Clinical Reviews in Allergy & Immunology

, Volume 54, Issue 2, pp 244–260 | Cite as

Unmet Needs in the Pathogenesis and Treatment of Vasculitides

  • Francesco Muratore
  • Giulia Pazzola
  • Alessandra Soriano
  • Nicolò Pipitone
  • Stefania Croci
  • Martina Bonacini
  • Luigi Boiardi
  • Carlo Salvarani


Despite the progress in the last years on the field of vasculitides, there are several unmet needs regarding classification, disease activity assessment, predictors of flares and complications, and type of treatment for the different forms. The 1990 American College of Rheumatology (ACR) classification criteria currently used to define giant cell arteritis and Takayasu arteritis were designed to discriminate between different types of vasculitides but not to differentiate vasculitis from other disorders. Recently, efforts have been made to overcome the shortcomings of the ACR criteria. The lack of an accepted definition of disease activity in large-vessel vasculitides presents a major challenge in creating useful and valid outcome tools for the assessment of disease course. Identification of predictors of flares can aid in optimizing therapeutic strategies, minimizing disease flares, and reducing treatment-related side effects. It is furthermore important to recognize and characterize the risk factor that might predict the manifestations associated with poor outcome and prognosis. Two RCTs have evidenced the efficacy of tocilizumab in addition to glucocorticoids (GCs) in the treatment of giant cell arteritis (GCA). However, the role of tocilizumab or other biological agents without GCs needs to be investigated. Recent observational studies have suggested that rituximab is also effective in patients with eosinophilic granulomatosis with polyangiitis and in antineutrophil cytoplasmic antibodies (ANCA)-negative patients with granulomatosis with polyangiitis and microscopic polyangiitis. Rituximab or anti-TNF alfa may represent a possible alternative therapy in case of refractory or difficult to treat polyarteritis nodosa (PAN) patients. The new International Criteria for Behçet’s Disease have shown a better sensitivity and a better accuracy compared to the older International Study Group on Behçet’s Disease criteria. The EULAR recommendations for the management of Behçet’s disease (BD) have been recently updated. However, the treatment of refractory disease is still a real challenge.


Vasculitis Treatment Unmet needs Tocilizumab Rituximab Large-vessel vasculitis ANCA-associated vasculitis Behçet’s disease 




Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Francesco Muratore
    • 1
    • 2
  • Giulia Pazzola
    • 1
    • 2
  • Alessandra Soriano
    • 1
    • 3
  • Nicolò Pipitone
    • 1
  • Stefania Croci
    • 4
  • Martina Bonacini
    • 4
  • Luigi Boiardi
    • 1
  • Carlo Salvarani
    • 1
    • 2
  1. 1.Division of Rheumatology, Department of MedicineArcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere ScientificoReggio EmiliaItaly
  2. 2.University of Modena and Reggio EmiliaModenaItaly
  3. 3.Campus Bio-MedicoUniversity of RomeRomeItaly
  4. 4.Unit of Clinical Immunology, Allergy and Advanced BiotechnologiesArcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere ScientificoReggio EmiliaItaly

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