Advances in the diagnosis, assessment, management and outcome of takayasu's arteritis: A narrative Review

Abstract

Takayasu arteritis (TA) is a rare, chronic large-vessel vasculitis (LVV) characterized by granulomatous inflammation of the vessel wall with an unknown etiopathogenesis. TA predominantly affects young females during the 2nd or 3rd decades of life and mainly involves the aortic arch and its major branches, ascending aorta, thoracic descending aorta and abdominal aorta. A physical examination is the first step for disease assessment. Systemic inflammatory response does not always show a positive correlation with inflammatory activity in the vessel wall. Imaging modalities are very important for establishing the diagnosis of TA. Conventional angiography, the gold standard for initial diagnosis, seems to be replaced with the new imaging modalities such as magnetic resonance angiography, ultrasonography, computerized tomography and, 18Ffluorodeoxyglucose positron emission tomography in recent years. Prognosis is possibly getting better with lower mortality in recent years. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as methotrexate, azathioprine, micophenolate mofetil and leflunomide. However, in resistant and/or intolerant patients, biologic drugs including anti-TNF agents (mostly infliximab), rituximab and tocilizumab seem to be promising. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. Endovascular interventions (balloon angioplasty or stent graft replacement) or by-pass surgery may be useful for critical arterial occlusions. There is a clear need to develop a validated set of outcome measures in TA, such as measures of disease activity, health-related quality of life and diseaserelated damage. The OMERACT Vasculitis Working Group has taken on this task and aims to develop a core set of outcomes for LVV. © 2015 by Nova Science Publishers, Inc. All rights reserved.