Recent advances in the management of Takayasu arteritis

Misra, Durga Prasanna; Wakhlu, Anupam; Agarwal, Vikas; Danda, Debashish

doi:10.1111/1756-185x.13285

Cited by 62 publications

(56 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Treatment options. Even though the majority of patients with TA are treated with medication only, in the case of stenosed or occluded arteries, vascular intervention offers the most effective long-term treatment option, particularly for organ ischemia, hypertension and aneurysmal disease (11,17,19,20).…”

Section: Discussionmentioning

confidence: 99%

“…Disease activity in TA can be inferred from increased levels of serum IL-6 and TNFα and a higher uptake of 18F-Fluorodeoxyglucose [(18)F-FDG] in the arterial wall (25,22); even so, distinguishing between systemic and vascular inflammation is difficult and various evaluations have been suggested towards this end: The Indian Takayasu Clinical Activity Score (12), while other authors have recommended direct imaging of vessel wall thickening (ultrasound, CT, angiogram) or positron emission tomography computerized tomography (PET CT) (11).…”

Section: Discussionmentioning

confidence: 99%

“…Apart from mycobacterium tuberculosis, other pathogens may be involved in TA; elevated plasma levels of pentraxin-related protein (PTX-3) are observed both in TA and in infections with Aspergillus fumigatus, Neisseria meningitidis and Pseudomonas aeruginosa (10). The treatment of patients with TA aims to suppress both systemic and vascular inflammation with either corticosteroids, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide or leflunomide (11,12). In refractory cases there are good results with biological agents, antagonists of TNF-α and the Il-6 receptor (IL-6R), such as ustekinumab, infliximab, etanercept, adalimumab, rituximab, tocilizumab, and in pregnant patients treated with certolizumab pegol (13).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Takayasu arteritis in a patient presenting with stroke and improvement of hemiparesis following vascular bypass surgery: A case report

et al. 2020

View full text Add to dashboard Cite

Takayasu arteritis (TA) is a rare disease, with an estimated incidence in general population of <1/year/million, and its presentation as a stroke is an even less common occurrence. The case presented herein is unusual for the fact that the surgical procedure was performed on an urgent basis, irrespective of the active or inactive status of the disease; the bypass technique involved multiple sites; the patient was administered an original combination of medications before and after the procedure, and the patient exhibited significant neurological improvement after the subacute period of the stroke (6 weeks after stroke, 1 week after the procedure), which was sustained at the 18-month follow-up. Published literature on bypass surgery for TA indicate that the majority of complications (aneurysms, stenosis, intracerebral hemorrhage, etc.) occur during the early stages and affect approximately one-third of patients; this procedure was also successful as the patient subsequently began recovering motor function, indicating the successful, sustained re-vascularization of the affected motor areas. Being able to restore the patient's independent activities of daily living is an important goal, which was achieved in this patient and may serve as a reference point for what is possible to achieve in these cases.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Takayasu arteritis in a patient presenting with stroke and improvement of hemiparesis following vascular bypass surgery: A case report

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Takayasu arteritis (TA) is a large vessel vasculitis predominantly found in Asian populations [1]. Recently various treatment options have come up, including multiple biologicals [2]. This, along with improved medical care, is bringing down mortality in this dreaded disease [3].…”

Section: Introductionmentioning

confidence: 99%

Poor obstetric outcomes in Indian women with Takayasu arteritis

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction: Takayasu's arteritis (TA) affects young women in the childbearing age group. We studied obstetric outcomes in these patients before and after disease onset. Methods: Women aged more than 18 years with Takayasu's arteritis (ACR 1990 criteria) were included. Demographic data, clinical features, disease activity using Indian Takayasu Arteritis clinical score (ITAS), Disease Extent Index for TA (DEI.TaK) and damage assessment using TA Damage score (TA), history of conception and maternal and fetal outcomes were recorded from hospital records and telephonic interview. Results are in median and IQR. Results: Of the 64 women interviewed, aged 29 (24-38) years and disease duration 5 (4-10) years, 74 and 38 pregnancies had occurred before and after disease diagnosis in 29 and 20 women respectively. In eight, the diagnosis was made during pregnancy. Age at disease onset was 22 (18-30) years. Type 5 disease was the most common (n = 32, 59.3%), and an equal number of patients had Ishikawa's class I and II disease (n = 26, 40.6%). Median ITAS (n = 44) was 13 (7-16), DEI.Tak 12.5 (9-16.75) and TADS 8 (6.5-10). Twenty-five patients wanted to get pregnant, of which 8 (32%) did not do so because of their disease. Fifteen were unmarried of whom 6 did not marry due to disease. Obstetric outcomes were poorer in pregnancies that occurred after the onset of disease as compared with those before it (RR = 1.5, p = 0.01). Pregnancies after the onset of TA carried a very high risk of maternal [RR3.9 (1.8-8.5), P < 0.001] as well as fetal complications [RR = 2.0 (1.2-3.4), p = 0.001]. Hypertension was the most common maternal complication and occurred most often in the last trimester. The baby weight at birth was lower in pregnancies after disease (2.3 vs. 3.0, p = 0.01). Wong's score greater than or equal to 4 predicted lower birth weight (p = 0.04). ITAS, ITAS-A, DEI. Tak and TADS could not predict obstetric outcomes, and ITAS score exhibited moderate correlation with DEI. Tak (r = 0.78) and TADS (r = 0.58). Conclusion: Women with TA suffer from extremely high risk of poor maternal and foetal outcomes. Wong's scoring can be useful to predict birth weight.

show abstract

“…The present position of various biomarkers like serum autoantibodies, interleukins, vascular endothelial growth factor, matrix metalloproteinase, pentraxin 3 as well as adipokines in assessing disease activity is also discussed in detail. This is followed by a write‐up on recent advances in management of TAK by Danda's group . Their group had recently published treatment outcomes in a large cohort of TAK patients .…”

mentioning

confidence: 99%

Vasculitis research: Moving east

Sharma

2019

Int J of Rheum Dis

View full text Add to dashboard Cite

It gives me immense pleasure to present this special issue of the International Journal of Rheumatic Diseases on "Vasculitis." I thank the editor-in-chief Professor Danda for asking me to be the guest editor with a brief that this issue should give an overview of the recent advances in various vasculitic disorders from all over the world, with a focus on contributions from the APLAR region. The topics for this supplement have been chosen keeping in mind their relevance both to avid researchers in the field and practicing rheumatologists. The supplement starts with a tribute to Professor Paul Bacon, whom unfortunately we recently lost. He was a stalwart of the field, a champion of collaborative research and was a great support to the Indian Rheumatology Association vasculitis (IRAVAS) research group. He was the guiding force behind the development and validation of Indian Takayasu Clinical Activity Score (ITAS2010). 1 There have been significant advancements in the field of various vasculitides in recent times. The first write-up by Durga et al is on current trends and future directions in vasculitis research. 2 This is an exhaustive review, which summarizes the research published in the field of large vessel vasculitis (LVV), and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) in the last 3 years and also details the studies that are in the pipeline and would be looked up to in the coming years. The write-up ends with a perspective of vasculitis research from a viewpoint of developing countries and resource-poor settings. There have been significant developments in nomenclature and classification of various vasculitic disorders. The draft classification criteria of AAV, which are an outcome of the data-driven multi-center Diagnostic and Classification Criteria for Vasculitis study (DCVAS), were presented at the American College of Rheumatology 2017 meeting in San Diego, USA in November, 2017. The next write-up is by Richard Watts on evolving concepts in classification of systemic vasculitis, the stage at which the various new criteria are and what is the way forward?. 3 The next section is on LVV. The first write-up by Tanaz Kermani discusses the similarities and differences in giant cell arteritis (GCA) and Takayasu arteritis (TAK) and whether they are a spectrum of the same disease. 4 The shared clinical, histopathologic and radiographic features of GCA and TAK suggest that the two conditions may be a spectrum of the same disease. However, the geographical differences, association with different major histocompatibility complex classes and differential treatment responses to same biological agents suggest that these may not be same. Then there is a detailed write-up by Jiang's group on the role of radiology and biomarkers in assessing disease activity in TAK. 5 The precise assessment of TAK disease activity has been a challenge in clinical practice. The role of positron emission tomography/computed tomography, magnetic resonance imaging, CT angiography and contrast ultrasound in assessing diseas...

show abstract

Recent advances in the management of Takayasu arteritis

Cited by 62 publications

References 45 publications

Takayasu arteritis in a patient presenting with stroke and improvement of hemiparesis following vascular bypass surgery: A case report

Takayasu arteritis in a patient presenting with stroke and improvement of hemiparesis following vascular bypass surgery: A case report

Poor obstetric outcomes in Indian women with Takayasu arteritis

Vasculitis research: Moving east

Contact Info

Product

Resources

About