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Management of Takayasu arteritis
Durga Prasanna Misra1, Kritika Singh1, Upendra Rathore1
1Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
Best Practice & Research. Clinical Rheumatology
|May 28, 2023
Summary
Assessing Takayasu arteritis (TAK) activity and damage presents challenges. While new scores aid follow-up, validated damage metrics and optimal therapies, including biologics, are crucial for managing this rare vasculitis.
Area of Science:
- Rheumatology
- Vascular Medicine
- Immunology
Background:
- Takayasu arteritis (TAK) is a large-vessel vasculitis with significant diagnostic and management challenges.
- Accurate assessment of disease activity and damage is crucial for effective treatment of TAK.
Purpose of the Study:
- To review the current challenges and advancements in assessing disease activity, damage, and therapy in Takayasu arteritis.
- To highlight the utility of various imaging modalities and biomarkers in TAK management.
Main Methods:
- Review of recent literature on Takayasu arteritis assessment and treatment.
- Analysis of disease activity scores, imaging techniques (CTA, MRA, ultrasound, 18-FDG PET), and laboratory markers (ESR, CRP).
- Evaluation of therapeutic strategies including corticosteroids, conventional synthetic DMARDs, and biologic agents.
Main Results:
- Recently developed disease activity scores for TAK require further validation for active disease cut-offs.
- A validated damage score for TAK is currently lacking.
- Imaging modalities like CTA, MRA, ultrasound, and 18-FDG PET provide valuable insights into vascular involvement and inflammation.
- ESR and CRP offer moderate reflection of disease activity, while biologics and targeted therapies show promise as second-line agents.
Conclusions:
- Effective management of Takayasu arteritis necessitates validated tools for assessing disease activity and damage.
- A multimodal approach combining clinical assessment, advanced imaging, and appropriate therapeutic strategies is essential for optimal patient outcomes.
- Judicious use of revascularization procedures during inactive disease phases is recommended.
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