Takayasu arteritis: an update

Area of Science:

• Rheumatology
• Internal Medicine
• Immunology

Background:

• Takayasu arteritis (TAK) is a chronic, granulomatous, large-vessel vasculitis.
• Diagnosis and assessment of disease activity in TAK are challenging due to a lack of specific biomarkers.
• Delayed diagnosis is common, impacting patient outcomes.

Purpose of the Study:

• To review diagnostic challenges and strategies for Takayasu arteritis.
• To discuss methods for assessing disease activity in TAK.
• To outline current and emerging treatment options for TAK.

Main Methods:

• Literature review of diagnostic and management strategies for Takayasu arteritis.
• Analysis of current guidelines and clinical trial data.
• Synthesis of information on laboratory tests, imaging, clinical scores, and therapeutic interventions.

Main Results:

• Early diagnosis of TAK can be improved by considering clinical suspicion alongside acute phase responses and imaging studies.
• Assessing disease activity requires a combination of physical examination, imaging findings, and clinical scores like the Indian Takayasu Clinical Activity Score (ITAS2010), as systemic inflammation markers may not correlate with vascular inflammation.
• Treatment involves systemic immunosuppression (corticosteroids, conventional agents), with options like leflunomide and biologics (TNF inhibitors, tocilizumab) for refractory cases. Endovascular or surgical interventions are reserved for inactive disease stages.

Conclusions:

• Improved diagnostic approaches and reliable disease activity assessment are crucial for managing Takayasu arteritis.
• Advances in medical and interventional treatments are leading to better prognoses and reduced mortality rates in TAK.
• Multidisciplinary care integrating rheumatology, radiology, and interventional services is essential for optimal patient outcomes.