In a recent article in Rheumatology (Oxford) (Aug 22nd 2025) the Canadian vasculitis experts Christian Pagnoux and Arielle Mendel reflected on the launch of the new BSR Guidelines for the management of AAV.

The authors are welcoming the new 2025 British Society for Rheumatology (BSR) guidelines while emphasizing why doctors should read ALL available guidelines, not just one.

What Just Happened?

On June 12, 2025, the British Society for Rheumatology released updated guidelines for treating ANCA-associated vasculitis. This article is an expert editorial *reacting to* that launch, written by two prominent vasculitis specialists who want to explain what makes these BSR guidelines special and why the existence of multiple guidelines actually benefits patients.

The “Multiple Guidelines” Reality

Here’s something important: over 10 different guidelines for vasculitis treatment now exist worldwide, created by various national and international medical organizations including:

– EULAR (European)

– ACR/Vasculitis Foundation (American)

– KDIGO (Kidney-focused, international)

– CanVasc (Canadian)

– PANLAR (Pan-American)

– And now, updated BSR (British)

The experts’ key message: Rather than seeing this as confusing, doctors should read them ALL because each offers valuable perspectives and highlights current medical debates.

Why Multiple Guidelines Help Patients

The editorial authors argue that having different guidelines is actually **beneficial** because:

• Different populations have different needs – what works best for Asian patients might differ from European patients
• Each guideline highlights current controversies in treatment, helping doctors make better decisions
• Healthcare systems vary – medication availability and resources differ between countries 
• Guidelines legitimize treatments and help patients access newer therapies

What Makes the BSR Guidelines Unique

BSR-Specific Treatment Recommendations:

• Combination Therapy Preference: The BSR guidelines specifically recommend considering both rituximab AND cyclophosphamide together for severe disease – a more “British-flavored practice” that differs from most other guidelines.
• Broad Avacopan Use: While other guidelines recommend avacopan more selectively, BSR recommends considering it for ALL patients with active GPA or MPA, regardless of severity.
• Aggressive Steroid Reduction: BSR specifically states that complete steroid withdrawal may be possible within 6-12 months (especially for patients on rituximab) – shorter than what other guidelines suggest.

Groundbreaking Quality-of-Care Focus:

This is uniquely BSR: For the first time in any vasculitis guideline, BSR includes detailed recommendations about healthcare service organization:

• Specialized vasculitis clinics
• Nurse-led follow-up care 
• Multidisciplinary team meetings
• Patient education programs
• Fast referral targets (under 1 week)

These service standards were based on a UK study called VOICES, which found that better-organized services led to fewer hospital visits, infections, and even reduced mortality.

How BSR Compares to Other Guidelines

Where BSR Agrees with Others:

• Rituximab or cyclophosphamide for severe disease induction
• Preference for rituximab in relapsing disease
• Moving away from plasma exchange for most situations

Where BSR Stands Apart:

• More willing to combine rituximab + cyclophosphamide
• More aggressive about avacopan use
• Shorter steroid duration recommendations
• Revolutionary focus on service quality (no other guideline does this !)

The Experts’ Bottom Line

The editorial authors emphasize that each guideline adds something valuable. They specifically praise the BSR guidelines for:

• Practical experience from clinicians with real-world expertise
• First-ever national improvement targets for vasculitis care
• Innovation in addressing non-medical aspects of patient care
• But they stress that the real value comes from reading multiple guidelines because differences between them usually highlight:
• Current medical controversies
• Areas needing more research 
• Different approaches that might work better for individual patients

What This Means for Patients

Your doctor should be aware of multiple guidelines, not just one. This gives them:

• A broader perspective on treatment options
• Understanding of current debates in your care
• Flexibility to choose approaches best suited to your situation

The BSR’s service quality standards might influence how vasculitis care is organized in other countries, potentially leading to:

• Better coordinated care
• More patient education resources
• Faster access to specialists
• More comprehensive support

Don’t expect your doctor to follow BSR recommendations exactly – they should consider multiple guideline perspectives alongside your individual needs.

Looking Forward

This editorial celebrates the BSR guidelines while reinforcing a crucial message: medical progress happens through multiple perspectives, not single authorities. The experts are essentially saying “read them all” – and as patients, we benefit when our doctors do exactly that.