The management of Takayasu's arteritis: personal experience

Takayasu's arteritis is a chronic vasculitis mainly involving the aorta and its main branches. Almost all patients have ischemic disorders of the involved vessels. Treatment is nowadays controversial. Relapses are frequent. In the present study, we elucidate the long-term outcomes of our patients with Takayasu's arteritis. Between November 1993 and October 2003, 10 patients with Takayasu's disease were treated. All patients underwent medical treatment (corticosteroid for 7 months, cyclophosphamide for 3 months, and methotrexate for 12 months). Two patients stopped treatment with methotrexate when renal failure occurred. Four patients underwent a surgical procedure. During treatment, erythrocyte sedimentation rate and C-reactive protein concentrations were determined as indexes of inflammatory activity and treatment responsiveness. Four out of eight patients (50%) who underwent the full treatment with methotrexate had no relapse of the disease. The other four patients (50%) had relapse of the disease but had a better response to new corticosteroid treatment. The two patients who stopped methotrexate treatment died from complications of Takayasu's arteritis. In our personal experience, long-term treatment with methotrexate demonstrated a certain efficacy in avoiding relapse, maintaining stability of results, and amplifying the effects of steroid in patients with relapse.