From the Guidelines
The treatment for celiac axis vasculitis should prioritize immunosuppressive therapy, with a combination of glucocorticoids and either rituximab or cyclophosphamide as the first-line treatment, as recommended by the EULAR guidelines for the management of ANCA-associated vasculitis 1.
Key Considerations
- The choice of immunosuppressant depends on the severity and organ involvement of the disease, with cyclophosphamide preferred for severe cases and rituximab for relapsing disease 1.
- Glucocorticoids should be initiated at a dose of 50-75 mg prednisolone equivalent/day, with a stepwise reduction to 5 mg/day by 4-5 months 1.
- Biologic agents like rituximab may be considered in resistant cases, with a dose of 375 mg/m² IV weekly for 4 weeks 1.
- Regular monitoring with clinical assessments, inflammatory markers, and vascular imaging studies is crucial to adjust treatment and prevent complications.
Additional Therapies
- Antiplatelet therapy with aspirin may be added to prevent thrombotic complications.
- Management of underlying conditions, such as systemic vasculitides or autoimmune disorders, is essential to prevent disease progression.
- Treatment aims to suppress inflammation, prevent vascular complications, and address ischemic symptoms affecting the organs supplied by the celiac axis.
Important Recommendations
- A positive biopsy is strongly supportive of a diagnosis of vasculitis, and biopsies should be performed to establish a new diagnosis or evaluate relapsing disease 1.
- Testing for PR3-ANCA and MPO-ANCA using a high-quality antigen-specific assay is recommended for patients with suspected ANCA-associated vasculitis 1.
From the Research
Treatment for Celiac Axis Vasculitis
- The treatment for celiac axis vasculitis typically involves the use of oral corticosteroids, as seen in cases reported in 2 and 3, where patients were successfully treated with a short course of oral corticosteroids.
- In the case reported in 2, the patient was treated with oral corticosteroids for 10 days, which led to symptom resolution and normalization of C-reactive protein levels.
- The use of corticosteroids is aimed at reducing inflammation and preventing further damage to the blood vessels.
- In some cases, other treatments such as azathioprine and prednisone combination therapy may be considered, as reported in 4, although this is more commonly used in the treatment of refractory coeliac disease.
- It is essential to note that the treatment approach may vary depending on the underlying cause of the vasculitis, such as Takayasu arteritis, as reported in 5.
- A multidisciplinary approach to management, involving interventional radiologists, gastrointestinal surgeons, vascular surgeons, and medical physicians, may be necessary, as highlighted in 6.