ahead of print.
2. 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 and Arthritis Care Res (Hoboken). 2021 Jul 8. Online ahead of print.
3. Chung SA, Gorelik M, Langford CA, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Polyarteritis Nodosa. Arthritis Rheumatol and Arthritis Care Res (Hoboken). 2021 Jul 8. Online ahead of print.
4. Jennette JC. Overview of the 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Clin Exp Nephrol. 2013 Oct;17(5):603–606.
5. Gorelik M, Chung SA, Ardalan K, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease. Arthritis Rheumatol. 2022 Apr; 74(4):586–596; and Arthritis Care Res (Hoboken). 2022 Apr;74(4):538–548.