Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis

Alexandre Wagner S. De Souza, Emilia I. Sato, Maria Lorena Brance, Daniel G. Fernández-Ávila, Marina Scolnik, Sebastián Juan Magri, Manuel Francisco Ugarte-Gil, Luis Felipe Flores-Suárez, Lina María Saldarriaga-Rivera, Alejandra Babini, Natalia V. Zamora, María Laura Acosta Felquer, Facundo Vergara, Leandro Carlevaris, Santiago Scarafia, Enrique Roberto Soriano Guppy, Sebastian Unizony

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). Methods A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members. Results Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible. Conclusion The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.

Original languageEnglish
Pages (from-to)316-325
Number of pages10
JournalJournal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
Issue number7
StatePublished - 1 Oct 2023


  • Takayasu arteritis
  • guideline
  • treatment
  • vasculitis


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