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Objective: To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK)., Methods: A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members., Results: Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible., Conclusion: The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries., Competing Interests: D.G.F.-Á. is consultant to Abbvie, Bristol Myers-Squibb, Eli Lilly, Fresenius Kabi, Janssen, Novartis, and Pfizer. M.V.S. is a speaker for and consultant to and receives research support from Abbvie, Bristol Myers-Squibb, GlaxoSmithKline, Janssen, Eli Lilly, Pfizer, Roche, and AstraZeneca. S.J.M. is a speaker for and consultant to and receives research support from Abbvie, Boehringer Ingelheim, GlaxoSmithKline, and Janssen. M.F.U.-G. receives research support and consulting fee from and is a speaker for Janssen, Pfizer, AztraZeneca, and GlaxoSmithKline. L.F.F.-S. is a speaker for Nippon Boehringer Ingelheim Co Ltd, Roche México, and Werfen Mexico. L.M.S.-R. is a speaker for and consultant to the advisory board of Novartis, Pfizer, Janssen, Bristol-Myers Squibb, Sanofi-Genzyme, Biopas, Amgen, Boehringer, Roche, and Eli Lilly. A.B. is a speaker and consultant to Abbvie, GlaxoSmithKline, Janssen, Pfizer, Boehringer Ingelheim, and Bristol-Myers Squibb. E.R.S.G. is a speaker for and consultant to and receives research support from Abbvie, Amgen, Bristol Myers-Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Roche, Sandoz, and UCB. S.U. is a consultant to and receives research support from Kiniksa, Janssen, and Genentech. The other authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Giant cell arteritis (GCA) is the most common primary systemic vasculitis worldwide, although it seems to be very rare in some areas, such as Latin America., Objectives: The objective of the study was to describe the clinical, laboratory, and treatment features in a Mexican Mestizo population with GCA., Methods: Retrospective data chart review (1989-2010)., Results: Twenty-two patients with GCA were identified, 18 women and 4 men. Mean age was 73 (SD, 7.9) years. Diagnosis was made at a mean of 67 (SD, 83.6) days from symptom onset. Most frequent presenting symptoms included headache (90%), constitutional symptoms (86%), and polymyalgia rheumatica (59%). Severe cranial ischemic complications were present in 32%. Amaurosis fugax and blindness were present in 36% and 27%, respectively. High erythrocyte sedimentation rate was present in 89% of patients. Rapid response to prednisone treatment was seen, but in 10 patients, relapse occurred, possibly related to fast tapering. Additional treatment was methotrexate (n = 8), azathioprine (n = 5), and cyclophosphamide (n = 3). Median follow-up was 242 (SD, 214) weeks., Conclusions: Giant cell arteritis is rarely recognized in Latin America. We report on characteristics of GCA in a population of Mexican Mestizos, as ours is the largest series to be reported from Latin America so far. When compared with other series, age at onset is similar, females are more affected, and although a good response to corticosteroid treatment was seen, a higher frequency of amaurosis fugax and blindness was observed, accounting for an unfavorable functional outcome in 6 (27%) of 22 patients.

Whether autoimmune or rheumatic disease may be precipitated after vaccination is controversially discussed among experts. Here we describe 4 cases of new onset or relapsing antineutrophil cytoplasmic antibodies associated vasculitis occurring in timely association with influenza vaccination. In the literature different subtypes of vasculitis have been repeatedly reported after influenza vaccination. Several trials in patients with preexisting auto-immune disease failed to indicate an increased risk for disease recurrence after influenza vaccination but these investigations might be underpowered to detect this very rare but relevant side effect. Although our report does not prove a causal association between vaccination and vasculitis, it seems possible that in rare cases vaccination might induce vasculitic disease.

Amyopathic dermatomyositis is a rare condition. We describe the clinical and histopathologic findings of a 53-year-old woman who developed cutaneous lesions similar to those described in dermatomyositis after fibrate therapy for hypertriglyceridemia. Our patient fits the proposed criteria for amyopathic dermatomyositis, and after 8.5 years, muscular involvement has not been detected, although the dermatologic lesions are still present despite different treatments reported to treat this condition (steroids, antimalarials, methotrexate, dapsone). However, an initial good response has been observed with thalidomide, a drug used increasingly in the dermatologic field. As far as we know, this case is the first of drug-induced amyopathic dermatomyositis.