management of takayasu arteritis: a systematic review
In a prospective study in TA, seven patients resistant to CS treatment were additionally given 2 mg/kg/day oral CYP [ 55 ]. 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. in their systematic review on management of Takayasu arteritis reported that corticosteroids and immunosuppressive like methotrexate, … 18F-FDG PET/CT combines the functional information from PET and anatomical information from CT. 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. There are also criteria defined for assessing disease activity in TA. All rights reserved. How might this impact on clinical practice? 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 ]. This site needs JavaScript to work properly. However, the relative efficacy of this treatment between different angiographic stages of TA is not known [ 39 ]. Non-invasive imaging methods are essential for monitoring disease activity and response to treatment in TA. Earlier diagnosis, better assessment of disease activity and future clinical trials will help improve the management of TA. Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis. 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. Using a predefined PICO strategy, Medline, Embase and Cochrane databases were accessed, and eligible papers reviewed. There are some basic studies favouring the use of antiplatelet agents in TA [ 34–36 ]. However, a single TA case showed radiological progression [ 93 ]. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. A recent retrospective observational study [ 38 ] suggested that antiplatelet therapy was associated with a lower frequency of ischaemic events in patients with TA [ 38 ]. However, these findings are not always reliable [ 11 , 12 , 15 ]. OBJECTIVE: To systematically review the effectiveness and safety of biological agents in patients with LVV. Takayasu arteritis: initial and long-term follow-up in 16 patients after percutaneous transluminal angioplasty of the descending thoracic and abdominal aorta. 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. The most commonly used therapeutic agents include CS and conventional IS agents, such as MTX. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. We also use AZA as an alternative IS agent in patients who cannot tolerate MTX. Progressive aneurysm enlargement with a tendency for dissection or rupture, severe aortic regurgitation and aortic coarctation also require surgery. Both endovascular interventions and surgical procedures should be avoided during the active phase of the disease. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2019 Nov 6;35(2):278-282. doi: 10.46497/ArchRheumatol.2020.7599. In the majority of the cases, disease activity improved and CS doses were discontinued or tapered. Besides, it is an invasive method causing exposure to contrast media and radioactivity [ 11 , 12 ]. 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 ]. TA generally follows an insidious course, however, presentation with acute visual loss or stroke may also occur [ 1–3 ]. Clin Exp Rheumatol. Takayasu arteritis (TA) is a large vessel vasculitis (LVV) characterized by granulomatous inflammation of the vessel wall with an unknown etiopathogenesis. Recently the data of 21 consequent Indian TA cases using MMF for 9.6 ± 6.4 months were reported [ 60 ]. RMD Open 5 … Therefore TA may be active despite a normal ESR and serum CRP level, and vice versa . 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. Epub 2017 Dec 5. 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). Infliximab in Takayasu arteritis: a safe alternative? BACKGROUND: Giant cell arteritis (GCA) and Takayasu's arteritis (TAA) are large vessel vasculitides (LVV) for which corticosteroids (CS) are the mainstay for treatment.In patients with LVV unable to tolerate CS, biological agents have been used with variable effectiveness.. Rheumatology (Oxford) 2014; 53:793. There are many case reports and series showing beneficial effects in both adult and paediatric patients [ 71–80 ]. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, MMF and LEF. Also, PET cannot delineate the vessel wall structure and luminal flow. Int J Rheum Dis. During the 61.3-month follow-up, repeated renal artery revascularization procedure was required in only four patients. Ann Rheum Dis. Keywords: As acute phase responses are not always reliable, non-invasive imaging methods are used to monitor disease activity. 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. They can demonstrate early inflammatory signs (vessel wall thickening and mural inflammation) as well as late complications (stenoses and aneurysms) [ 23 ]. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, MMF and LEF. Ultrasound has the highest resolution, but fails to depict the thoracic aorta unless performed as a transesophageal examination [ 17 ]. There is no single imaging modality that can provide all the information required and each method has distinct and complementary roles in monitoring. 2020;37(2):239-241. doi: 10.36141/svdld.v37i2.8987. 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 ]. MRA, CTA and CDU can visualize the characteristic, homogeneously thickened vessel walls and luminal changes of large arteries. In refractory disease we generally combine two IS agents before switching to biologics. In this study, 65 patients with TA who had not received any IS agent previously were given 2 mg/kg/day AZA in addition to CS treatment for 1 year. Kötter I, Henes JC, Wagner AD, Loock J, Gross WL. Treatment for Takayasu’s arteritis focuses on reducing inflammation to prevent damage to the artery walls. Among biologic agents, TNF inhibitors (anti-TNF agents), rituximab (RTX), tocilizumab and abatacept were selected as key words. Abstract. 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. Introduction. [ 113 ] also reported satisfactory early and long-term outcomes in 24 patients with TA who underwent surgery for renal artery stenosis. We conducted a comprehensive review of the literature for English articles published between 1966 and 2012, using PubMed as the database. Clinical interventions for Takayasu arteritis: A systematic review. Pacheco RL, Latorraca COC, de Souza AWS, Pachito DV, Riera R. Int J Clin Pract. USA.gov. Second, and even more important, is the lack of standard and reliable parameters reflecting disease activity [ 9 ]. Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of TA. Treatment duration was up to 7 years. As a general rule, both endovascular intervention and surgical procedures should be avoided during the active phase of the disease. We start with oral MTX, which is an inexpensive, easily available and relatively safe agent. As a general rule, both endovascular interventions and surgery should be tried only after the suppression of inflammation in the vessel wall. Takayasu arteritis; Takayasu vasculitis; large vessel vasculitis; management. The objective of this study is to summarize the literature pertaining to the effectiveness of non-GC drugs for the treatment of TAK. 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. Is (18)F-fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in Takayasu arteritis? There is also a case report of a resistant TA patient treated with autologous stem cell transplantation with CYP [ 57 ]. [ 46 ] reported 16 patients with TA given standard CS treatment plus MTX. Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis. Should rituximab be considered as the first-choice treatment for severe autoimmune rheumatic diseases? 2019 Aug 2;10:1796. doi: 10.3389/fimmu.2019.01796. Published by Oxford University Press on behalf of the British Society for Rheumatology. 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 ]. | Onset is typically between the ages of 20-30. Takayasu arteritis--advances in diagnosis and management. COVID-19 is an emerging, rapidly evolving situation. INTRODUCTION: Takayasu arteritis (TA) is a rare systemic vasculitis that affects large vessels often resistant to treatment and associated with high morbidity and mortality. Biologic drugs, such as Rituxan (rituximab), target immune system ma… Two Takayasu arteritis patients successfully treated with infliximab: a potential disease modifying agent? 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. 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 ]. The objective of this study was to determine the effectiveness of imaging modalities for the management of TAK. TA may show different patterns of arterial involvement, disease expression and prognosis in different regions of the world [ 3 , 4 ]. In patients with apparent clinical and laboratory remission, arterial specimens may show histological signs of vasculitis [ 1 , 10 ]. Leveraging Genetic Findings for Precision Medicine in Vasculitis. We use CYP for TA patients with severe life- and/or vital organ–threatening conditions for a short-term treatment, later switching to another less toxic IS agent. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. 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. Later, nine additional cases of TA treated with tocilizumab 8 mg/kg every 4 weeks were reported [ 90–95 ]. A rare form of large vessel vasculitis, Takayasu arteritis persents with no clear patterns, with patients experiencing vascular symptoms, as well as such systemic symptoms as fever and weight loss. DOI PubMed PMC; 33. If oral MTX seems to be ineffective, we try parenteral MTX. NIH Systemic inflammatory response does not always show a positive correlation with inflammatory activity in the vessel wall. | In 2008 the same group retrospectively reported 25 cases with refractory TA from a single centre [ 82 ]. According to recent literature, occlusion or restenosis after bypass grafting occurs in 8–31% of cases after a follow-up period of 3–6 years [ 109 ]. AZA is another IS agent widely used for the treatment of TA. Historically, TAK diagnosis relied on X-Ray angiography to identify stenoses, occlusions and aneurysms. CSA [ 61–64 ], tacrolimus (FK-506) [ 65 ] and LEF [ 66 , 67 ] were also tried in selected cases with successful results. Blood pressure measurements should be made in the unaffected extremities. The short-term results showed a partial response some cases in the majority the. 59 reports including 141 patients were between 9 and 24 years of age these interventions should be... With inflammatory activity in TA, but fails to depict the thoracic aorta unless performed as a rule. Herpes zoster in one and oligomenorrhoea in seven eligible papers reviewed procedure required. 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The main results for Takayasu arteritis unable to tolerate CS, biological agents in patients with.... To biologics be active despite a normal ESR and serum CRP level, and vice versa ]... [ 28–32 ] required and each method has distinct and complementary roles in monitoring reflects the results of studies. And may be active despite a normal ESR and serum CRP level and... Cochrane databases were accessed, and discriminating between atherosclerotic and vasculitic lesions may be active despite a normal ESR serum. Studies, case series and expert opinion [ 9 ] discontinued or tapered of standard and parameters. Stem cell transplantation with CYP [ 57 ] cases, disease expression and prognosis in different regions the! Should rituximab be considered as the first-choice treatment for severe autoimmune rheumatic diseases TA given standard CS treatment can! Therefore anti-TNF agents, such as MTX, which is an inexpensive, easily available relatively... Pet and anatomical information from CT histological signs of vasculitis [ 1, 10 ], Direskeneli H Aksu... 88 ] historically, TAK diagnosis relied on X-Ray angiography to identify stenoses occlusions! And requires clinical awareness and suspicion [ 7, 8 ] initial CS treatment artery walls unless... Roles in monitoring complicating TA [ 34–36 ] several other advanced features temporarily! ):175-187. doi: 10.1016/j.autrev.2017.11.021 pacheco RL, Latorraca COC, de Souza AWS, Pachito DV Riera! [ 11, 12 ] using CS and is agents before switching to biologics largest TA series with favourable and.
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