Takayasu arteritis: an update
Makaleler > Tam Makale · 2018
Yazarlar: Gökhan KESER, Kenan AKSU, H Dıreskenelı
TURKISH JOURNAL OF MEDICAL SCIENCES, SCI Expanded İndekslerine Giren Dergi, Uluslararası, 2018, cilt 48, ss 681-697
DOI: 10.3906/sag-1804-136
Özet
<p>Abstract: Takayasu arteritis (TAK) is a challenging chronic, granulomatous, large-vessel systemic vasculitis, mostly due to difficulties in<br>early diagnosis and assessing actual disease activity. Since there are no specific diagnostic laboratory tests, biomarkers, or autoantibodies,<br>many patients experience considerable delay in diagnosis. Remembering the possibility of TAK together with the use of acute phase<br>responses and appropriate imaging studies may be helpful for early diagnosis. Since there may be discrepancies between systemic and<br>vascular wall inflammation, using only acute phase responses is not reliable in assessing current disease activity. Therefore, physical<br>examination and new imaging findings should also be used to assess current disease activity. Despite its limitations, the Indian Takayasu<br>Clinical Activity Score (ITAS2010) may also be helpful for this purpose. The rationale of medical treatment is to suppress both vascular and<br>systemic inflammation with appropriate systemic immunosuppression, including corticosteroids and conventional immunosuppressive<br>agents. In cases of refractory disease activity, leflunomide and biologic agents such as TNF inhibitors and tocilizumab may be tried.<br>In selected cases with persistent lesions that cannot be reversed with medical treatment, endovascular interventions including balloon<br>angioplasty, stent and stent graft replacement, or surgery may be tried. However, such procedures should be performed after suppression<br>of inflammation, i.e. during inactive disease. Prognosis of TAK is probably getting better with lower mortality rates reported in recent<br>years, probably due to the use of more effective medical treatments as well as the use of endovascular interventions when necessary and<br>available.<br></p>