सक्रिय गैर-गंभीर पॉलीआर्टेराइटिस नोडोसा — जब प्रारंभिक इम्यूनोसप्रेसिव थेरेपी छूट प्राप्त करने में विफल हो जाती है

References

DOI: 10.1002/art.41776

• Nonsevere disease: Vasculitis without life- or organ-threatening manifestations (e.g., mild systemic symptoms, uncomplicated cutaneous disease, mild inflammatory arthritis).
• For patients with severe PAN that is refractory to treatment with glucocorticoids and nonglucocorticoid immunosuppressive agents other than cyclophosphamide, we conditionally recommend switching the nonglucocorticoid immunosuppressive agent to cyclophosphamide, over increasing glucocorticoids alone.
• Based on the effectiveness of cyclophosphamide in new-onset severe PAN, indirect evidence suggests that cyclophosphamide should be used in patients with PAN that has evolved from a nonsevere presentation to one that is severe and does not adequately respond to other immunosuppressive agents.
• Cyclophosphamide therapy should not continue indefinitely and should generally be limited to 3–6 months per course.
• For patients with newly diagnosed PAN who have achieved disease remission with cyclophosphamide, we conditionally recommend transitioning to another nonglucocorticoid immunosuppressive agent over continuing cyclophosphamide.
• Transitioning to another less toxic agent such as methotrexate or azathioprine is recommended once disease remission has been attained.
• Absence of clinical signs or symptoms attributed to PAN, on or off immunosuppressive therapy.