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Vasculitis
Original article
Validation of the EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis by disease content experts
  1. Max Yates1,2,
  2. Richard Watts2,3,
  3. Ingeborg Bajema4,
  4. Maria Cid5,
  5. Bruno Crestani6,
  6. Thomas Hauser7,
  7. Bernhard Hellmich8,
  8. Julia Holle9,
  9. Martin Laudien10,
  10. Mark A Little11,
  11. Raashid Ahmed Luqmani12,
  12. Alfred Mahr13,
  13. Peter Merkel14,
  14. John Mills15,
  15. Janice Mooney1,
  16. Mårten Segelmark16,
  17. Vladimir Tesar17,
  18. Kerstin W A Westman18,
  19. Augusto Vaglio19,
  20. Nilüfer Yalçındağ20,
  21. David R Jayne21 and
  22. Chetan Mukhtyar1
  1. 1Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
  2. 2Norwich Medical School, Bob Champion Research and Education Building, Colney Lane, Norwich, UK
  3. 3Department of Rheumatology, Ipswich Hospital NHS Trust, Norwich Medical School, Norwich, UK
  4. 4Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
  6. 6Assistance Publique-Hôpitaux de Paris, Department of Pulmonology, Bichat-Claude Bernard University Hospital, Paris, France
  7. 7Immunologie-Zentrum Zürich, Zürich, Switzerland
  8. 8Vaskulits-Zentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Klinik Kirchheim, Kirchheim-Teck, Germany
  9. 9Rheumazentrum Schleswig-Holstein Mitte, Kuhberg 5a-7, Neumünster, Germany
  10. 10Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Kiel, Germany
  11. 11Trinity Health Kidney Centre, Tallaght Hospital, Dublin, Ireland
  12. 12Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
  13. 13Department of Internal Medicine, Hôpital Saint-Louis, Université Paris 7 René Diderot, Paris, France
  14. 14Division of Rheumatology and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  15. 15Vasculitis UK, West Bank House, Winster, Matlock, UK
  16. 16Department of Medical and Health Sciences Nephrology, Linköping University, Linköping, Sweden
  17. 17Department of Nephrology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  18. 18Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö, Sweden
  19. 19Nephrology Unit, University Hospital of Parma, Parma, Italy
  20. 20Department of Ophthalmology, School of Medicine, Ankara University, Ankara, Turkey
  21. 21Lupus and Vasculitis Unit, Addenbrooke's Hospital, Cambridge, UK
  1. Correspondence to Dr Max Yates, Norwich Medical School; maxyates{at}doctors.org.uk

Abstract

The European League Against Rheumatism recommendations for the management of antineutrophil cytoplasmic antibody-associated vasculitis have been recently published. Unique to recommendation development, they were also voted on by members of a learned society. This paper explores the wider validity of the recommendations among people who self-identify as clinicians caring for patients with vasculitis. In addition to the task force, a learned society (European Vasculitis Society—EUVAS) was invited, through online survey, to rate independently the strength of evidence of each recommendation to obtain an indication of the agreement among the final target audience and ultimate end-users of the recommendations. The survey took place in June 2015. Of the 158 EUVAS members surveyed, there were 88 responses (55.7%). There was a large degree of agreement in the voting patterns between EUVAS survey participants and task force members. Notable exceptions were lower grades for the recommendation of the use of rituximab for remission induction in patients with eosinophilic granulomatosis with polyangiitis and for methotrexate and mycophenolate mofetil as remission maintenance agents in patients with granulomatosis with polyangiitis/microscopic polyangiitis by EUVAS members. These results are encouraging and suggest that the voting patterns of the task force are representative of the wider vasculitis community. We recommend future recommendations adopt this approach for data/expert-based treatment guidelines, especially for multisystem diseases.

  • ANCA-associated vasculitis
  • Recommendations
  • Survey

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000449

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    Footnotes

    • Contributors MY drafted the manuscript. All authors have contributed to editing the drafts of the paper.

    • Funding MY is a recipient of a Clinical Research PhD Fellowship from Arthritis Research UK.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data from this survey are available from the corresponding author on request.