The European League Against Rheumatism (EULAR) has developed 12 evidence-based recommendations for the use of imaging in the diagnosis and monitoring of suspected large vessel vasculitis, including giant cell arteritis and Takayasu arteritis. The recommendations have been published in the Annals of the Rheumatic Diseases.

In their literature search, the investigators collected data on the role of imaging modalities, including ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and [18F]-fluorodeoxyglucose positron emission tomography (PET) scans, in patients with large vessel vasculitis. The task force comprised 20 physicians, healthcare professionals, and patients from 10 EULAR countries, who worked to develop recommendations based on evidence and expert opinion. A consensus was obtained through voting, with an additional anonymous vote at the final level of agreement.

EULAR developed a total of 12 recommendations. The task force recommends that patients with suspected large vessel vasculitis undergo an early imaging test. Ultrasound should be used as the first choice for patients with suspected giant cell arteritis, and MRI should be used for those with suspected Takayasu arteritis. Alternatively, CT or PET scanning may be used.

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Following clinical examination and imaging, if a patient’s diagnosis is still questionable, further recommendations include the use of temporal artery biopsy or additional imaging as needed. In individuals who experience a suspected flare, imaging might be beneficial to better evaluate disease activity. The choice and frequency of imaging modalities for long-term monitoring of structural damage should be an individual decision. Patients who are at risk for the development of aortic aneurysms should be closely monitored. All imaging should be performed by trained, skilled specialists with the use of appropriate operational procedures and settings.

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The investigators noted that these are the first EULAR recommendations that provide current guidance for imaging in the diagnosis and monitoring of patients with suspected large vessel vasculitis. All of the recommendations are supported by evidence and expert consensus. The authors added that future progress is expected regarding the use of imaging in patients with large vessel vasculitis, and an amendment to the current EULAR recommendations may be warranted.

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Dejaco C, Ramiro S, Duftner C, et al.  EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice [published online January 22, 2018]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-212649