Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

Christian Dejaco; Andreas Kerschbaumer; Daniel Aletaha; Milena Bond; Elvis Hysa; Dario Camellino; Lisa Ehlers; Andy Abril; Simone Appenzeller; Maria C Cid; Bhaskar Dasgupta; Christina Duftner; Peter C Grayson; Bernhard Hellmich; Alojzija Hočevar; Tanaz A Kermani; Eric L Matteson; Susan P Mollan; Lorna Neill; Cristina Ponte; Carlo Salvarani; Sebastian Eduardo Sattui; Wolfgang A Schmidt; Philip Seo; Josef S Smolen; Jens Thiel; Carlos Enrique Toro-Gutiérrez; Madeline Whitlock; Frank Buttgereit

doi:10.1136/ard-2022-223429

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

Ann Rheum Dis. 2024 Jan 2;83(1):48-57. doi: 10.1136/ard-2022-223429.

Authors

Christian Dejaco^{1

2}, Andreas Kerschbaumer³, Daniel Aletaha⁴, Milena Bond², Elvis Hysa⁵, Dario Camellino⁶, Lisa Ehlers⁷, Andy Abril⁸, Simone Appenzeller⁹, Maria C Cid¹⁰, Bhaskar Dasgupta¹¹, Christina Duftner¹², Peter C Grayson¹³, Bernhard Hellmich¹⁴, Alojzija Hočevar^{15

16}, Tanaz A Kermani¹⁷, Eric L Matteson¹⁸, Susan P Mollan^{19

20}, Lorna Neill²¹, Cristina Ponte^{22

23}, Carlo Salvarani^{24

25}, Sebastian Eduardo Sattui²⁶, Wolfgang A Schmidt²⁷, Philip Seo²⁸, Josef S Smolen²⁹, Jens Thiel^{30

31}, Carlos Enrique Toro-Gutiérrez³², Madeline Whitlock³³, Frank Buttgereit³⁴

Affiliations

¹ Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria [email protected].
² Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy.
³ Abteilung für Rheumatologie, Medizinische Universitat Wien Universitatsklinik fur Innere Medizin III, Wien, Austria.
⁴ Department of Rheumatology, Medizinische Universität Wien, Wien, Austria.
⁵ Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, University of Genoa, Genova, Italy.
⁶ Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Italy.
⁷ Department of Rheumatology and Clinical Immunology, Charite Medical Faculty Berlin, Berlin, Germany.
⁸ Rheumatology, Mayo Clinic, Jacksonville, Florida, USA.
⁹ Departamento de Clínica Médica. Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil.
¹⁰ Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
¹¹ Rheumatology, Southend Hospital NHS Trust, Westcliff-on-sea, UK.
¹² Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria.
¹³ National Institutes of Health/NIAMS, Bethesda, Maryland, USA.
¹⁴ Klinik für Innere Medizin, Rheumatolgie und Immunologie, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany.
¹⁵ Department of Rheumatology, Universitiy Medical Centre, Ljubljana, Slovenia.
¹⁶ Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
¹⁷ Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
¹⁸ Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
¹⁹ Ophthalmology, University Hospitals Birmingham, Birmingham, UK.
²⁰ Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
²¹ Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Nethy Bridge, UK.
²² Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal.
²³ Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal.
²⁴ Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.
²⁵ Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
²⁶ Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁷ Rheumatology, Immanuel Krankenhaus Berlin, Berlin-Buch, Berlin, Germany.
²⁸ Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA.
²⁹ Rheumatology, Medical University of Vienna, Wien, Austria.
³⁰ Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria.
³¹ Clinic for Rheumatology and Clinical Immunology, University Hospital Freiburg, Faculty of Medicine, Freiburg, UK.
³² Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia.
³³ Rheumatology, Southend University Hospital, Southend, UK.
³⁴ Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.

Abstract

Objectives: To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).

Methods: A systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously.

Results: Five overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment.

Conclusion: These are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.

Keywords: Biological Therapy; Giant Cell Arteritis; Outcome and Process Assessment, Health Care; Polymyalgia Rheumatica.

Publication types

Systematic Review

MeSH terms

Comorbidity
Giant Cell Arteritis* / complications
Humans
Polymyalgia Rheumatica* / epidemiology
Quality of Life