Updated EULAR recommendations for managing polymyalgia rheumatica (PMR), giant cell arteritis (GCA), and Takayasu arteritis (TAK), developed by an international task force using systematic literature reviews of evidence published since the 2015 PMR and 2018 GCA/TAK guidelines.
The task force produced 4 overarching principles, 12 recommendations, and 2 quality indicators with high levels of agreement. Key updates include: immediate GC start for suspected GCA (without waiting for confirmatory tests); GC initiation at 15–25 mg/day for PMR and 40–60 mg/day for GCA/TAK; IL-6 receptor inhibitors as adjunctive therapy for PMR and GCA; upadacitinib as an option for GCA; and mandatory GC-sparing agents for all TAK patients.
As a consensus recommendations paper, the strength of individual recommendations depends on underlying trial evidence, which may be limited for some conditions (especially TAK). The systematic reviews cover only data published after prior guideline versions, so older evidence is inherited rather than re-evaluated.
Refer all suspected GCA patients to a specialist within 24 hours and start glucocorticoids immediately — do not wait for biopsy or imaging results. For GCA or TAK, combine GC with a GC-sparing agent (IL-6 receptor inhibitor, upadacitinib, or methotrexate) in selected patients; all TAK patients should receive combination therapy.
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