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Clinical Reviews in Allergy & Immunology
Published in: Clinical Reviews in Allergy & Immunology 2/2018

01-04-2018

Unmet Needs in the Pathogenesis and Treatment of Vasculitides

Authors: Francesco Muratore, Giulia Pazzola, Alessandra Soriano, Nicolò Pipitone, Stefania Croci, Martina Bonacini, Luigi Boiardi, Carlo Salvarani

Published in: Clinical Reviews in Allergy & Immunology | Issue 2/2018

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Abstract

Despite the progress in the last years on the field of vasculitides, there are several unmet needs regarding classification, disease activity assessment, predictors of flares and complications, and type of treatment for the different forms. The 1990 American College of Rheumatology (ACR) classification criteria currently used to define giant cell arteritis and Takayasu arteritis were designed to discriminate between different types of vasculitides but not to differentiate vasculitis from other disorders. Recently, efforts have been made to overcome the shortcomings of the ACR criteria. The lack of an accepted definition of disease activity in large-vessel vasculitides presents a major challenge in creating useful and valid outcome tools for the assessment of disease course. Identification of predictors of flares can aid in optimizing therapeutic strategies, minimizing disease flares, and reducing treatment-related side effects. It is furthermore important to recognize and characterize the risk factor that might predict the manifestations associated with poor outcome and prognosis. Two RCTs have evidenced the efficacy of tocilizumab in addition to glucocorticoids (GCs) in the treatment of giant cell arteritis (GCA). However, the role of tocilizumab or other biological agents without GCs needs to be investigated. Recent observational studies have suggested that rituximab is also effective in patients with eosinophilic granulomatosis with polyangiitis and in antineutrophil cytoplasmic antibodies (ANCA)-negative patients with granulomatosis with polyangiitis and microscopic polyangiitis. Rituximab or anti-TNF alfa may represent a possible alternative therapy in case of refractory or difficult to treat polyarteritis nodosa (PAN) patients. The new International Criteria for Behçet’s Disease have shown a better sensitivity and a better accuracy compared to the older International Study Group on Behçet’s Disease criteria. The EULAR recommendations for the management of Behçet’s disease (BD) have been recently updated. However, the treatment of refractory disease is still a real challenge.
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Metadata
Title
Unmet Needs in the Pathogenesis and Treatment of Vasculitides
Authors
Francesco Muratore
Giulia Pazzola
Alessandra Soriano
Nicolò Pipitone
Stefania Croci
Martina Bonacini
Luigi Boiardi
Carlo Salvarani
Publication date
01-04-2018
Publisher
Springer US
Published in
Clinical Reviews in Allergy & Immunology / Issue 2/2018
Print ISSN: 1080-0549
Electronic ISSN: 1559-0267
DOI
https://doi.org/10.1007/s12016-017-8643-2

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