Takayasu arteritis—advances in diagnosis and management

Abstract

Takayasu arteritis, a rare granulomatous vasculitis affecting young people, is associated with considerable morbidity and premature mortality. In most patients the diagnosis is delayed until after the development of substantial arterial injury. Studies of noninvasive imaging techniques suggest that these approaches might facilitate earlier diagnosis and have a role in monitoring disease progress; however, they remain limited in their ability to accurately quantify inflammatory disease activity in the arterial wall. A lack of controlled clinical trial data complicates the choice of therapy for Takayasu arteritis, and clinical indices for monitoring disease activity are currently suboptimal. Increasing knowledge of the pathogenesis of the large vessel vasculitides might eventually lead to novel targeted therapies. Preliminary data from open-label trials of anti-tumor necrosis factor therapy are encouraging, but there is an urgent need for controlled clinical trials to establish optimum therapeutic approaches for this disease. These trials should include a prospective assessment of the use of noninvasive imaging modalities in the diagnosis and subsequent management of Takayasu arteritis.

FDG Uptake by Prosthetic Arterial Grafts in Large Vessel Vasculitis Is Not Specific for Active Disease

“…18 F]-fluoro-2-deoxy-D-glucose positron emission tomography ( 18 F-FDG-PET) is commonly used for investigation of large vessel vasculitis (LVV) [1,2]. 18 F-FDG uptake by metabolically active cells provides an estimate of the extent and intensity of arterial wall inflammation in active giant cell (GCA) and Takayasu arteritis (TA) [3][4][5][6].…”

“…Co-registration of images generated by 18 F-FDG-PET/computerised tomography (CT) allows precise anatomic location of metabolic activity and enhanced sensitivity for detection of arterial wall inflammation [7]. In TA, the principle role for 18 F-FDG-PET/CT lies in the diagnosis of active disease [1]. Likewise, 18 F-FDG-PET/CT can demonstrate LVV in patients with GCA and facilitates diagnosis in those presenting with prominent systemic symptoms, but without characteristic features such as headache and jaw claudication [6].…”

Isolated Aortic Aneurysm with Aortic Valve Regurgitation in Takayasu Disease

“…Adjunctive, steroid-sparing immunosuppressants such as methotrexate, and azathioprine, are frequently paired with glucosteriods [11]. Other agents that have been tried include, cyclophosphamide and mycophenolate mofetil [12].…”

Avaliação não invasiva das propriedades estruturais de grandes artérias em pacientes com arterite de Takayasu

“…Resultados: A média de VOP-CF foi maior em pacientes com arterite de Takayasu do que em controles (9,77 ± 3,49 vs. 7,83 ± 1.06 m/s, p = 0,009 (Ishikawa 1978;Arend et al 1990;Ishikawa;Maetani 1994;Kerr et al 1994;Mason 2010).…”

“…Takayasu arteritis (TA) predominantly affects large and middle-sized arteries and is related to a higher cardiovascular risk [1,2]. Increased arterial stiffness is associated with atherosclerosis and it is a known independent risk factor for cardiovascular events [3,4].…”