Takayasu Arteritis: a Systematic Review and Meta‐Analysis of Test Accuracy and Benefits and Harms of Common Treatments

Abstract

Objective Takayasu’s arteritis (TAK) is a granulomatous large‐vessel vasculitis primarily affecting the aorta and its proximal branches. TAK can be a difficult disease to diagnose and manage given the rarity of the disease as well as current limitations in biomarkers, imperfect imaging modalities, and few randomized controlled trials. Methods In developing the American College of Rheumatology/Vasculitis Foundation guideline for the management of TAK, we performed an extensive systematic literature review to guide our recommendations. We included RCTs first. When RCTs were not available, we included observational studies that reported on patient‐important outcomes for the intervention and comparison. When studies with comparative data were not available, we included case series that present patient‐important outcomes for either the intervention or the comparison. Results Three hundred forty‐seven articles were included for full review to answer 27 population, intervention, comparison, and outcome questions related to TAK. Ten studies were evaluated that addressed the use of glucocorticoids (GCs), non‐GC nonbiologic therapies, as well as biologics in treating TAK. A total of 33 studies, including 8 comparative studies, were included to determine the test accuracy of commonly available diagnostic tests for TAK. Conclusion This comprehensive systematic review synthesizes and evaluates the benefits and harms of different treatment options and the accuracy of commonly used tests for the management of TAK.

Clinical and vascular lesion characteristics of the patients with takayasu arteritis manifested firstly as acute myocardial infarction at onset

“…This result indicates that stent implantation in large artery vessels is effective. Pharmacologic treatment for TA includes antithrombotic therapies, glucocorticoids, and immunosuppressive agents [ 35 , 36 ]. Methotrexate is recommended to use for the treatment of all patients with TA [ 37 ].…”

Derivation and Validation of a New Disease Activity Assessment Tool With Higher Accuracy for Takayasu Arteritis

“…However, imaging findings are not included as a scoring item in the ITAS (13). As patients with active TAK commonly have non-specific disease manifestations and unreliable laboratory parameters, imaging findings are of importance in monitoring disease activity in patients with TAK (19,20). On this basis, it is reasonable to combine clinical manifestations and acute phase reactants with imaging findings to yield a highly accurate disease activity assessment tool.…”

Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis

“…4a). Park et al reported a decrease in median (interquartile range) of PET Vascular Activity Score from 12 (11-15.5) to 11 (8)(9)(10)(11)(12) with infliximab therapy over a follow-up period of 30 weeks [74]. Normalization of inflammatory markers was seen in 80% (95% CI 56-98%, 2 studies, 17 patients, I 2 not assessable, Fig.…”

“…While the role of DMARD therapy in ameliorating disease activity in TAK has been the subject of previous systematic reviews [6][7][8][9], there remains a need to update this information in the context of emerging new literature regarding the pharmacotherapy of TAK. Lack of extensive database searches is another limitation of existing systematic reviews on this topic [10]. In this context, we undertook a systematic review to critically evaluate the literature supporting the use of DMARDs in the management of TAK with respect to outcomes assessed by clinical assessment, angiography and other imaging modalities, inflammatory markers and relapses.…”