Treatment of Takayasu arteritis
- Gene G Hunder, MD
Gene G Hunder, MD
- Section Editor — Vasculitis
- Professor Emeritus
- Mayo Clinic College of Medicine
Takayasu arteritis (TA) is a chronic vasculitis of unknown etiology. Women are affected in 80 to 90 percent of cases, with an age of onset that is usually between 10 and 40 years.
TA primarily affects the aorta and its primary branches (table 1). The initial vascular lesions frequently occur in the left middle or proximal subclavian artery. As the disease progresses, the left common carotid and vertebral, brachiocephalic, right middle or proximal subclavian, right carotid and vertebral arteries, as well as the aorta, may also be affected. The abdominal aorta and pulmonary arteries are involved in approximately 50 percent of patients. (See "Classification of and approach to the vasculitides in adults".)
The inflammatory processes cause thickening of the walls of the affected arteries. The proximal aorta (eg, aortic root) may become dilated secondary to inflammatory injury. Narrowing, occlusion, or dilation of involved portions of the arteries in varying degrees results in a wide variety of symptoms.
The treatment of TA will be reviewed here. The pathogenesis, pathology, clinical manifestations, and diagnosis of this disorder are discussed separately. (See "Clinical features and diagnosis of Takayasu arteritis".)
The mainstay of therapy for Takayasu arteritis (TA) is glucocorticoids. Angioplasty or bypass grafts may be necessary once irreversible arterial stenosis has occurred. Treatment of hypertension and heart failure should be instituted if these complications occur.
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- - Initial glucocorticoid dose
- - Assessing response to treatment
- Clinical findings
- - Tapering glucocorticoids
- - Preventing glucocorticoid adverse effects
- Glucocorticoid-resistant disease
- - Methotrexate
- - Leflunomide
- - Mycophenolate mofetil
- - Tocilizumab
- - Azathioprine
- - Anti-TNF agents
- - Other medications
- - Recommendation
- Aortic valve surgery
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS