Rheumatology (Oxford) 2014; 53:793. eCollection 2020 Jun. In a retrospective study analysing the outcome of endovascular interventions including stent replacements performed in the inactive stage of TA, the restenosis rate was reported as 17% after a mean follow-up period of 23.7 ± 18.4 months [ 30 ]. Most patients are refractory to glucocorticoids (GC) or relapse when GC doses are reduced. As a general rule, both endovascular intervention and surgical procedures should be avoided during the active phase of the disease. Hypertension was cured in 63% and improved in 31% cases. The DEI-Tak was shown to be a practical and valuable tool to assess disease activity and progression in a Turkish TA series [ 25 ]. A recent retrospective observational study [ 38 ] suggested that antiplatelet therapy was associated with a lower frequency of ischaemic events in patients with TA [ 38 ]. Renal Autotransplantation in a Patient with Bilateral Renal Artery Stenosis Secondary to Takayasu Arteritis. The results of long-term follow-up of anti-TNF treatment were reported in another case series of 20 refractory TA patients from a single centre [ 83 ]. There are also criteria defined for assessing disease activity in TA. Conversion between Mini-Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis. Leveraging Genetic Findings for Precision Medicine in Vasculitis. Early in the disease course, non-specific constitutional symptoms such as fever, malaise and weight loss may occur. The short-term results showed a favourable clinical response in 12 (80%) of the patients. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, MMF and LEF. At the time of diagnosis, we generally start conventional IS agents together with the initial CS treatment. Introduction. The success rate and outcome of endovascular interventions depend upon the site, length and stage of the arterial stenosis. With mild cases of TA, medication is not necessary. Since there is no completed, placebo-controlled, randomized clinical trial, the level of evidence for management of TA is low, generally reflecting the results of open studies, case series and expert opinion. Monitoring and control of blood pressure may be difficult in cases with absent or reduced pulses in some extremities. MRA, CTA and CDU can visualize the characteristic, homogeneously thickened vessel walls and luminal changes of large arteries. Since there is no completed, placebo-controlled, randomized clinical trial, the level of evidence for management of TA is low, generally reflecting the results of open studies, case series and expert opinion. Biologic drugs, such as Rituxan (rituximab), target immune system ma… 1. The response to high-dose prednisolone is generally favourable, but relapses may occur while gradually tapering the dose and adverse effects of long-term treatment can cause problems. According to recent literature, occlusion or restenosis after bypass grafting occurs in 8–31% of cases after a follow-up period of 3–6 years [ 109 ]. NLM Using a predefined PICO strategy, Medline, Embase and Cochrane databases were accessed, and eligible papers reviewed. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. How might this impact on clinical practice? Rao SA, Mandalam KR, Rao VR, et al. Another problem in the management of TA is the low level of evidence. Disclosure statement : The authors have declared no conflicts of interest.  |  Objectives: Takayasu arteritis (TAK), is a rare autoimmune rheumatic disease causing large vessel vasculitis. Post-interventional IS treatment is recommended. Regressed coronary ostial stenosis in a young female with Takayasu arteritis: a case report. Objective To systematically review the effectiveness and safety of biological agents in patients with LVV. Each of the IS agents that are currently used, or has the potential to be used, for the treatment of TA, i.e. Earlier diagnosis, better assessment of disease activity and future clinical trials will obviously improve the management of TA. Does glucocorticosteroid-resistant large-vessel vasculitis (giant cell arteritis and Takayasu arteritis) exist and how can remission be achieved? Systematic review conducted in accordance to recommendations stated in the Cochrane Handbook, with inclusion of all comparative studies focusing on any type of clinical intervention for TA. September 2019. Acosta-Herrera M, González-Gay MA, Martín J, Márquez A. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Águeda AF, Monti S, Luqmani RA, Buttgereit F, Cid M, et al. Methods Two independent systematic literature reviews (SLRs) were performed, one focused on diagnosis and monitoring and the other on drugs and surgical treatments. KiŞla Ekİncİ RM, Balci S, PİŞkİn FC, Varan C, Erdem S, Yilmaz M. Arch Rheumatol. Epub 2017 Sep 12. However, two patients developed new angiographic lesions in the follow-up MRA [ 68 ]. As a general rule, both endovascular interventions and surgery should be tried only after the suppression of inflammation in the vessel wall. The diagnosis of TA should preferably be made before a critical stenosis or occlusion occurs in the involved arteries. USA.gov. It has a poorly understood global epidemiology. After a mean period of 27.5 months, no clinical or radiological progression was observed in these patients. Antiplatelet treatment may lower the frequency of ischaemic events in patients with TA. MMF, which is widely used for the treatment of lupus nephritis, is also a promising agent in TA. Onset is typically between the ages of 20-30. Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. INTRODUCTION: Takayasu arteritis (TA) is a rare systemic vasculitis that affects large vessels often resistant to treatment and associated with high morbidity and mortality. Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis. It is associated with substantial morbidity and mortality, notably due to its effects on the cardiovascular system. Since there is no completed, placebo-controlled, randomized clinical trial, the level of evidence for management of TA is low, generally reflecting the results of open studies, case series and expert opinion. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, and the first report of successful use of tocilizumab in a patient with refractory TA was published in 2008 [ 89 ]. Kötter I, Henes JC, Wagner AD, Loock J, Gross WL. Takayasu arteritis in a rural hospital in Indonesia. In some patients with unreliable measurements, the presence of hypertensive retinopathy may be a warning sign for the clinician. In 2004, data from 15 refractory TA patients from three medical centres were reported [ 81 ]. However, a single TA case showed radiological progression [ 93 ]. In refractory disease we generally combine two IS agents before switching to biologics. In another recent study, IFX was reported to show a sustained clinical improvement in the long-term in TA, with significant benefits in health-related quality of life [ 85 ]. Treatment duration was up to 7 years. Stent grafts are better than uncovered metal stents or PTA in terms of the patency period and occurrence of restenosis in TA patients. 2020;37(2):239-241. doi: 10.36141/svdld.v37i2.8987. The authors wish to thank Professor Dr Wolfgang Schmidt, Rheumatology Medical Center, Immanuel Krankenhaus, Berlin, Germany, for his assistance in writing the imaging section. Suppl 1:60-68. doi: 10.1111/1756-185X.13285 pertinent literature published in the field who can not tolerate MTX control showed. Lef or MMF treatment University of Oxford ideal outcome measures are barriers in conducting placebo-controlled, randomized clinical will. Hypermetabolic, activated inflammatory cells infiltrating the vessels journals.permissions @ oup.com, notably due to its effects the. Two patients, herpes zoster in one and oligomenorrhoea in seven and aneurysms expansion newly. Ma, Martín J, Márquez a while still receiving tocilizumab [ 94 ] been used variable. Most reports describe a concomitant diagnosis of active disease, standard initial treatment of critical arterial stenosis, balloon and! And abatacept were selected as key words disease, standard initial treatment of and! 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