Takayasu’s arteritis

Abstract

Takayasu's arteritis is a worldwide entity that requires astuteness for early diagnosis. The challenge for the practicing physician is to document active disease, not only to justify immunosuppressive therapy but also to determine the appropriate timing for surgical intervention. No single laboratory assay or imaging modality establishes disease activity, though T2-weighted magnetic resonance imaging, magnetic resonance angiography, and spiral computed tomographic angiography have shown potential in identifying acute inflammatory changes within the vessel wall. Treatment consists primarily of glucocorticoids, but cytotoxic agents such as methotrexate and cyclophosphamide may be added to treat recalcitrant disease. New immunomodulating agents such as leflunomide and tumor necrosis factor inhibitors require further study before they can be added to the treatment armamentarium.

Reduced aortic elastic properties in a child with Takayasu arteritis: case report and literature review

“…As parts of the aorta are involved in most patients with TA, evaluation of aortic elasticity is appropriate for screening of vascular involvement and can be used to determine the benefit of therapy. Glucocorticoid treatment is unequivocally recommended in active disease as soon as TA is diagnosed [11]. Immunosuppressive therapy in general has a favourable effect on the general symptoms of inflammation in patients with TA, a fact which we observed in our patient within 2 weeks after initiation of treatment.…”

“…In the past, conventional angiography was proposed as the gold standard for the assessment of arterial vasculature [10,11]. Within the last few years, MRI, MR-angiography, 2-dimensional and colour duplex ultrasound, CT and 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET) proved to be potentially useful for evaluation of TA [3,8,11,14,17,22].…”

“…Within the last few years, MRI, MR-angiography, 2-dimensional and colour duplex ultrasound, CT and 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET) proved to be potentially useful for evaluation of TA [3,8,11,14,17,22]. MR-and CT-angiography provide a generalised arterial survey of affected vessels.…”

“…MR-and CT-angiography provide a generalised arterial survey of affected vessels. MRI and 2D ultrasound provide information on arterial wall anatomy and thus can be used to detect new vascular lesions in the early ''prepulseless'' stage of the disease, when intimal thickening and mild stenoses are the dominant characteristics [3,4,8,11,22]. Both techniques allow us to recognise the progress of stenoses, the presence of vascular occlusions, aneurysms and dissections, while avoiding the risks of arterial puncture, iodinated contrast load, and radiation exposure.…”

“…This is of special interest, because then surgical or interventional therapy is contraindicated [11]. Therefore, these therapy options should be considered before progressive vascular lesions cause severe problems like end-organ damage that can occur despite treatment with anti-inflammatory drugs [7,19].…”