How is Takayasu's arteritis treated?
Corticosteroids are the most common treatment for TAK. The most frequently used drug in this category is prednisone or prednisolone. Corticosteroids work within hours after the first dose is given. While this drug is often dramatically effective in bringing about remission (the absence of active blood vessel inflammation), it may be only partially effective for some patients and it may not prevent TAK from coming back (called a relapse).
The goal of therapy is to stop all injury due to vasculitis. Once it is apparent that the disease is under control, doctors slowly reduce the dose of prednisone to the lowest effective dose in order to minimize treatment side effects. In some patients, it is possible to gradually discontinue medication without a relapse.
As the dose of prednisone is gradually reduced, over half of all patients will have recurrent symptoms or progression of illness. This has led to exploring additional therapies to produce remission. Among drugs that have been tried, with varying degrees of success, are immunosuppressive medications such as methotrexate, azathioprine (Imuran®), mycophenolate (Cellcept® or Myfortic®), or rarely cyclophosphamide (Cytoxan®) . Preliminary reports also suggest encouraging results with use of certain biologic agents. These experiences will have to be confirmed in formal studies before they can be generally recommended.
When these drugs are added to prednisone to treat TAK, 50% of patients who had previously relapsed will achieve remission and be able to gradually discontinue prednisone. Overall, about 25% of patients will have disease that is not entirely controlled without continued use of these therapies. This emphasizes the need for continuing research to identify better and less toxic treatments for TAK and other forms of vasculitis.
Many patients with TAK have high blood pressure (hypertension). Careful control of blood pressure is very important. Inadequate treatment of high blood pressure may result in stroke, heart disease, or kidney failure.
In some instances, narrowing of arteries to the kidney may be the cause of hypertension. Whenever possible, it is desirable to stretch narrow vessel openings with a balloon (angioplasty) or to do a bypass operation to restore normal flow to the kidney. This may result in normal blood pressure, without the need to use antihypertensive medications.
Some patients may have serious disabilities because of narrowed blood vessels to other sites such as the arms or legs. Bypass operations may correct these abnormalities. Aneurysms can also be surgically repaired or bypassed.