Childhood‐onset Takayasu arteritis: an update

Abstract

Childhood-onset Takayasu arteritis (c-TA) is a distinct subset affecting a wide age group, ranging from young infants to adolescents and it differs from adult TA in many aspects. There is scarcity of data on c-TA worldwide. The disease is classified using the European League Against Rheumatism/Pediatric Rheumatology International Trials Organization/Pediatric Rheumatology European Society criteria. The non-specific nature of presenting complaints and lack of appropriate biomarkers delay the early diagnosis of this illness and many children present with complications, which become irreversible once they set in. One of the largest cohorts of 40 children with c-TA from our center reports hypertension as the commonest presenting feature. Systemic symptoms like headache, fever and weight loss are also described. Assessment of disease in c-TA is done by correlating clinical features with raised inflammatory markers. Advanced imaging plays an important role in diagnosis. In c-TA, the role of magnetic resonance angiography is advocated, taking into consideration the enormous amount of radiation exposure with other modalities. Complications of c-TA include cardiovascular, pulmonary, neurological and those arising secondary to long-term steroid and immunosuppression therapy.

Portal hypertension: an uncommon clinical manifestation of Takayasu arteritis in a 9-year-old child

“…Although there is a lack of data on childhood-onset TA (c-TA) worldwide, a few series of cases of c-TA have been reported. Diagnosis delay observed in these cases was 17 months and in our patient it was 24 months 1–3,6. He had neither murmurs nor hypertension at the beginning, but one remarkable sign was daily fever.…”

“…The use of an anticlotting agent is controversial, and there is no agreement on this matter yet 6,15,16. After the second intracranial hemorrhage, our patient needed an external ventriculostomy, and according to the patient’s risk–benefit ratio neither aspirin nor anticoagulation was continued.…”

“…However, due to the absence of randomized trials comparing different immunosuppressive agents, no immunosuppressive agent can be considered more effective than others 5. Other interventional or surgical options are available (balloon dilatation, stents placement, and bypass grafting) 6,15,16…”

Continuous infusion of lipo-prostaglandin E1 for Takayasu’s arteritis with heart failure in an 11-month-old baby: a case report

“…Corticosteroids are the mainstay of treatment, and attempts have been made to use other immunosuppressants for second-line therapy. There is no standard treatment for progressive vascular stenosis [3, 4]. …”

Renal autotransplantation for the management of renal artery in-stent restenosis in an adult patient with Takayasu arteritis

“…The basic pathology in TA is panarteritis that begins from the adventitial layer and spreads up to the intimal layer, thereby leading to vascular manifestations 1. It is an important cause of secondary hypertension, especially in the South Asian region 2.…”