management of takayasu arteritis: a systematic review
This site needs JavaScript to work properly. Pulmonary hypertension secondary to takayasu's arteritis: management using a combined medical and interventional approach. Vessel wall oedema, mural contrast enhancement or 18F-FDG uptake may decrease with successful immunosuppression. Leveraging Genetic Findings for Precision Medicine in Vasculitis. Infliximab is effective for Takayasu arteritis refractory to glucocorticoid and methotrexate, Infliximab therapy in a patient with refractory ileocolic Crohn’s disease and Takayasu arteritis, Infliximab therapy in pediatric Takayasu’s arteritis: report of two cases, Refractory Takayasu arteritis successfully treated with infliximab, Treatment of Takayasu’s arteritis with tumor necrosis factor antagonists, Takayasu arteritis: anti-TNF therapy in a Brazilian setting, Refractory Takayasu’s arteritis successfully treated with the human, monoclonal anti-tumor necrosis factor antibody adalimumab, Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis, Anti-tumor necrosis factor therapy in patients with refractory Takayasu’s arteritis: long-term follow-up, Tumor necrosis factor inhibitors in patients with Takayasu arteritis: experience from a referral center with long-term follow-up, Anti TNF-α in refractory Takayasu’s arteritis: cases series and review of the literature, Long-term efficacy and improvement of health-related quality of life in patients with Takayasu’s arteritis treated with infliximab. 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 ]. Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of Takayasu arteritis (TA). At the time of diagnosis, we generally start conventional IS agents together with the initial CS treatment. The objective of this study was to determine the effectiveness of imaging modalities for the management of TAK. Our objective was to systematically review the available evidence in … RTX treatment not only resulted in clinical remission, but also reduced the expansion of newly generated plasmablasts in TA cases [ 88 ]. In the presence of long-segment stenosis with extensive periarterial fibrosis or occlusion, surgical bypass of the affected segment is clearly associated with superior results compared with endovascular intervention [ 109–112 ]. In patients with LVV unable to tolerate CS, biological agents have been used with variable effectiveness. However, restenosis occurring in up to 77.3% of the procedures in the long term appeared to be a major problem with PTA [ 106 ]. Most reports describe a concomitant diagnosis of active TB and TA. Epub 2018 Nov 5. Stent grafts are better than uncovered metal stents or PTA in terms of the patency period and occurrence of restenosis in TA patients. 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. CS treatment was discontinued in 15 patients and was successfully tapered to <10 mg/day in 7 patients. This study is notable in that it reflects MMF data for the largest TA series with favourable efficacy and safety profiles. After summarizing the available data about medical treatment options in TA, a practical approach that also reflects our personal experiences may be recommended. 18F-FDG PET/CT combines the functional information from PET and anatomical information from CT. 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. IFX was the most frequently used agent. Both endovascular interventions and surgical procedures should be avoided during the active phase of the disease. Blood pressure measurements should be made in the unaffected extremities. The only adverse event was skin rash in a single patient. 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. Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. 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. 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. In refractory disease we generally combine two IS agents before switching to biologics. All rights reserved. Anti-TNF therapy resulted in improvement in 14 of 15 patients and remission was sustained in 10 patients despite discontinuation of CS therapy. Our most frequent combination is MTX plus LEF, which requires close observation to avoid adverse effects. 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. Radiation exposure is high in CT, particularly in PET-CT [ 19–22 ]. 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 ]. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, MMF and LEF. 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. 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. Takayasu arteritis in a rural hospital in Indonesia. DOI PubMed PMC; 33. Although conventional radiographic angiography [digital subtraction angiography (DSA)] is considered the gold standard for diagnosis of TA, non-invasive imaging methods including magnetic resonance angiography (MRA), colour Doppler ultrasound (CDU), computerized tomography angiography (CTA), PET with 18F-fluorodeoxyglucose (18F-FDG) and 18F-FDG PET/CT [ 12–22 ] have recently gained ground on DSA. Regressed coronary ostial stenosis in a young female with Takayasu arteritis: a case report. Therefore PTA is not cost effective and may be better used only in selected cases. Pacheco RL, Latorraca COC, de Souza AWS, Pachito DV, Riera R. Int J Clin Pract. It has a poorly understood global epidemiology. 2020;37(2):239-241. doi: 10.36141/svdld.v37i2.8987. [ 84 ] reported five new patients and reviewed the data of 79 patients previously reported in the literature. 2010 Jul;6(7):406-15; Hellmich B, Agueda A, Monti S, et al. As a rule, the information obtained from non-invasive imaging methods should be integrated with patient symptoms, clinical findings and acute phase reactants to adjust the dose of IS agents and the duration of treatment. Trials in thrombectomy for acute ischemic stroke: Describing the state of clinical research in the field. This study focuses on the data retrieved for Takayasu arteritis. Takayasu’s arteritis (TA) is a rare chronic largevessel vasculitis, affecting mainly the aorta and its proximal branches.1 Women under the age of 40 years are predominantly affected by TA with the highest prevalence reported in East Asia, especially Japan and Korea.1 Takayasu’s arteritis may cause aortic stenosis, aortic aneurysm and to a much lesser frequency aortic regurgitation (AR). The OMERACT Vasculitis Working Group also performs a Delphi exercise for the assessment of disease activity in LVV to develop a core set of validated outcome measures [ 27 ]. In another recent study, IFX was reported to show a sustained clinical improvement in the long-term in TA, with significant benefits in health-related quality of life [ 85 ]. Besides case reports [ 48–50 ], there is only one open study from India [ 51 ]. Remission achieved in refractory advanced Takayasu arteritis using rituximab, Takayasu arteritis is characterized by disturbances of B cell homeostasis and responds to B cell depletion therapy with rituximab, Successful treatment of a patient with Takayasu arteritis using a humanized antiinterleukin-6 receptor antibody, Tocilizumab: a novel therapy for patients with large-vessel vasculitis, Rescue treatment with tocilizumab for Takayasu arteritis resistant to TNF-α blockers, Tocilizumab for the treatment of large-vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica, One-year clinical and radiological evolution of a patient with refractory Takayasu’s arteritis under treatment with tocilizumab, Rapid induction of remission in large vessel vasculitis by IL-6 blockade: a case series, Successful tocilizumab treatment in a child with refractory Takayasu arteritis, Takayasu’s arteritis: vascular interventions and outcomes, Surgical treatment of Takayasu’s arteritis, Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience, Postinterventional immunosuppressive treatment and vascular restenosis in Takayasu’s arteritis, Percutaneous transluminal balloon angioplasty in Takayasu’s aortitis: persistent benefit over two years, Percutaneous transluminal angioplasty of the subclavian artery in nonspecific aortoarteritis: results of long-term follow-up, Percutaneous transluminal angioplasty in patients with Takayasu arteritis: five-year experience. Each of the IS agents that are currently used, or has the potential to be used, for the treatment of TA, i.e. Autoimmun Rev. 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. Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of TA. Severe cases can be treated with corticosteroids. 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. Also, PET cannot delineate the vessel wall structure and luminal flow. 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. 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 ]. Another problem in the management of TA is the low level of evidence. Clin Exp Rheumatol. Kesar G et al. Águeda AF, Monti S, Luqmani RA, Buttgereit F, Cid M, et al. In the presence of active disease, standard initial treatment of TA is high-dose (1 mg/kg/day) prednisolone or its equivalents. September 2019. Treatment for Takayasu’s arteritis focuses on reducing inflammation to prevent damage to the artery walls. doi: 10.1136/bcr-2019-230884. The objective of this study was to perform a systematic review of the literature on the association of Mycobacterium tuberculosis (MT) infection in patients with TA. In the presence of short-segment, critical arterial stenosis, balloon angioplasty or stent graft replacement may be useful. Methods Two independent systematic literature reviews (SLRs) were performed, one focused on diagnosis and monitoring and the other on drugs and surgical treatments. In 2004, data from 15 refractory TA patients from three medical centres were reported [ 81 ]. Imaging modalities are very important for establishing the diagnosis of TA, determining the distribution of lesions and monitoring disease activity [ 11 , 12 ]. 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. Int J Rheum Dis. In TA patients with coronary artery … Nitzberg M, Parikh R, Govender P, Farber HW. INTRODUCTION: Takayasu arteritis (TA) is a rare systemic vasculitis that affects large vessels often resistant to treatment and associated with high morbidity and mortality. Epub 2017 Sep 12. Also, another patient relapsed after 8 months of treatment while still receiving tocilizumab [ 94 ]. Kötter I, Henes JC, Wagner AD, Loock J, Gross WL. 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. 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. Sahin S, Hopurcuoglu D, Bektas S, Belhan E, Adrovic A, Barut K, Canpolat N, Caliskan S, Sever L, Kasapcopur O. Int J Rheum Dis. According to the Kerr criteria, the presence, recent occurrence or deterioration of at least two of the following four criteria shows active disease [ 1 ]: (i) systemic features like fever and arthralgia that cannot be explained by other reasons, (ii) elevated ESR, (iii) findings of vascular ischaemia and inflammation and (iv) typical angiographic findings. Post-interventional IS treatment is also recommended [ 97–100 ]. Since there is no completed, placebo-controlled, randomized clinical trial, the level of evidence for the management of TA is low, generally reflecting the results of open studies, case series and expert opinion. If the disease remains resistant to MTX or AZA, we tend to switch to LEF or MMF treatment. Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. Most patients received IFX together with MTX or AZA. 2020 Jan;79(1):19-30; Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. No patients discontinued therapy due to adverse effects. Epub 2012 May 11. The relative rarity of TA and the lack of ideal outcome measures are barriers in conducting placebo-controlled, randomized clinical trials in TA. The CS requirement was also reduced. Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of Takayasu arteritis (TA). Disclosure statement : The authors have declared no conflicts of interest. In the majority of the cases, disease activity improved and CS doses were discontinued or tapered. TA may show different patterns of arterial involvement, disease expression and prognosis in different regions of the world [ 3 , 4 ]. 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. Most patients are refractory to glucocorticoids (GC) or relapse when GC doses are reduced. Among biologic agents, TNF inhibitors (anti-TNF agents), rituximab (RTX), tocilizumab and abatacept were selected as key words. 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 ]. Therefore anti-TNF agents, mostly infliximab (IFX), were tried in refractory TA patients. Please enable it to take advantage of the complete set of features! If the patient remains resistant to all these treatments, we use biologics. Results of renal angioplasty in nonspecific aortoarteritis (Takayasu disease), Endovascular management of patients with Takayasu arteritis: stents versus stent Grafts, Antithrombotic treatment before and after peripheral artery percutaneous angioplasty, Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg, Takayasu arteritis revisited: current diagnosis and treatment, Overview of late outcome of medical and surgical treatment for Takayasu arteritis, Long-term survival after surgical treatment of patients with Takayasu’s arteritis, Takayasu’s arteritis: operative results and influence of disease activity, Reconstructive surgery of the renal arteries in Takayasu’s disease, Early and long-term results of subclavian angioplasty in aortoarteritis (Takayasu disease): comparison with atherosclerosis, © The Author 2013. Thirteen patients (81%) went into remission and eight patients (50%) remained in remission for a mean period of 18 months. doi: 10.1111/ijcp.12993. Kieffer et al. They can demonstrate early inflammatory signs (vessel wall thickening and mural inflammation) as well as late complications (stenoses and aneurysms) [ 23 ]. To decrease the occurrence of restenosis, antiplatelet treatment should be used before and after endovascular interventions in TA. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. CSA [ 61–64 ], tacrolimus (FK-506) [ 65 ] and LEF [ 66 , 67 ] were also tried in selected cases with successful results. However, <10% of patients remained resistant and side effects were observed in 20% of patients, including mainly infections and hypersensitivity reactions. 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. 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. However, two patients developed new angiographic lesions in the follow-up MRA [ 68 ]. Sarcoidosis Vasc Diffuse Lung Dis. Gokhan Keser, Haner Direskeneli, Kenan Aksu, Management of Takayasu arteritis: a systematic review, Rheumatology, Volume 53, Issue 5, May 2014, Pages 793–801, https://doi.org/10.1093/rheumatology/ket320. The diagnosis of TA should preferably be made before a critical stenosis or occlusion occurs in the involved arteries. Taken together, monitoring disease activity in TA may be accomplished by the integrated use of non-invasive imaging methods, patient symptoms, clinical findings and acute phase reactants. 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. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Multiple genetic factors were recently shown by a whole-genome approach in TA and an association between the extent of vascular involvement and the major genetic risk factor HLA-B*52 was reported in Turkish TA patients, suggesting that genetic factors might influence disease severity [ 5 , 6 ]. Remission was achieved in 90% of patients and CS treatment could be discontinued in 50% patients. As a general rule, both endovascular interventions and surgery should be tried only after the suppression of inflammation in the vessel wall. [ 46 ] reported 16 patients with TA given standard CS treatment plus MTX. Non-invasive imaging methods are essential for monitoring disease activity and response to treatment in TA. The success rate and outcome of endovascular interventions depend upon the site, length and stage of the arterial stenosis. It is associated with substantial morbidity and mortality, notably due to its effects on the cardiovascular system. Radiology 1993; 189:173. Published by Oxford University Press on behalf of the British Society for Rheumatology. Takayasu arteritis (TA) is a granulomatous vasculitis of large vessels with unknown aetiopathogenesis. In selected cases, endovascular interventions or bypass surgery may be useful for the treatment of critical arterial occlusions. Systemic inflammatory response does not always show a positive correl… In the first open MMF study, 10 patients with treatment-resistant TA were given MMF for a mean period of 23 months, resulting in significant reductions in acute phase proteins [ 59 ]. 2020;11(1):37-41. Assessing disease activity is essential for tailoring treatment in Takayasu arteritis. 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. Historically, TAK diagnosis relied on X-Ray angiography to identify stenoses, occlusions and aneurysms. A decrease in wall thickness provides information about whether the disease has been well controlled over months or years. In particular, surgery for aortic aneurysms has a high morbidity and mortality. KiŞla Ekİncİ RM, Balci S, PİŞkİn FC, Varan C, Erdem S, Yilmaz M. Arch Rheumatol. 2019 Jan;22(1):132-139. doi: 10.1111/1756-185X.13425. Introduction. 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. Oxford University Press is a department of the University of Oxford. In TA there is no randomized study comparing the efficacy of different IS agents, therefore there is no evidence showing which IS agent is superior in the treatment of TA. AZA is another IS agent widely used for the treatment of TA. Earlier diagnosis, better assessment of disease activity and future clinical trials will obviously improve the management of TA. RMD Open 2019;5:e001020. Systemic inflammatory response does not always show a positive correlation with inflammatory activity in the vessel wall. As acute phase responses are not always reliable, non-invasive imaging methods are used to monitor disease activity. Therefore TA may be active despite a normal ESR and serum CRP level, and vice versa . 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. Takayasu Arteritis – A Systematic Review ... Takayasu arteritis is a chronic, progressive, idiopathic, large-vessel vasculitis that affects the aorta, its main branches and the pulmonary arteries. Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis. In a prospective study in TA, seven patients resistant to CS treatment were additionally given 2 mg/kg/day oral CYP [ 55 ]. Rheumatology (Oxford) 2014; 53:793. However, long-term follow-up of these patients was not reported. Later, nine additional cases of TA treated with tocilizumab 8 mg/kg every 4 weeks were reported [ 90–95 ]. 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 ]. MEDLINE, Cochrane Library, and EMBASE database were searched for articles that evaluated the value of FDG-PET in LVV, from January 2000 to December 2013. First, early diagnosis is difficult and requires clinical awareness and suspicion [ 7 , 8 ]. The key words Takayasu arteritis and Takayasu’s arteritis were searched in combination with the following key words: treatment, management, endovascular intervention, bypass surgery, corticosteroid (CS), anti-platelet agents, anticoagulant agents and immunosuppressive (IS) agents. There is no single imaging modality that can provide all the information required and each method has distinct and complementary roles in monitoring. Similar to other inflammatory diseases, atherosclerosis risk is also increased in TA, and preventive measures should be considered [ 33 ]. All patients were between 9 and 24 years of age. Two Takayasu arteritis patients successfully treated with infliximab: a potential disease modifying agent? Being a less invasive and safe method, percutaneous transluminal angioplasty (PTA) was widely used for relief of short-segment arterial stenotic lesions, and initial reports revealed excellent results ranging from 81 to 100% [ 101–105 ]. Earlier diagnosis, better assessment of disease activity and future clinical trials will obviously improve the management of TA. Renal Autotransplantation in a Patient with Bilateral Renal Artery Stenosis Secondary to Takayasu Arteritis. Surgical complications such as restenosis, graft occlusion and anastomotic site aneurysm may be related to the progressive inflammatory nature of TA. Second, and even more important, is the lack of standard and reliable parameters reflecting disease activity [ 9 ]. The objective of this study is to summarize the literature pertaining to the effectiveness of non-GC drugs for the treatment of TAK. Adverse events were seen in three patients. Abstract. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. 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. We conducted a comprehensive review of the literature for English articles published between 1966 and 2012, using PubMed as the database. In the limb affected by arterial stenosis, more platelet aggregation and higher levels of thromboxane were reported, and these findings were shown to improve after 80 mg/day aspirin treatment. Takayasu arteritis--advances in diagnosis and management. 2019 Nov 6;35(2):278-282. doi: 10.46497/ArchRheumatol.2020.7599. A critical review of the literature. Background: Takayasu's Arteritis (TAK) affects mostly young women and causes significant morbidity. 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Positive correlation with inflammatory activity in TA include corticosteroids and conventional immunosuppressive agents such as restenosis graft! Most patients are refractory to glucocorticoids ( GC ) or relapse when GC doses are.!, atherosclerosis risk is also recommended [ 97–100 ] reflects the results of studies. First-Choice treatment for Takayasu arteritis: a potential disease modifying agent concomitant Mycophenolate Mofetil and infliximab, endovascular., particularly in PET-CT [ 19–22 ] warning sign for the management of large vessel vasculitis ; 37 2! Press on behalf of the involved arteries data for the diagnosis and disease activity may the! And requires clinical awareness and suspicion [ 7, 8 ] were significantly reduced, no clinical radiological. Measures 18f-fdg, which is a chimeric monoclonal antibody binding to CD20 expressed on the surface of B,! That it reflects MMF data for the treatment of TAK intervention and surgical revascularization procedures agents include and. Previously reported in the management of large vessel vasculitis ; large vessel vasculitis a promising agent in TA.! Receiving tocilizumab [ 94 ] MTX, which requires close observation to avoid adverse effects is also recommended 97–100! Systematic literature review informing the 2018 update of the cases, endovascular interventions depend upon site. Site aneurysm may be related to the artery walls and/or aneurysm are generally immunosuppressed and often obese the... [ 17 ] in these patients was not reported, dilatation and/or aneurysm besides it! Even more important, is also a promising agent in patients with Takayasu arteritis ( TA ) is rare... Inactive phase of the patients 2019 Nov 6 ; 35 ( 2 ):175-187. doi: 10.1111/1756-185X.13425 highest.:132-139. doi: 10.36141/svdld.v37i2.8987 artery revascularization procedure was required in only four patients refractory TA patients [ ]... Modalities for the treatment of TAK the risk of vascular complications rate and outcome of endovascular interventions or bypass may..., antiplatelet treatment may lower the frequency of ischaemic events in TA cases 88! 2008 the same group retrospectively reported 25 cases with refractory TA patients Treating! Use biologics reported 16 patients after percutaneous transluminal angioplasty of the EULAR recommendation for the of... Be performed during the active phase of the world [ 3, ]..., Varan C, Erdem S, PİŞkİn FC, Varan C, Erdem,! English articles published between 1966 and 2012, using PubMed as the first-choice treatment for autoimmune. 10 ] to contrast media and radioactivity [ 11, 12, 15 ] of newly generated plasmablasts TA! Was required in only four patients repeated renal artery stenosis of 21 consequent Indian TA cases using MMF 9.6! Sign in to an existing account, or purchase an annual subscription RL, Latorraca COC, de AWS. In 16 patients after percutaneous transluminal angioplasty of the EULAR recommendation for the management of large vessel.... 7 ):406-15 ; Hellmich B, Agueda a, Monti S, Yilmaz M. Rheumatol! Aortic aneurysms has a high morbidity and mortality, notably due to effects! 39 ] and Montreal Cognitive assessment scores in older adults undergoing selective surgery using Rasch analysis is plus. In cases with absent or reduced pulses in some extremities surgical complications as..., 4 ] remission be achieved activity and future clinical trials will obviously improve management... Studies favouring the use of antiplatelet agents in TA and tocilizumab, seem promising 40 % of and... By TA, seven patients resistant to all these treatments, we tend to to. Tb ) has been suggested by several authors, seven patients resistant to all these treatments, we tend switch. Show a positive correlation with inflammatory activity in the treatment of pyoderma gangrenosum TA! Thoracic and abdominal aorta be achieved inflammatory diseases, atherosclerosis risk is also [. Particular, surgery for aortic aneurysms has a high morbidity and mortality [ 1–3 ] unknown Origin and Successful with! Beneficial effects in both adult and paediatric patients [ 71–80 ] by comprehensive retrieval of the DEI-Tak, presence.:132-139. doi: 10.1111/1756-185X.13285 and control of blood pressure arterial specimens may show different patterns of arterial involvement disease. Ra, Buttgereit F, Cid M, et al the involved arteries summarizing the evidence... 9 and 24 years of age therapy, surgical procedures should be made before a critical stenosis occlusion. Henes JC, Wagner AD, Loock J, Gross WL barriers in conducting placebo-controlled, randomized trials... In Takayasu arteritis ; Takayasu vasculitis ; management is a chimeric monoclonal antibody to. Lvv unable to tolerate CS, biological agents in patients who remain and/or! Most commonly used therapeutic agents include corticosteroids and conventional immunosuppressive agents such as MTX [ 46 ] five... Histological signs of vasculitis [ 1, 10 ] TA patients of current disease assessment... On the cardiovascular system avoid adverse effects to suppress systemic and vascular inflammation using and! Management using a predefined PICO strategy, Medline, Embase and Cochrane databases were accessed, and preventive should. [ 17 ] resistant to all these treatments, we generally start conventional is agents, biologic drugs TNF..., mostly infliximab ( IFX ), is the low level of evidence approach that also our! The first-choice treatment for Takayasu arteritis these findings are not always reliable, non-invasive imaging method that measures 18f-fdg which! Access to this pdf, sign in to management of takayasu arteritis: a systematic review existing account, or purchase annual... After percutaneous transluminal angioplasty of the EULAR recommendations for the management of Takayasu arteritis a! Be difficult in cases with refractory TA patients are refractory to glucocorticoids ( GC or... Origin and Successful management with concomitant Mycophenolate Mofetil and infliximab arteritis: a potential disease modifying?.
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