Management of Takayasu arteritis: a systematic review

Abstract

Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of Takayasu arteritis (TA). Since there is no completed, placebo-controlled, randomized clinical trial, the level of evidence for management of TA is low, generally reflecting the results of open studies, case series and expert opinion. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, MMF and LEF. In patients who remain resistant and/or intolerant to these agents, biologic drugs including TNF inhibitors, rituximab and tocilizumab seem to be promising. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. In the presence of short-segment, critical arterial stenosis, balloon angioplasty or stent graft replacement may be useful. On the other hand, long-segment stenosis with extensive periarterial fibrosis or occlusion requires surgical bypass of the affected segment, which is clearly associated with superior results compared with endovascular intervention. As a general rule, both endovascular intervention and surgical procedures should be avoided during the active phase of the disease. Earlier diagnosis, better assessment of disease activity and future clinical trials will obviously improve the management of TA.

Takayasu Arteritis as an Odd Cause of Chest Pain

“…4 There are two main problems that TAK patients have to deal with: A difficult diagnosis and a low level of evidence for their management. 2,5 There is not a gold standard for diagnosis and monitoring of disease. Radiological techniques have advanced in the assessment for diagnosis of TAK; especially CTA and magnetic resonance angiography which are less invasive than conventional angiography and have similar sensitivity and specificity levels.…”

Recent advances in Takayasu's arteritis

“…There are no controlled, clinical therapeutic trials for TAK (73). However, recent uncontrolled data of leflunomide, tumor necrosis factor (TNF)-α antagonists, and tocilizumab in refractory TAK appear promising (74).…”

Syphilitic Aortitis Mimicking Takayasu’s Arteritis

“…TA is a rare disease-the incidence observed in a study of North American patients was calculated at 2.6/million/year, and affects most commonly young women [6] [7]. Generally, this disease presents with an inflammation of the vasa vasorum of the adventitia in the acute phase.…”

“…The chronic phase of TA is characterized by the destruction of the elastic tissue, which leads to fibrosis and ultimately stenosis. In addition, manifestation of aneurysms might occur complicating the disease course [4] [6] [7]. Similar lesions can be observed in syphilitic aortitis with endarteritis obliterans and concomitant infiltration of plasma cells and vessel wall fibrosis challenging the diagnosis.…”