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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.

Original publication

DOI

10.1038/nrrheum.2012.188

Type

Journal article

Journal

Nature reviews. Rheumatology

Publication Date

02/2013

Volume

9

Pages

127 - 132

Addresses

NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Oxford OX3 7HE, UK. raashid.luqmani@ndorms.ox.ac.uk

Keywords

Humans, Cyclophosphamide, Methotrexate, Glucocorticoids, Plasmapheresis, Drug Therapy, Combination, Remission Induction, Disease Management, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Antibodies, Monoclonal, Murine-Derived, Rituximab