Remission achieved in refractory advanced takayasu arteritis using rituximab

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Takayasu arteritis (TA) is a large vessel vasculitis often presenting with diverse symptoms.
• Vascular stenosis and occlusion are hallmarks of TA, leading to significant morbidity.
• Refractory disease poses a therapeutic challenge, necessitating novel treatment strategies.

Purpose of the Study:

• To report a case of Takayasu arteritis with refractory disease activity.
• To describe the management of a patient with TA experiencing multiple arterial stenoses and treatment resistance.
• To evaluate the potential role of rituximab in managing refractory Takayasu arteritis.

Main Methods:

• Diagnosis of Takayasu arteritis based on clinical presentation, Doppler ultrasound, and MRI angiography.
• Initial treatment with high-dose prednisolone and intravenous cyclophosphamide (CYC).
• Subsequent addition of azathioprine due to relapsing disease activity and introduction of rituximab for refractory symptoms.

Main Results:

• The patient presented with subclavian stenosis, exertional dyspnea, claudication, and neurological deficits.
• Initial immunosuppressive therapy failed to prevent disease progression, with new pulmonary artery stenosis identified.
• Rituximab was initiated due to persistent disease activity refractory to maximal standard therapy.

Conclusions:

• Takayasu arteritis can present with severe, multi-arterial involvement and refractory disease.
• Standard immunosuppressive regimens may be insufficient for controlling aggressive TA.
• Rituximab represents a promising therapeutic option for refractory Takayasu arteritis, warranting further investigation.