10
Treatment/Management of TAK
Table 5. Recommendations/Statements for Medical and
Surgical Management in TAK
A. Medical Management Level of Evidence
In patients with active, severe TAK not on immunosuppression,
we conditionally recommend initiating treatment with high
dose oral glucocorticoids over pulse intravenous glucocorticoids
followed by high dose oral glucocorticoids.
Very low
In patients with newly diagnosed active, severe TAK, we
conditionally recommend initiating treatment with high-dose
glucocorticoids over low-dose glucocorticoids.
Very low / Low
In patients with TAK who achieved remission on glucocorticoids
for at least 6–12 months, we conditionally recommend tapering
off glucocorticoids over long-term treatment with low dose
glucocorticoids for remission maintenance.
Very low
In patients with active TAK, we conditionally recommend
using a non-glucocorticoid immunosuppressive agent plus
glucocorticoids over glucocorticoids alone.
Low
In patients with active TAK, we conditionally recommend
using other non-glucocorticoid immunosuppressive therapy over
tocilizumab as initial therapy.
Very low / Low
In patients with TAK refractory to treatment with
glucocorticoids alone, we conditionally recommend adding a
tumor necrosis factor inhibitor over adding tocilizumab.
Very low
In patients with TAK and asymptomatic progression of a previously
identified vascular lesion seen on imaging, without evidence of
inflammation, we conditionally recommend continuing current
therapy over escalating/changing immunosuppression.
Very low
In patients with active TAK and critical cranial or vertebrobasilar
involvement, we conditionally recommend adding aspirin or
another anti-platelet therapy.
Low
B. Surgical Management Level of Evidence
Ungraded Position Statement: For any patient requiring surgical
vascular intervention, the type and timing of invention should
be a collaborative decision between the vascular surgeon and
rheumatologist.
N/A
In patients with known TAK and persistent limb claudication
without evidence of ongoing active disease, we conditionally
recommend against surgical intervention.
Very low / Low
In patients with known TAK with worsening signs of limb/organ
ischemia on immunosuppression, we conditionally recommend
escalating immunosuppression over surgical intervention with
escalation of immunosuppression.
Very low
In patients with TAK with renovascular hypertension and
renal artery stenosis, we conditionally recommend medical
management over surgical intervention.
Very low / Low
