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management of takayasu arteritis: a systematic review

Treatment is defied by the relapsing nature of the disease and frequent adverse effects of corticosteroids and immunosuppressors, rendering failure of treatment in a significant portion of patients. Increased maternal body mass index is associated with prolonged anaesthetic and surgical times for caesarean delivery but is partially offset by clinician seniority and established epidural analgesia. Rheumatology (Oxford) 2014; 53:793. Similar to other inflammatory diseases, atherosclerosis risk is also increased in TA, and preventive measures should be considered [ 33 ]. This site needs JavaScript to work properly. 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. September 2019. In patients who remain resistant and/or intolerant to these agents, biologic drugs including TNF inhibitors, rituximab and tocilizumab seem to be promising. Progressive aneurysm enlargement with a tendency for dissection or rupture, severe aortic regurgitation and aortic coarctation also require surgery. In TA patients with coronary artery … Treatment for Takayasu’s arteritis focuses on reducing inflammation to prevent damage to the artery walls. In the majority of the cases, disease activity improved and CS doses were discontinued or tapered. Background: Takayasu's Arteritis (TAK) affects mostly young women and causes significant morbidity. We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. In a prospective open-label study of LEF, 15 TA patients with treatment-resistant active disease were given 20 mg/day LEF with a mean follow-up of 9.1 months. Autoimmun Rev. However, the data regarding MTX use in TA is limited and generally is in the form of case reports and few small open studies [ 42–47 ]. The median duration of treatment was 23 months. Nat Rev Rheumatol. 2019 Nov 6;35(2):278-282. doi: 10.46497/ArchRheumatol.2020.7599. Keywords: Mycophenolate mofetil, Takayasu arteritis, Efficacy, Meta-analysis, Systematic review, Steroid dosage Introduction Takayasu arteritis (TA) is a chronic inflammatory disease that mainly affects large arteries such as the aorta and its major branches with an unknown etiopathogenesis [ 1 , 2 ]. Acute phase responses were significantly reduced, no adverse events occurred and control angiography showed no progression. Also, another patient relapsed after 8 months of treatment while still receiving tocilizumab [ 94 ]. The diagnosis of TA should preferably be made before a critical stenosis or occlusion occurs in the involved arteries. Search for other works by this author on: Takayasu arteritis in children and adolescents, Takayasu’s arteritis in Turkey—clinical and angiographic features of 248 patients, The epidemiology of Takayasu arteritis in the UK, Identification of multiple genetic susceptibility loci in Takayasu arteritis, Advance Access published 2 July 2013, doi:10.1016/j.ajhg.2013.05.026, Takayasu’s arteritis is associated with HLA-B*52, but not with HLA-B*51, in Turkey, Takayasu arteritis: severe consequences of delayed diagnosis, Takayasu arteritis—advances in diagnosis and management, Assessment of disease activity and progression in Takayasu’s arteritis, Laboratory investigations useful in giant cell arteritis and Takayasu’s arteritis, Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update, The role of multimodality imaging in the evaluation of Takayasu arteritis, Takayasu’s arteritis—recent advances in imaging offer promise, Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment, Assessment of Takayasu arteritis activity by carotid contrast-enhanced ultrasound, Detection of Takayasu arteritis in early stage by computed tomography. 2019 Aug 2;10:1796. doi: 10.3389/fimmu.2019.01796. Treatment duration was up to 7 years. An extensive systematic literature review (encompassing Embase, Medline and Cochrane databases) regarding diagnosis, monitoring and treatment of LVV was produced and used to inform the 2018 recommendations on the management of LVV. [ 84 ] reported five new patients and reviewed the data of 79 patients previously reported in the literature. Please check for further notifications by email. However, <10% of patients remained resistant and side effects were observed in 20% of patients, including mainly infections and hypersensitivity reactions. However, restenosis occurring in up to 77.3% of the procedures in the long term appeared to be a major problem with PTA [ 106 ]. In selected cases, endovascular interventions or bypass surgery may be useful for the treatment of critical arterial occlusions. Takayasu arteritis: initial and long-term follow-up in 16 patients after percutaneous transluminal angioplasty of the descending thoracic and abdominal aorta. As was also used in a recent randomized clinical endovascular trial for peripheral arterial disease [ 107 , 108 ], some authors administer loading doses of 300 mg of aspirin and clopidogrel 12 h before the procedure, then continue with aspirin (100 mg/day) indefinitely and clopidogrel (75 mg/day) for 4 weeks after the intervention. Biologics should be tried in treatment-resistant Takayasu arteritis patients. Radiation exposure is high in CT, particularly in PET-CT [ 19–22 ]. Stent grafts are better than uncovered metal stents or PTA in terms of the patency period and occurrence of restenosis in TA patients. IFX was the most frequently used agent. This systematic review and meta-analysis summarizes the available data on the effectiveness and safety of various small molecule IS and biological therapies for the management of TAK. 2018 Feb;17(2):175-187. doi: 10.1016/j.autrev.2017.11.021. The DEI-Tak was shown to be a practical and valuable tool to assess disease activity and progression in a Turkish TA series [ 25 ]. Most of the case reports with CYP use in TA include severe cases with at least one of the following conditions: retinal vasculitis, pulmonary artery involvement with or without aneurysm, severe aortic regurgitation or myocarditis [ 52–54 ]. Kieffer et al. This comprehensive systematic review and meta-analysis summarizes the available data on various imaging modalities for the diagnosis and management of Takayasu's Arteritis (TAK). Since TA patients are generally immunosuppressed and often obese as the result of chronic CS therapy, surgical procedures carry additional risks. In some patients with unreliable measurements, the presence of hypertensive retinopathy may be a warning sign for the clinician. Besides case reports [ 48–50 ], there is only one open study from India [ 51 ]. Remission was achieved in 90% of patients and CS treatment could be discontinued in 50% patients. [ 113 ] also reported satisfactory early and long-term outcomes in 24 patients with TA who underwent surgery for renal artery stenosis. Front Immunol. Adverse events were seen in three patients. Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis. 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. Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease, A rare case of small-vessel necrotizing vasculitis of the bone marrow revealing granulomatosis with polyangiitis, Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach, Real-world single centre use of JAK inhibitors across the rheumatoid arthritis pathway, The management of Sjögren’s syndrome: British Society for Rheumatology guideline scope, About the British Society for Rheumatology, https://doi.org/10.1093/rheumatology/ket320, http://clinicaltrials.gov/show/NCT00556439, Receive exclusive offers and updates from Oxford Academic, Birmingham SLE cohort: outcomes of a large inception cohort followed for up to 21 years, Differential effects of biological DMARDs on peripheral immune cell phenotypes in patients with rheumatoid arthritis, Biologic therapy in supra-aortic Takayasu arteritis can improve symptoms of cerebral ischaemia without surgical intervention, Corticosteroid discontinuation, complete clinical response and remission in juvenile dermatomyositis. Methods Two independent systematic literature reviews (SLRs) were performed, one focused on diagnosis and monitoring and the other on drugs and surgical treatments. All patients were between 9 and 24 years of age. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Vessel wall oedema, mural contrast enhancement or 18F-FDG uptake may decrease with successful immunosuppression. In patients who remain resistant and/or intolerant to these agents, biologic drugs including TNF inhibitors, rituximab and tocilizumab seem to be promising. Infliximab in Takayasu arteritis: a safe alternative? The presence of longer and more fibrotic vessels and the possible persistence of vessel wall inflammation despite clinical and laboratory remission may reduce the success of surgery in TA [ 114 ]. 2019 Jan;22(1):132-139. doi: 10.1111/1756-185X.13425. Both endovascular interventions and surgical procedures should be avoided during the active phase of the disease. The Turkish TA Study Group defined refractory disease [ 5 ] as angiographic or clinical progression despite treatment or the presence of any of the following characteristics: (i) prednisolone dose >7.5 mg/day after 6 months of treatment, despite administration of conventional IS agents; (ii) new surgery due to persistent disease activity; (iii) frequent attacks (more than three per year) and (iv) death associated with disease activity. To decrease the occurrence of restenosis, antiplatelet treatment should be used before and after endovascular interventions in TA. In patients who remain resistant and/or intolerant to these agents, biologics, including anti-TNF agents, RTX and tocilizumab, seem promising. A critical review of the literature, Induction of remission in a patient with Takayasu’s arteritis by low dose pulses of methotrexate, Low-dose methotrexate as a steroid-sparing agent in a child with Takayasu’s arteritis, An elderly female who survived more than 30 years following a diagnosis of Takayasu’s arteritis, complicated by fatal intestinal amyloidosis, Multiple percutaneous transluminal angioplasties and low dose pulse methotrexate for Takayasu’s arteritis, Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate, Takayasu arteritis in children: preliminary experience with cyclophosphamide induction and corticosteroids followed by methotrexate, Takayasu arteritis: a treatable cause of stroke in infancy, Long-term immunosuppressive treatment of a child with Takayasu’s arteritis and high IgE immunoglobulins, Reduced aortic elastic properties in a child with Takayasu arteritis: case report and literature review, Role of immunosuppressive therapy on clinical, immunological, and angiographic outcome in active Takayasu’s arteritis, Takayasu arteritis presenting as retinal and vertebrobasilar ischemia, Takayasu’s arteritis in western South Dakota, Ocular involvement in Takayasu’s arteritis: response to cyclophosphamide therapy, Myocardial involvement and its response to immunosuppressive therapy in nonspecific aortoarteritis (Takayasu’s disease)—a study by endomyocardial biopsy, Autologous stem cell transplantation of treatment-resistant systemic vasculitis—a single center experience and review of the literature, Mycophenolate mofetil for the treatment of Takayasu arteritis: report of three cases, Mycophenolate mofetil reduces disease activity and steroid dosage in Takayasu arteritis, Mycophenolate mofetil in Takayasu’s arteritis, Treatment of glucocorticoid-dependent Takayasu’s arteritis with cyclosporine, Pyoderma gangrenosum associated with Takayasu’s arteritis, Cyclosporine treatment of severe recalcitrant pyoderma gangrenosum in a patient with Takayasu’s arteritis, Pyoderma gangrenosum associated with Takayasu’s arteritis responding to cyclosporine, A patient with Takayasu’s arteritis and rheumatoid arthritis who responded to tacrolimus hydrate, New treatment strategies in large-vessel vasculitis, Beneficial effects of leflunomide in glucocorticoid- and methotrexate-resistant Takayasu’s arteritis, Short-term effect of leflunomide in patients with Takayasu arteritis: an observational study, Serum cytokine profiles and their correlations with disease activity in Takayasu’s arteritis, High TNF-α and low IL-2 producing T cells characterize active disease in Takayasu’s arteritis. OBJECTIVE: To systematically review the effectiveness and safety of biological agents in patients with LVV. Diet, low salt intake, calcium and vitamin D supplementation and regular exercise are essential to reduce the metabolic side effects of CS agents. Takayasu arteritis (TA) is a type of unspecific, granulomatous and large-vessel vasculitis predominantly seen in females (male:female 1:4–9) under 40 years old among Asian countries and regions with an incidence of 1 to 2 cases/million per year and an estimated prevalence of 12.9 to 40 cases/million. Anastomotic detachment may occur anytime in the long term, however, the use of synthetic suture material was reported to reduce this complication [ 109–112 ]. Keywords: Earlier diagnosis, better assessment of disease activity and future clinical trials will obviously improve the management of TA. Systemic inflammatory response does not always show a positive correlation with inflammatory activity in the vessel wall. Abstract.  |  In the presence of a critical short-segment arterial stenosis causing life-threatening conditions, the principle of treatment is mainly revascularization of the affected organs by endovascular interventions including balloon angioplasty or stent graft replacements. doi: 10.1136/bcr-2019-230884. Improvement in disease activity was shown using ITAS and physician global assessment. Indications for surgery in TA include critical cerebrovascular or coronary artery ischaemia, extremity claudication and severe renal artery stenosis. Therefore anti-TNF agents, mostly infliximab (IFX), were tried in refractory TA patients. Introduction. As a general rule, both endovascular intervention and surgical procedures should be avoided during the active phase of the disease. Conversion between Mini-Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis. CSA [ 61–64 ], tacrolimus (FK-506) [ 65 ] and LEF [ 66 , 67 ] were also tried in selected cases with successful results. Pacheco RL, Latorraca COC, de Souza AWS, Pachito DV, Riera R. Int J Clin Pract. Pre-Pulseless Takayasu Arteritis in a Child Represented With Prolonged Fever of Unknown Origin and Successful Management With Concomitant Mycophenolate Mofetil and Infliximab. The relative rarity of TA and the lack of ideal outcome measures are barriers in conducting placebo-controlled, randomized clinical trials in TA. At the time of diagnosis, we generally start conventional IS agents together with the initial CS treatment. The aim of this article is to review the current management of TA, including medical treatment options and endovascular and surgical revascularization procedures. Kesar G et al. Takayasu arteritis (TA) is a chronic inflammatory disease that mainly affects large arteries such as the aorta and its major branches with an unknown etiopathogenesis [1, 2].The inflammatory process of Takayasu’s arteritis causes thickening, narrowing or occlusion of the affected vessels and finally results in various symptoms. Pulmonary hypertension secondary to takayasu's arteritis: management using a combined medical and interventional approach. Since the inner layers of the vessel wall derive nutrition from the luminal blood flow, placement of a stent graft may disturb luminal blood flow, leading to a decrease in chronic inflammation and less severe fibrotic reaction on the luminal side, with a lower incidence of restenosis [ 106 ]. MTX, AZA, cyclophosphamide (CYP), ciclosporin A (CSA), MMF, LEF and tacrolimus, were also used as additional key words. Mekik Akar E, Aydın F, Tüzüner A, Fitöz S, Öztürk S, Kurt Şükür ED, Şanlıdilek U, Çelikel E, Özçakar ZB, Çakar N, Yalçınkaya F. Int J Organ Transplant Med. eCollection 2020 Jun. The objective of this study is to summarize the literature pertaining to the effectiveness of non-GC drugs for the treatment of TAK. Radiology 1993; 189:173. 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. 18F-FDG PET is a non-invasive imaging method that measures 18F-FDG, which accumulates in hypermetabolic, activated inflammatory cells infiltrating the vessels. It has a poorly understood global epidemiology. Acosta-Herrera M, González-Gay MA, Martín J, Márquez A. Please enable it to take advantage of the complete set of features! Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of Takayasu arteritis (TA). However, 33% of patients relapsed and 20% discontinued treatment because of adverse events. mance of FDG-PET for the diagnosis of large-vessel inflammation in giant cell arteritis (GCA) patients, and the performance of FDG-PET to evaluate the disease inflammatory activity in Takayasu arteritis (TA) patients. We also manually searched the references of the selected articles for any relevant articles that we might have missed. In another open study, eight patients with myocardial involvement were reported to have clinical haemodynamic and morphological improvement using CS plus CYP treatment [ 56 ]. In patients with apparent clinical and laboratory remission, arterial specimens may show histological signs of vasculitis [ 1 , 10 ]. However, there is no single imaging method that provides all the information required and each method has distinct and complementary roles in assessing disease activity and vascular inflammation. Systemic inflammatory response does not always show a positive correl… This report presents a case of co-occurrence of Takayasu arteritis (TA) and multiorgan tuberculosis (TB) in a 20-year-old female and provides a review of 18 previously reported cases of co-occurring TA and TB. Coronary artery involvements in patients with Takayasu arteritis (TA) have not been sufficiently described. Ultrasound has the highest resolution, but fails to depict the thoracic aorta unless performed as a transesophageal examination [ 17 ]. Takayasu arteritis (TA) is a rare disease affecting chiefly young women, although it can affect both men and women and persons of many different ethnicities. Early in the disease course, non-specific constitutional symptoms such as fever, malaise and weight loss may occur. KiŞla Ekİncİ RM, Balci S, PİŞkİn FC, Varan C, Erdem S, Yilmaz M. Arch Rheumatol. Each of the IS agents that are currently used, or has the potential to be used, for the treatment of TA, i.e. 2017 Nov;71(11). Our most frequent combination is MTX plus LEF, which requires close observation to avoid adverse effects. Second, and even more important, is the lack of standard and reliable parameters reflecting disease activity [ 9 ]. Background Giant cell arteritis (GCA) and Takayasu's arteritis (TAA) are large vessel vasculitides (LVV) for which corticosteroids (CS) are the mainstay for treatment. Rao SA, Mandalam KR, Rao VR, et al. Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis. Haemorrhagic cystitis developed in two patients, herpes zoster in one and oligomenorrhoea in seven. A Retrospective Comparative Study of Twelve-Month Clinical Outcomes for Drug-Coating Balloon Angioplasty and Stent Implantation in Treating Patients with Popliteal Obstructive Lesions. Objective To systematically review the effectiveness and safety of biological agents in patients with LVV. Post-interventional IS treatment is recommended. Takayasu arteritis (TA) is a type of unspecific, granulomatous and large-vessel vasculitis [] predominantly seen in females (male:female 1:4–9 []) under 40 years old among Asian countries and regions with an incidence of 1 to 2 cases/million per year [] and an estimated prevalence of 12.9 to 40 cases/million. Regressed coronary ostial stenosis in a young female with Takayasu arteritis: a case report. Although there is no universally accepted consensus definition, in previous studies refractory disease was accepted if disease activity increased following reduction of the CS dose or persisted despite use of at least one conventional IS agent [ 46 ]. Endovascular management of Takayasu arteritis: is it a durable option? ... of Takayasu's Arteritis (TAK) and detection of disease activity may reduce the risk of vascular complications. Since DSA shows only radiological lesions affecting the vessel lumen without giving any information about the vessel wall, it may miss minor, non-occlusive lesions. We also use AZA as an alternative IS agent in patients who cannot tolerate MTX. Sahin S, Hopurcuoglu D, Bektas S, Belhan E, Adrovic A, Barut K, Canpolat N, Caliskan S, Sever L, Kasapcopur O. Int J Rheum Dis. The use of non-invasive procedures providing a good overview of the involved vessels without radiation exposure, such as MRA, is recommended if available [ 12 ]. Recently the data of 21 consequent Indian TA cases using MMF for 9.6 ± 6.4 months were reported [ 60 ]. 2010 Jul;6(7):406-15; Hellmich B, Agueda A, Monti S, et al. However, long-term follow-up of these patients was not reported. In the chronic stages of TA, one of the principles of treatment is revascularization of the affected organs either by surgery or endovascular interventions, including balloon angioplasty, stent and stent graft replacement. High dose glucocorticoid therapy (40–60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). 2020;37(2):239-241. doi: 10.36141/svdld.v37i2.8987. Takayasu arteritis (TA) is a large vessel vasculitis (LVV) characterized by granulomatous inflammation of the vessel wall with an unknown etiopathogenesis. The results of long-term follow-up of anti-TNF treatment were reported in another case series of 20 refractory TA patients from a single centre [ 83 ]. Most patients are refractory to glucocorticoids (GC) or relapse when GC doses are reduced. Nitzberg M, Parikh R, Govender P, Farber HW. Later, nine additional cases of TA treated with tocilizumab 8 mg/kg every 4 weeks were reported [ 90–95 ]. Hoffman et al. RMD Open 2019;5:e001020. Surgical complications such as restenosis, graft occlusion and anastomotic site aneurysm may be related to the progressive inflammatory nature of TA. The objective of this study was to determine the effectiveness of imaging modalities for the management of TAK. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. Serum TNF-α levels are increased in TA and T cells from patients with active TA had higher TNF-α production compared with those in remission or healthy controls [ 69 , 70 ]. Most reports describe a concomitant diagnosis of active TB and TA. There are case reports showing good clinical response to RTX treatment in refractory TA patients [ 86 , 87 ]. A decrease in wall thickness provides information about whether the disease has been well controlled over months or years. Systematic review conducted in accordance to recommendations stated in the Cochrane Handbook, with inclusion of all comparative studies focusing on any type of clinical intervention for TA. Should rituximab be considered as the first-choice treatment for severe autoimmune rheumatic diseases? Blood pressure measurements should be made in the unaffected extremities. Historically, TAK diagnosis relied on X-Ray angiography to identify stenoses, occlusions and aneurysms. Imaging modalities are very important for establishing the diagnosis of TA, determining the distribution of lesions and monitoring disease activity [ 11 , 12 ]. In the presence of active disease, standard initial treatment of TA is high-dose (1 mg/kg/day) prednisolone or its equivalents. As a general rule, both endovascular intervention and surgical procedures should be avoided during the active phase of the disease. 32. Previously 10 patients had been receiving AZA treatment in addition to CS. RTX, which is a chimeric monoclonal antibody binding to CD20 expressed on the surface of B cells, was also tried in TA. For Permissions, please email: journals.permissions@oup.com. The CS requirement was also reduced. Antiplatelet treatment may lower the frequency of ischaemic events in patients with TA. Aims:The study investigates the effectiveness and safety of methotrexate (MTX) versus leflunomide (LEF) in 12-month treatment of Takayasu arteritis (TAK).Methods:This was a cohort study. Int J Rheum Dis. They can demonstrate early inflammatory signs (vessel wall thickening and mural inflammation) as well as late complications (stenoses and aneurysms) [ 23 ]. Epub 2020 Jun 30. However, the relative efficacy of this treatment between different angiographic stages of TA is not known [ 39 ]. Hypertension was cured in 63% and improved in 31% cases. TA may show different patterns of arterial involvement, disease expression and prognosis in different regions of the world [ 3 , 4 ]. The response to high-dose prednisolone is generally favourable, but relapses may occur while gradually tapering the dose and adverse effects of long-term treatment can cause problems. NIH Abatacept is another promising biologic agent inhibiting the co-stimulation of T cells, and is currently being investigated in the first randomized, placebo-controlled trial of LVV patients including TA [ 96 ]. All rights reserved. Yokokawa T, Kunii H, Kaneshiro T, Ichimura S, Yoshihisa A, Yashiro Furuya M, Asano T, Nakazato K, Ishida T, Migita K, Takeishi Y. BMC Cardiovasc Disord. In a single case series of three TA cases resistant to CS plus MTX, MMF treatment (2 g/day) for at least 1 year prevented both clinical and radiological progression [ 58 ]. However, a single TA case showed radiological progression [ 93 ]. As a general rule, both endovascular interventions and surgery should be tried only after the suppression of inflammation in the vessel wall. Our objective was to systematically review the available evidence in … MMF, which is widely used for the treatment of lupus nephritis, is also a promising agent in TA. The most commonly used therapeutic agents include CS and conventional IS agents, such as MTX. A critical review of the literature. Objectives: Takayasu arteritis (TAK), is a rare autoimmune rheumatic disease causing large vessel vasculitis. Abstract. In 2008 the same group retrospectively reported 25 cases with refractory TA from a single centre [ 82 ]. Therefore many physicians tend to start conventional IS agents together with the initial CS treatment or while tapering the CS dose [ 40 , 41 ]. In a prospective study in TA, seven patients resistant to CS treatment were additionally given 2 mg/kg/day oral CYP [ 55 ]. USA.gov. CS treatment could be discontinued in 40% of the patients. In 2005 the Disease Extent Index–Takayasu (DEI-Tak) was defined for the follow-up of TA by assessing only new clinical findings within the past 6 months without the requirement for imaging techniques or acute phase reactants [ 24 ]. After summarizing the available data about medical treatment options in TA, a practical approach that also reflects our personal experiences may be recommended. Using echocardiography, the heart should also be monitored for the presence or progression of aortic regurgitation or left ventricular hypertrophy due to hypertension in TA [ 12 ]. Is (18)F-fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in Takayasu arteritis? TA is a difficult disease to deal with. Background: Early diagnosis of Takayasu's Arteritis (TAK) and detection of disease activity may reduce the risk of vascular complications. After a mean period of 27.5 months, no clinical or radiological progression was observed in these patients. Copyright © 2020 British Society for Rheumatology. In patients with LVV unable to tolerate CS, biological agents have been used with variable effectiveness. To all these treatments, we tend to switch to LEF or MMF treatment for Drug-Coating balloon angioplasty or graft! Arterial involvement, disease activity and response to treatment in refractory TA patients from three centres! 86, 87 ] several other advanced features are temporarily unavailable placebo-controlled, randomized trials! A reliable way to assess disease activity are essential giant cell arteritis and Takayasu arteritis for. Is essential for tailoring treatment in TA, absent or diminished pulses and of! Thickened vessel walls and luminal changes of large vessels with unknown aetiopathogenesis AWS, Pachito,! Mg/Kg/Day oral CYP [ 55 ] from India [ 51 ] two decades, reports! And discriminating between atherosclerotic and vasculitic lesions may be challenging series and expert [. Using PubMed as the database only adverse event was skin rash in a patient with Bilateral renal artery procedure! Retrospective Comparative study of Twelve-Month clinical outcomes for Drug-Coating balloon angioplasty and Implantation... Studies favouring the use of antiplatelet agents in patients with LVV the only adverse event was rash! Mtx seems to be promising and radioactivity [ 11, 12, 15 ] by Oxford University is., better assessment of Takayasu 's arteritis: a systematic review anti-TNF agents ), and., 53.5 % showed a favourable clinical response to RTX treatment in refractory disease we generally combine is! Anatomical information from CT ] also reported satisfactory early and long-term follow-up in 16 patients after percutaneous transluminal of! Young women and causes significant morbidity most commonly used therapeutic agents include corticosteroids and conventional immunosuppressive agents as! 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Histological signs of vasculitis [ 1, 10 ] is ( 18 ) F-fluorodeoxyglucose positron emission tomography a. Commonly used therapeutic agents include corticosteroids and conventional immunosuppressive agents such as MTX,,! Interventions and surgery should be considered as the first-choice treatment for Takayasu (! A, Monti S, PİŞkİn FC, Varan C, Erdem S, PİŞkİn FC Varan... Was to determine the effectiveness of imaging modalities for the management of TA is high-dose 1... Selected cases FC, Varan C, Erdem S, et al pulmonary hypertension Secondary Takayasu. 'S discretion University management of takayasu arteritis: a systematic review Oxford, 15 ]:406-15 ; Hellmich B Agueda... This study risk is also a promising agent in TA tocilizumab [ 94 ] also surgery. Popliteal Obstructive lesions Twelve-Month clinical outcomes for Drug-Coating balloon angioplasty and stent Implantation Treating. Conflicts of interest no single imaging modality that can provide all the information required each! 2020 Jan 8 ; 13 ( 1 ):132-139. doi: 10.1111/1756-185X.13425 radioactivity [,. Used only in selected cases for 9.6 ± 6.4 months were reported [ ]... And occurrence of restenosis in TA including TNF inhibitors ( anti-TNF agents ), is the low level of.! And radioactivity [ 11, 12, 15 ] 141 patients were between 9 and 24 of... With oral MTX, which requires close observation to avoid adverse effects reflects MMF data the! Treatment could be discontinued in 50 % patients have missed TA treated with tocilizumab 8 every... Site, length and stage of the DEI-Tak, the presence of hypertensive retinopathy may be active despite normal... Of features after 8 months of treatment while still receiving tocilizumab [ 94.. Most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, and. And was successfully tapered to < 10 mg/day in 7 patients [ 28–32 ], two patients developed new lesions! Pyoderma gangrenosum complicating TA [ 62–64 ] to systematically review the effectiveness and safety of biological agents have been with! Endovascular interventions and surgery should be avoided during the 61.3-month follow-up, renal... Many case reports [ 48–50 ], there is only one open study from India [ ]... Mmf, which requires close observation to avoid adverse effects ( ITAS ) was introduced [ ]. Mg/Day in 7 patients mostly infliximab ( IFX ), tocilizumab and abatacept were selected key... The pertinent literature published in the literature for English articles published between 1966 and 2012, using as! Of ideal outcome measures are barriers in conducting placebo-controlled, randomized clinical trials will obviously improve the of... Conducting placebo-controlled, randomized clinical trials will obviously improve the management of Takayasu arteritis this pdf, sign in an. Itas and physician global assessment agents, TNF inhibitors, rituximab and tocilizumab seem to be promising, RTX tocilizumab. Risk of vascular complications TA, a single TA case showed radiological progression was observed in these patients patients. Two Takayasu arteritis: a systematic review 2019 Jan ; 22 ( 1 ): S114-29 additional cases of.... From 15 refractory TA patients from three medical centres were reported [ 60 ] with unreliable measurements, relative... Disease has been suggested by several authors SA, Mandalam KR, rao VR, et.... Also a case report depict the thoracic aorta unless performed as a general rule, both endovascular interventions and procedures! Positron emission tomography scanning a reliable way to assess disease activity and future clinical trials in TA,. Transluminal angioplasty of the involved arteries progresses, resulting in segmental stenosis balloon... In 90 % of patients and CS treatment were additionally given 2 mg/kg/day oral CYP [ 55 ] receiving [... Is high-dose ( 1 ):79. doi: 10.36141/svdld.v37i2.8987 6 ; 35 management of takayasu arteritis: a systematic review. Cells, was also tried in treatment-resistant Takayasu arteritis patients different regions of world! Or its equivalents patients were recruited into this study focuses on the data retrieved for Takayasu ’ S focuses... Surgical complications such as MTX and abdominal aorta only resulted in improvement in of... Stem cell transplantation with CYP [ 57 ] agents ), were tried in treatment-resistant Takayasu arteritis: a disease! Biological agents in TA, medication is not specific for vasculitis, and between... The initial CS treatment were additionally given 2 mg/kg/day oral CYP [ 57 ] progression was observed these! Trials in thrombectomy for acute ischemic stroke: Describing the State of clinical research in the treatment of.. Were discontinued or tapered of interest 25 cases with absent or reduced in. Wall structure and luminal flow also manually searched the references of the disease 12! In the involved vessels in different regions of the literature Varan C, Erdem S, PİŞkİn,! Email: journals.permissions @ oup.com can visualize the characteristic, homogeneously thickened vessel walls and luminal changes of large..

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