Latest news with #vasculitis
Medscape
07-07-2025
- Health
- Medscape
Fast Five Quiz: Management of MPA
Microscopic polyangiitis (MPA) represents one category within the antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV), alongside granulomatosis with polyangiitis (GPA) and eosinophilic GPA (EGPA). MPA is associated with distinct presentations, organ involvement, and worse prognosis than EGPA and GPA; treatment strategies must be customized according to disease severity, affected organs, and individual patient characteristics. What do you know about the management of MPA? Check your knowledge with this quick quiz. Although renal involvement is common in ANCA vasculitis owing to a high concentration of blood vessels, subtypes of ANCA vasculitis have distinct patterns of extrarenal involvement. These varying clinical presentations correlate with different antibody profiles: MPA commonly associates with myeloperoxidase (MPO) serology while GPA generally presents with proteinase 3 (PR3) serology. Following renal involvement, the pulmonary system is a commonly involved organ system in MPA; cutaneous involvement and neurologic manifestations are also common. MPA typically shows fewer manifestations in the ear, nose, and throat region and eyes than other subtypes. Cardiovascular system and gastrointestinal system involvement are more often seen in EGPA, though patients with MPA can experience cardiovascular and gastrointestinal symptoms. Learn more about renal involvement in MPA. The latest Kidney Disease Improving Global Outcomes (KDIGO) and European Alliance of Associations for Rheumatology (EULAR) guidelines recommend beginning plasma exchange in patients with MPA when serum creatinine rises above > 300 µmol/L (equivalent to 3.4 mg/dL, as stated by KDIGO). This is supported by a recent meta-analysis that reported plasma exchange reduces the risk for end-stage kidney disease at 12 months; the same serum creatinine level for initiation was recommended by the researchers. However, they noted that plasma exchange was not found to improve the combined endpoint of "death and/or end-stage kidney disease." Additionally, KDIGO also recommends plasma exchange for patients requiring dialysis or those with diffuse alveolar hemorrhage and hypoxemia, but EULAR specifically recommends against routine use of plasma exchange for diffuse alveolar hemorrhage in patients with MPA and GPA. Learn more about creatinine monitoring in MPA. The latest KDIGO guidelines recommend considering discontinuation of immunosuppressive therapy in patients with MPA who have remained on dialysis for 3 months without extrarenal disease manifestations. This approach acknowledges that patients with MPO-ANCA-associated vasculitis (which is most strongly associated with MPA) who have kidney failure without involvement of other organs face minimal relapse risk. Supporting this, the EULAR cites research demonstrating that patients who are dependent on dialysis and in remission without immunosuppression are significantly more likely to experience serious infectious or cardiovascular complications from continued treatment than suffer disease recurrence; they specifically recommend weighing benefits and harms in continuing immunosuppressive therapy in the MPA subtype of ANCA. Learn more about immunosuppressive therapy in MPA. According to a recent review citing data from KDIGO, patients with MPA typically have the worst kidney prognosis due to the chronic damage associated with this subtype. Further, patients with EGPA less often have kidney involvement than GPA or MPA and usually have better kidney prognosis. Kidney prognosis is generally worse in patients with MPA than those with GPA as well. KDIGO also cites previously developed prognostic scoring systems (which include sclerotic, focal, crescentic, and mixed class), depending on most of the glomeruli histology. For example, focal class (> 50% normal glomeruli) is associated with a favorable outcome, while sclerotic class (≥ 50% sclerotic glomeruli) is associated with poorer outcomes. Learn more about prognosis in MPA. Both KDIGO and EULAR guidelines recommend a tapering schedule of 4-5 months after initiating glucocorticoids in patients with MPA, reaching a reduced dose (listed as " 5 mg prednisolone equivalent" per day) by that point. Tapering schedule is generally based on weight and disease severity. For example, for patients weighing > 75 kg (165 lb), EULAR suggests starting at 75 mg, then tapering to 40 mg by week 2, then lowering the dose by approximately 25% every 2 weeks until reaching 5 mg by week 19. This is the same tapering schedule recommended by KDIGO; the full tapering schedule for this weight and others can be found here. Clinical evidence supporting this strategy comes from the PEXIVAS trial, which demonstrated that lowering steroid exposure by 40% during the initial 6 months maintained therapeutic effectiveness while significantly decreasing serious infection rates compared to conventional dosing. This accelerated reduction strategy effectively balances inflammatory control with minimizing steroid-related complications. Learn more about glucocorticoids in MPA.
Medscape
03-07-2025
- Health
- Medscape
Fast Five Quiz: Management of GPA
Granulomatosis with polyangiitis (GPA) is a variant of anti-neutrophil cytoplasmic antibody ( ANCA)-associated vasculitis that most commonly presents with proteinase 3 (PR3) serology and distinct clinical features that necessitates swift identification and therapeutic intervention. Prompt treatment plays a crucial role in minimizing permanent organ damage, particularly in the renal and pulmonary systems. What do you know about the management of GPA? Check your knowledge with this quick quiz. The latest guidelines from the Kidney Disease Improving Global Outcomes (KDIGO) and European Alliance of Associations for Rheumatology (EULAR) both recommend initiating immunosuppressive therapy in patients with suspected PR3 positive ANCA vasculitis, which is indicative of GPA, even if clinicians are still awaiting biopsy results. Further, EULAR specifically acknowledges that collecting biopsies might not be feasible for each patient with ANCA vasculitis and treatment should 'not be delayed while awaiting histological information.' Learn more about biopsy for GPA. KDIGO recommends maintaining therapeutic intervention for 18 months to 4 years following successful remission, which is similar to the EULAR guidelines recommending maintenance therapy for 24-48 months in patients with GPA. They also state, 'longer duration of therapy should be considered in relapsing patients or those with an increased risk of relapse, but should be balanced against patient preferences and risks of continuing immunosuppression.' Learn more about remission maintenance in GPA. Infection is a significant concern in ANCA vasculitis, especially regarding immunosuppressive therapies including glucocorticoids that are used to manage the clinical manifestations of the disease. Recent research has shown that chronic nasal carriage of S aureus is significantly higher in patients with the GPA subtype; it has also been shown to be associated with increased endonasal activity and risk for relapse. Although M catarrhalis, H influenzae, and S pneumoniae do not appear to have a specific association with GPA, data have shown that infection is among the most common causes of death in GPA. Learn more about infection in GPA. Data indicate that the GPA subtype is an independent risk factor for disease recurrence. Additionally, KDIGO also considers lower serum creatinine, more extensive disease, PR3 histology (which is associated with higher relapse rates than MPO-positive disease commonly seen in MPA) and ear, nose, and throat involvement as 'baseline factors' for disease recurrence. Factors after diagnosis include history of relapse, ANCA positivity at the end of induction, and rise in ANCA. Treatment-related relapse factors include lower cyclophosphamide exposure, immunosuppressive withdrawal, and glucocorticoid withdrawal. Learn more about prognosis in GPA. To ensure disease does not recur into the transplanted tissue, KDIGO specifically recommends delaying kidney transplantation until patients have achieved complete clinical remission for at least 6 months. Further, ANCA positivity or negativity should not factor into this decision, with KDIGO stating, 'the persistence of ANCA should not delay transplantation.' Although a serum creatinine of > 4 mg/dL is a significant predictor of relapse, guidelines recommend considering combination of a monoclonal antibody and an alkylating agent for this indication. Similarly, induction and maintenance of dialysis should also be done under various separate conditions. Learn more about kidney transplantation for GPA. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Medscape
01-07-2025
- Health
- Medscape
Fast Five Quiz: The Presentation and Diagnosis of GPA
Formerly known as Wegener granulomatosis, the granulomatosis with polyangiitis (GPA) subtype of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis can impact a variety of organ systems, often presenting with a diverse range of clinical features that complicate timely diagnosis. Knowing how to identify the symptoms and diagnose this rare disease is paramount for adequate treatment. What do you know about the presentation and diagnosis of GPA? Check your knowledge with this quick quiz. Upper and lower respiratory tract involvement, along with the skin, eyes, and nervous system (with or without kidney manifestations) are the classic presentations of ANCA vasculitis, with most common presentations of GPA being respiratory, renal, and ear, nose, and throat (ENT) symptoms. ENT manifestations are distinctive and include nasal tissue crusting, mucosal damage causing epistaxis, cartilage deterioration leading to saddle nose deformity, erosive sinus disease, and subglottic stenosis. Isolated liver involvement in GPA is considered rare. Gastrointestinal involvement can occur in patients with GPA, but it is also not common. Though neurological symptoms can be seen in patients with GPA, isolated involvement is not as common as upper and lower respiratory tract involvement. Learn more about the presentation of GPA. MRI is suggested for detecting pachymeningitis and retro-orbital lesions in patients with GPA, with researchers who have evaluated patient cases of GPA stating that the 'exploration of pachymeningitis relies on MRI.' Further, MRI is usually more effective than CT when detecting pachymeningitis. F-18-fluorodeoxyglucose PET with CT is usually used to detect occult inflammation and exclude malignancy and infection in this population; however, data have shown this method has high sensitivity for detecting cardiovascular, lung, nasal/sinus, and kidney involvements. Standard radiograph is not usually used in this setting. Learn more about imaging for GPA. The distinctive renal pathology in GPA is characterized by pauci-immune focal and segmental necrotizing and crescentic glomerulonephritis. This histological pattern features inflammatory destruction of small blood vessels with scant or undetectable immune complex deposits in vessel walls. Microscopic examination of kidney tissue typically reveals areas of fibrinoid necrosis within glomeruli and proliferative changes outside capillaries forming crescents; inflammation of small vessels with neutrophil infiltration and endothelial alterations might be observed as well. When examined with immunofluorescence techniques, the tissue shows minimal or absent staining for immunoglobulins and complement factors, confirming the pauci-immune nature of the condition. Though membranous nephropathy, minimal change disease, and lupus nephritis are types of glomerulonephritis, they are not characteristic of GPA. Learn more about renal histology in GPA. PR3-ANCA shows the strongest association with GPA. Various sources have shown that PR3-ANCA is present in approximately 80% of patients with GPA but can be positive in 2%-27% of patients with microscopic polyangiitis (MPA). Though ANCA testing offers valuable diagnostic insights, clinicians should evaluate results alongside clinical presentations and tissue examinations, since these antibodies occasionally appear in other inflammatory disorders or as medication side effects. MPO-ANCA is associated with GPA but it is not as common as PR3-ANCA. Anti-neutrophil elastase and ANTI-LAMP2 can be seen with ANCA-associated vasculitis but are not specific for GPA. Learn more about ANCA detection in GPA. The presence of lung nodules serves as a key distinguishing feature of GPA when compared with MPA. Although both conditions might present with pulmonary bleeding from capillaritis, nodular formations or cavitary nodules strongly suggest GPA rather than MPA. Conversely, pulmonary fibrosis typically appears in patients with MPA and rarely develops in those with GPA. Interstitial lung disease in an interstitial pneumonia pattern is associated with MPA. Learn more about pulmonary histology in GPA.
Yahoo
24-06-2025
- Health
- Yahoo
Vasculitis Market Analysis Report 2025-2035, Competitive Analysis of GlaxoSmithKline, Mitsubishi Tanabe Pharma, Novartis, and Amgen
Vasculitis, a severe blood vessel condition, drives the global market's growth due to advancements in biologic treatments like monoclonal antibodies. Enhanced diagnostics and personalized medicine bolster this trend. North America leads the market, backed by advanced healthcare infrastructure and research funding. Rising cases, driven by aging populations and lifestyle factors, highlight demand, while high treatment costs and unmet needs in rare forms pose challenges. For companies, focusing on innovation in biologics and strategic partnerships is key to competitive advantage. Discover insights on vasculitis market trends and opportunities for growth. Dublin, June 24, 2025 (GLOBE NEWSWIRE) -- The "Vasculitis Market - A Global and Regional Analysis: Analysis and Forecast, 2025-2035" report has been added to is a rare but severe condition that results in inflammation of blood vessels, leading to a wide range of symptoms that can disrupt normal blood flow and damage affected organs. The variability in its presentation, from mild cases to severe manifestations, necessitates the development of targeted therapies. The growing focus on biologic treatments, such as monoclonal antibodies and advanced immunomodulators, will continue to play a key role in driving the global vasculitis market forward during the forecast advancements in diagnostics, as well as a growing understanding of the pathophysiology of vasculitis, are also expected to contribute significantly to market expansion. Personalized medicine and the integration of digital health solutions in treatment management are poised to revolutionize the therapeutic landscape for vasculitis America is projected to remain the dominant region in the global vasculitis market. This is primarily due to the region's advanced healthcare infrastructure, higher levels of patient awareness, and robust government funding aimed at fostering research into autoimmune diseases like vasculitis. How Can This Report Add Value to an Organization?Product/Innovation Strategy: The global vasculitis market is witnessing a surge in product innovations, particularly in the field of biologics and personalized medicine. This report provides valuable insights into the development of new treatment strategies, helping companies identify new product opportunities, particularly in biologic therapy and patient management Strategy: Companies aiming to secure or enhance their market share in the global vasculitis market should focus on improving the efficacy and safety profiles of existing therapies, and exploring new biologic treatment combinations to offer personalized care solutions. Companies can also strengthen their position through strategic partnerships, collaborations with research institutions, and investments in early-stage - Drivers and LimitationsThe global vasculitis market is witnessing rising demand due to several key drivers: The rise in vasculitis cases is driven by an aging population, lifestyle factors, and improved awareness and diagnosis Biologics and immunomodulators are revolutionizing vasculitis treatment with more targeted and effective therapies Enhanced imaging, biomarkers, and genetic tests are enabling earlier and more accurate vasculitis diagnosis. Limitations: High costs of biologic therapies restrict access for some patients, particularly in low-income regions There is an unmet need for effective treatments for specific rare and refractory forms of vasculitis Companies Featured GlaxoSmithKline Mitsubishi Tanabe Pharma Corporation Novartis AG Amgen Key Topics Covered: Executive SummaryMarket/Product DefinitionInclusion and Exclusion1. Global Vasculitis Market: Industry Outlook1.1 Market Overview and Ecosystem1.2 Epidemiological Analysis of Vasculitis1.2.1 By Region1.3 Market Trends1.4 Clinical Trials Analysis1.4.1 By Phase1.5 Regulatory Landscape Analysis1.5.1 Legal Requirement and Framework in U.S.1.5.2 Legal Requirement and Framework in E.U.1.5.3 Legal Requirement and Framework in Asia-Pacific1.6 Market Dynamics1.6.1 Impact Analysis1.6.2 Market Drivers1.6.3 Market Restraints1.6.4 Market Opportunities2. Global Vasculitis Market, by Region, $Million, 2023-20352.1 North America2.1.1 Key Findings2.1.2 Market Dynamics2.1.3 Market Sizing and Forecast2.1.3.1 North America Vasculitis Market (by Country)2.1.3.1.1 U.S.2.1.3.1.2 Canada2.2 Europe2.2.1 Key Findings2.2.2 Market Dynamics2.2.3 Market Sizing and Forecast2.2.3.1 Europe Vasculitis Market (by Country)2.2.3.1.1 Germany2.2.3.1.2 France2.2.3.1.3 Italy2.2.3.1.4 U.K.2.3 Asia-Pacific2.3.1 Key Findings2.3.2 Market Dynamics2.3.3 Market Sizing and Forecast2.3.3.1 Asia-Pacific Vasculitis Market (by Country)2.3.3.1.1 Japan3. Global Vasculitis Market: Competitive Benchmarking and Company Profiles3.1 Competitive Landscape3.1.1 Key Strategies and Developments3.1.1.1 Funding Activities3.1.1.2 Mergers and Acquisitions3.1.1.3 Regulatory Approvals3.1.1.4 Partnerships, Collaborations and Business Expansions3.1.2 Key Developments Analysis3.2 Company Profiles3.2.1 Company Overview3.2.2 Product Portfolio3.2.3 Target Customers/End Users3.2.4 Key Personnel3.2.5 Analyst View4. Research Methodology For more information about this report visit About is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends. CONTACT: CONTACT: Laura Wood,Senior Press Manager press@ For E.S.T Office Hours Call 1-917-300-0470 For U.S./ CAN Toll Free Call 1-800-526-8630 For GMT Office Hours Call +353-1-416-8900Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Medscape
13-05-2025
- Health
- Medscape
Managing ANCA Vasculitis: Guideline ‘Transcends' Specialties
MANCHESTER, England — A soon-to-be-released guidance from the British Society for Rheumatology on the management of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) emphasizes not only the need for more aggressive management but also the importance of cross-specialty services that can be accessed quickly throughout the United Kingdom. The revised recommendations are timely as they coincide with a National Health Service (NHS) England initiative that is looking at how to improve rheumatology services across the board generally through its Getting It Right First Time initiative. One of the first steps in this initiative for improving AAV services in particular has been to set up a national cohort of patients that can be tracked through the healthcare system to see what improvements are needed in order to optimize overall care and service outcomes. 'The management of vasculitis transcends specialty,' Neil Basu, MBChB, PhD, professor of musculoskeletal medicine and vasculitis at the University of Glasgow, Glasgow, Scotland, said in introducing the updated AAV guidelines, which he was a part of, at the British Society for Rheumatology (BSR) 2025 Annual Meeting. 'I think it's entirely appropriate, and great, that we have a nephrologist leading the way with our BSR guidelines.' Lorraine Harper, MBChB, PhD That nephrologist is Lorraine Harper, MBChB, PhD, a consultant and professor at the University of Birmingham, Birmingham, England, and chair of the multidisciplinary team of experts who have been involved in updating the guidance. Harper noted at the BSR session that it was high time that the recommendations for managing AAV in the United Kingdom were reprised: 'The 2014 guidelines really did significantly impact the way we managed patients with vasculitis, but there's a lot gone on since 2014, and it now doesn't reflect best practice.' Moreover, the previous guidance did not 'span the age range,' Harper said, a consideration that has now been included in the AAV guidance update, as well as many other BSR clinical guidelines that have been updated recently. In comments to Medscape Medical News , Chetan Mukhtyar, MD, PhD, a consultant rheumatologist for Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England, who was not involved with creating the guidelines, said 'there are some emerging data that have now demonstrated what we have always known in vasculitis, that it is not something that should be taken lightly; it has significant immediate mortality, and it has long-term implications on resources. We need to get it right, quickly and first time, and the recommendations will help us get there, but the resource implications will need to be recognized by the wider NHS.' Building on Existing Evidence Members of the British AAV guideline working group consulted recent recommendations from other organizations, including that from the American College of Rheumatology (ACR) published in 2021, the European Alliance of Associations for Rheumatology (EULAR) published last year, and the Kidney Disease: Improving Patient Outcomes (KDIGO) organization, also published in 2024. 'Although we used the BSR methodology, we did adapt a little bit, so we didn't do the literature search from 2014; where the area we're looking at was covered by EULAR, we used their literature search. So that we weren't just reinventing the wheel,' Harper said. To produce the guidance, 30 experts across the five specialties of rheumatology, nephrology, otolaryngology, respiratory medicine, and pediatrics formed five small working groups to look at specific topic areas. These were the treatment of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA); the treatment of subglottic stenosis and ear, nose, and throat (ENT) disease associated with GPA; the treatment of eosinophilic granulomatosis with polyangiitis (EGPA); service specification; and patient education and support. Key Update Examples The revised recommendations, which are expected to be published in early June, include a change to how immunosuppression should be used in the initial treatment of GPA and MPA, with a more aggressive approach than previously. 'Back in 2014, we recommended [intravenous] pulsed cyclophosphamide or rituximab for organ- or life-threatening disease. We've amended that now to suggest that all patients with active ANCA vasculitis should be considered for intravenous pulsed cyclophosphamide or rituximab,' Harper said. In addition, treatment with rituximab should be preferred for patients with relapsing disease. This aligns with the 2024 EULAR guidance but differs from the 2021 ACR guidance, she said. The revised British guidance states that methotrexate and mycophenolate mofetil 'may be considered' as alternatives for induction therapy for patients with active disease but without any evidence of life- or organ-threatening disease, but that cyclophosphamide and rituximab are preferred. 'Plasma exchange remains a contentious issue, and should we use it?' Harper asked. In the PEXIVAS trial, there was no difference seen in the combined outcome endpoint of death and end stage kidney disease. However, post hoc data suggest there could be earlier and fuller recovery of renal function with plasma exchange. Based on available data, the British recommendation 'takes a pragmatic view' to think about using plasma exchange only in adult patients with active GPA or MPA and severe renal involvement if they have a serum creatinine level > 300 mmol/L (3.4 mg/dL). The use of adjunctive plasma exchange needs to be carefully balanced against the risk for potential adverse events, Harper cautioned. And while its use in pediatrics should be limited to a case-by-case basis, plasma exchange does appear to have beneficial role in managing pulmonary hemorrhage, so long as there is no severe kidney involvement. Reducing Glucocorticoid Dependency With avacopan (Tavneos) now available, the recommendations are to use it in active GPA or MPA as a potential glucocorticoid-sparing agent; this could be given with or without a short course of steroids, Harper explained, with tapering taking place over a 4-week period. For patients with organ- or life-threatening disease, the recommendation is to use oral steroids at a starting dose of 50-75 mg, or 1.0 mg/kg/d; dosing is dependent on weight, Harper said, with the maximum daily recommended dose at 75 mg. Oral prednisolone should be tapered in accordance with the schedule used in the PEXIVAS trial, with the aim to get the dose down to 5 mg prednisolone equivalent per day by 4-5 months. And if the disease is considered neither organ- nor life-threatening, lower steroid-tapering regimens can be considered, starting at a dose of 0.5 mg/kg/d, and tapering according to the schedule used in the LoVAS clinical trial. For maintenance therapy, Harper reported that the updated recommendation was to use rituximab in preference to other agents, using a fixed dosing regimen of 500-1000 mg every 4-6 months. Such treatment should be continued for at least 2-4 years. This was 'a big change' from the 2014 guidance, but again follows ACR, EULAR, and KDIGO guidance. 'Limited GPA' a Misnomer 'We want to get away from using the term 'limited,' when it comes to talking about GPA-related ENT disease because it underestimates the disease burden,' Harper said. Instead, 'ENT-localized' or 'sino-nasal GPA' would be preferred. ENT involvement is where multidisciplinary assessment is particularly vital, Harper said. If there is a plan for reconstructive surgery, the patient needs to be in remission for at least 12 months 'otherwise high failure and complication rates are observed,' she said. Recommendation Updates for EGPA The presence of asthma, particularly if it is adult-onset, remains important for making an EGPA diagnosis. Asthma combined with chronic rhinosinusitis with or without nasal polyps, eosinophilia (typically ≥ 1.5 × 109/L), and end-organ involvement would be considered indicative of having EGPA. Harper acknowledged that because of EGPA's heterogeneous clinical phenotype, a specialized multidisciplinary approach is necessary to exclude other eosinophilic syndromes. For initial treatment, it is recommended that all patients with active disease are assessed for their suitability for induction treatment with glucocorticoids combined with other immunomodulatory agents. Harper noted that the recommended first-line option is intravenous pulsed cyclophosphamide, but if it is contraindicated or unacceptable to the patient, rituximab would be the next choice. As for newer treatments, the anti–interleukin-5–directed therapies mepolizumab and benralizumab were recommended for induction and maintenance of remission, but only in people with nonorgan– or nonlife–threatening disease, Harper said. This is because the recommendation is based on the findings of the MIRRA and MANDARA trials, which excluded patients with more serious disease. Thus, the current recommendation is only to use these drugs in the same population of patients as had been studied in the trials, Harper said. Service Recommendations One of the unique aspects of the guideline update is its detailing of how vasculitis services in the United Kingdom should ideally be set up, and not just based on expert opinion. Rosemary J. Hollick This is the first time that specific, patient-led service recommendations have been included in BSR guidelines, or indeed any vasculitis guidelines, said Rosemary J. Hollick, MBChB, PhD, a senior clinical lecturer and rheumatologist at the University of Aberdeen, Aberdeen, Scotland, and the clinical lead for the Scottish Systemic Vasculitis Managed Clinical Network. The recommendations are based on findings from the Versus Arthritis–funded Vasculitis Outcomes In relation to Care Experience Study (VOICES), which looked at the key components of the best possible service and linked them to patient outcomes. Prompt Specialist Review A key recommendation is that people with newly suspected AAV should have a specialist vasculitis review within 7 days. This is backed up by data from VOICES, which showed prompt review to be associated with a 30% reduction in serious infections, a 22% drop in emergency hospital admissions, and a 41% reduction in deaths, Hollick noted. 'Vasculitis has been long overlooked,' Basu told Medscape Medical News in an interview. 'I think we finally have some excellent tools to improve outcomes dramatically, but the challenge is accessing these tools.' It is important for clinicians, particularly if they are not specialists, to be able to get the support they need to diagnose patients 'really promptly,' Basu added. Thus, the other key service recommendation in the guideline focuses on how to give that support to clinicians, such as in caring for patients in dedicated, 'cohorted' vasculitis clinics that include nurse-led components of care and regular specialist multidisciplinary team meetings. Data from the VOICES study have suggested that both nurse-led and cohorted clinics result in significant reductions in both serious infections (35% and 25%, respectively) and emergency hospital admissions (25% and 19%, respectively). A further recommendation is that people with AAV should feel empowered in shared decision-making and collaborate with their healthcare team to make joint decisions about their care. There are many tools already out there to help explain what shared decision-making should look like to patients, Hollick said. VOICES was funded by Versus Arthritis . Basu and Harper reported no relevant financial relationships. Hollick had received funding unrelated to her presentation from CSL Vifor. Mukhtyar was not involved in the guideline development.
