Hyperbaric Oxygen Therapy for ANCA Vasculitis
Hyperbaric oxygen therapy (HBOT) is not recommended for the treatment of ANCA-associated vasculitis as there are no clinical guidelines supporting its use for this condition, and established evidence-based treatments should be prioritized instead. 1
Current Treatment Recommendations for ANCA Vasculitis
- The 2021 American College of Rheumatology/Vasculitis Foundation guidelines and the 2024 EULAR recommendations provide comprehensive evidence-based treatment approaches for ANCA-associated vasculitis, with no mention of HBOT as a treatment option 1
- First-line remission induction therapy for severe GPA and MPA should include rituximab, which has demonstrated efficacy in clinical trials 1
- For maintenance therapy after induction of remission, rituximab is recommended as the preferred agent, with azathioprine or methotrexate as alternatives 1
- For refractory disease, a thorough reassessment of disease status and comorbidities is recommended, with consideration of switching from cyclophosphamide to rituximab or vice versa 1
Evidence Regarding HBOT for Vasculitis
- While there is limited evidence suggesting HBOT may have some benefit for non-healing vasculitic skin ulcers specifically, there is no evidence supporting its use for systemic ANCA vasculitis treatment 2, 3
- A small study of 35 patients with vasculitis-induced non-healing skin ulcers showed that 80% demonstrated complete healing after HBOT, but this was specifically for localized cutaneous manifestations, not for treating the underlying systemic vasculitis 2
- There is insufficient evidence to recommend HBOT as either primary or adjunctive therapy for ANCA vasculitis, as no clinical trials have evaluated its efficacy for this specific condition 4, 3
Limitations of HBOT for Vasculitis Treatment
- HBOT has significant practical limitations including high cost, limited availability, and requirement for specialized equipment and facilities 4, 5
- Potential side effects of HBOT include transient myopia, barotrauma of the middle ear or sinuses, claustrophobia, and rarely seizures 5
- The cost-benefit ratio for HBOT in ANCA vasculitis is unjustifiable given the lack of evidence and the existence of established effective treatments 4, 5
Recommended Approach for ANCA Vasculitis Management
- Follow evidence-based guidelines that recommend rituximab or cyclophosphamide for remission induction in severe disease 1
- For maintenance therapy, use rituximab as the preferred option, with azathioprine or methotrexate as alternatives 1
- For refractory disease, patients should be managed in close conjunction with, or referred to, centers with expertise in vasculitis 1
- Patient education and involvement in treatment decisions are important aspects of management that can improve outcomes 1
- Assessment for comorbidities following remission induction is recommended to address the comprehensive needs of patients with ANCA vasculitis 1
Conclusion for Clinical Practice
- Despite theoretical benefits of increased tissue oxygenation, HBOT should not be considered for systemic ANCA vasculitis treatment due to lack of supporting evidence 4, 6
- Clinicians should adhere to established guidelines from the American College of Rheumatology/Vasculitis Foundation and EULAR for the management of ANCA vasculitis 1
- For localized vasculitic skin ulcers that are refractory to standard immunosuppressive therapy, HBOT might be considered as an adjunctive treatment, but this is separate from treating the underlying systemic vasculitis 2, 3