Management of Takayasu Arteritis - A 2026 Update

Takayasu arteritis (TAK) is a chronic, large-vessel vasculitis disproportionately affecting young women. The consequences of vascular inflammation include stenotic and occlusive disease with resultant end organ ischemia and dysfunction impacting quality of life. In this review, we highlight the recent advances in the assessment of disease activity and damage and treatment of TAK.

Distinguishing disease activity from vascular damage in patients with TAK is challenging. The PET Vascular Activity Score (PETVAS) and Vasculitis Activity using MR and PET Vasculitis Activity using MR and PET (VAMP) hold promise. Composite scores such as the TAK Integrated Disease Activity Index (TAIDAI) combine information from prevalent clinical features and FDG-PET. For damage assessment, the validation of the Large Vessel Vasculitis Index of Damage (LVVID) in patients with TAK and reports of serum biomarkers of fibrosis are important advances. The usual practice for treating patients with TAK is to combine glucocorticoids with DMARDs. Recent studies have shown the effectiveness of methotrexate or mycophenolate mofetil (alone or in combination), secukinumab, tofacitinib, and baricitinib while confirming the role of tumor necrosis factor alpha inhibitors or tocilizumab in the management of TAK. Vascular interventions are reserved for vascular damage or ischemia of major organs threatening their function or affecting the quality of life. Advances in the assessment of disease activity and damage using composite tools hold promise to improve the management of patients with TAK. More high-quality trials are required to better inform the evidence base for treating patients with TAK.