التهاب الشرايين تاكاياسو: علاج الخط التالي عندما لا تحقق الكورتيكوستيرويدات والعلاج التقليدي بـ DMARD مغفرة مستدامة

References

DOI: 10.1136/annrheumdis-2019-215672

• Tocilizumab or TNF-inhibitors can be considered in case of relapsing or refractory disease despite conventional DMARD therapy.
• In relapsing TAK despite treatment with GC plus a conventional immunosuppressive agent, a TNF-inhibitor or TCZ can be used as second line agent.
• In case of major relapse (either with signs or symptoms of ischaemia or progressive vascular inflammation) we recommend reinstitution or dose escalation of GC therapy as recommended for new onset disease.
• For minor relapses we recommend an increase in GC dose at least to the last effective dose.
• The treatment target is sustained remission (absence of clinical signs and symptoms of active TAK associated with normal acute phase reactants) plus ability to taper GCs to the specified target without relapse.
• Absence of all clinical signs and symptoms attributable to active LVV and normalisation of ESR and CRP; in addition, for patients with extracranial disease there should be no evidence of progressive vessel narrowing or dilatation (frequency of repeat imaging to be decided on an individual basis).