Establishing clinical remission criteria forgiant cell arteritis: Results ofa Delphi exercise carried out by an expert panel ofthe Japan Research Committee ofthe Ministry ofHealth, Labour, andWelfare forIntractableVasculitis.

Abstract

To develop a proposal for giant cell arteritis remission criteria in order to implement a treat-to-targetalgorithm. A task force consisting of 10 rheumatologists, 3 cardiologists, 1 nephrologist, and 1 cardiac surgeon was established in the Large-vessel Vasculitis Group of the Japanese Research Committee of the Ministry of Health, Labour and Welfare for IntractableVasculitis to conduct a Delphi survey of remission criteria for giant cell arteritis. The survey was circulated among the members over four reiterations with four face-to-face meetings. Items with a mean score of ≥4 were extracted as items for defining remission criteria. An initial literature review yielded a total of 117 candidate items for disease activity domains and treatment/comorbidity domains of remission criteria, of which 35 were extracted as disease activity domains (systematic symptoms, signs and symptoms of cranial and large-vessel area, inflammatory markers, and imaging findings). For the treatment/comorbidity domain, ≤5 mg/day of prednisolone 1 year after starting glucocorticoids was extracted. The definition of achievement of remission was the disappearance of active disease in the disease activity domain, normalization of inflammatory markers, and ≤5 mg/day of prednisolone. We developed proposals for remission criteria to guide the implementation of a treat-to-targetalgorithm for giant cell arteritis.