82
Treatment
9. Other Aortic Conditions
9.1. Inflammatory Aortitis: Diagnosis and Treatment of
Takayasu Arteritis and Giant Cell Arteritis (GCA)
COR LOE
Recommendations
Diagnosis
1 C-LD 1. In patients with large vessel vasculitis (LVV), prompt evaluation
of the entire aorta and branch vessels with MRI or CT, with or
without F-FDG positron emission tomography (FDG-PET), is
recommended.
Treatment
1 B-NR 2. In patients with active GCA or Takayasu arteritis, initial
medical therapy should include high-dose glucocorticoids.
1 B-R 3. In patients with GCA who have evidence of active aortitis,
tocilizumab is recommended as adjunctive therapy to
glucocorticoids, with methotrexate as an alternative.
1 C-LD 4. In all patients with Takayasu arteritis, nonbiological disease-
modifying anti-rheumatic drugs (DMARD) should be given
in combination with glucocorticoids.
1 C-LD 5. In patients with active GCA or Takayasu arteritis, treatment
efficacy should be periodically assessed by monitoring
inflammatory serum markers (C-reactive protein and
erythrocyte sedimentation rate), imaging with CT, MRI, or
FDG-PET, and clinical symptoms.
2a C-LD 6. In patients with GCA or Takayasu arteritis who are in
remission, elective endovascular or open surgical intervention
is reasonable to treat aortic and branch vessel complications.
2a C-EO 7. In patients with GCA or Takayasu arteritis and aortic
involvement who are in remission, annual surveillance imaging
with CT, MRI, or FDG-PET is reasonable.
