Update on the management of systemic vasculitis: what did we learn in 2009?

In the past two decades, the clinical investigation of systemic vasculitis has advanced from small case series and cohort studies to large multicentric randomised controlled clinical trials. The growing evidence gathered from all these trials led to the development of international consensus guidelines on the management of systemic vasculitides. The combination of cyclophosphamide and prednisone is still regarded the induction treatment of first choice for most types of generalised systemic vasculitis. However, treatment-associated adverse events of this regimen occur frequently and have a considerable negative effect on outcomes. Therefore, the major challenge in the treatment of systemic vasculitis is the search for treatments that are less toxic, but similarly effective compared to cyclophosphamide. In 2009, several studies have addressed these issues. It was shown that the cumulative dosage can be reduced by pulse versus oral administration without losing efficacy. Furthermore, new data indicate that targeted treatments such as rituximab might have the potential to replace cyclophosphamide in the future. In this article, the key studies in the field of vasculitis that might affect clinical management are reviewed and their potential relevance for patient care and future research is discussed.