Vasculitis Management

Initial Treatment

• The American College of Rheumatology recommends an initial dose of prednisone of 1 mg/kg/day (generally up to 80 mg/day) for adults or 1-2 mg/kg/day (generally up to 60 mg/day) for children 1
• Consider IV pulse glucocorticoids (methylprednisolone 500-1000 mg/day for 3-5 days) before starting oral prednisone, as recommended by the American College of Rheumatology 1, 2

Dose Adjustment and Combination Therapy

• The American College of Rheumatology suggests adding cyclophosphamide to high-dose glucocorticoids for better outcomes 2
• Consider methotrexate with glucocorticoids as a less toxic alternative to cyclophosphamide, as recommended by the European League Against Rheumatism 3

Tapering and Maintenance

• Begin tapering prednisone by 10 mg every 2-4 weeks until reaching 20 mg/day, then taper more slowly at 2.5-5.0 mg every 2-4 weeks, with a target of ≤10 mg/day (low-dose) for maintenance, as recommended by the British Medical Journal 4
• Aim for 15 mg prednisolone at 12 weeks, as recommended by the British Medical Journal 4