Recommendations for Inflammatory Aortitis: Diagnosis and Treatment of Takayasu Arteritis and GCA

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

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 18F-FDG positron emission tomography (FDG-PET), is recommended.1–6
Treatment
1	B-NR	2. In patients with active GCA or Takayasu arteritis, initial medical therapy should include high-dose glucocorticoids.7–12
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.7,13,14
1	C-LD	4. In all patients with Takayasu arteritis, non-biological disease-modifying anti-rheumatic drugs (DMARD) should be given in combination with glucocorticoids.7,15,16
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.1,7,15,17–20
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.7,21
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.1,7,17–19