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Maintenance of clinical remission in ANCA-associated vasculitis

Nature Reviews Rheumatology volume 9, pages 127–132 (2013)Cite this article

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Abstract

A fundamental change in management of antineutrophil cytoplasmic antibody-associated vasculitis in the past 10 years is the early focussed use of aggressive immunosuppression, using regimens comprised of widely available medications. Using a clinical framework to quantify morbidity, we can induce remission in most patients within 3–6 months using glucocorticoids plus methotrexate, cyclophosphamide or rituximab, with additional plasmapheresis when indicated. Difficulty in maintaining remission probably relates to the difference between true pathophysiological remission and the absence of clinical, serological or radiological evidence of disease activity. For surviving patients, the cumulative problems of relapse, burden of disease, or its treatment are coupled with pre-existing diseases or new conditions arising since diagnosis. Initial early control should reduce subsequent damage, but what effect it will have on relapse is not clear. In the absence of a cure, future trials should focus on reducing toxicity and comorbidity as well as controlling disease.

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Figure 1: Algorithm for the management of ANCA-associated vasculitis.

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Acknowledgements

The author would like to acknowledge editorial assistance from Keri Fathers.

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  1. Nuffield Department of Orthopaedics, NIHR Musculoskeletal Biomedical Research Unit, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, OX3 7HE, Oxford, UK

    Raashid Luqmani

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Luqmani, R. Maintenance of clinical remission in ANCA-associated vasculitis. Nat Rev Rheumatol 9, 127–132 (2013). https://doi.org/10.1038/nrrheum.2012.188

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