Management of Takayasu arteritis

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology Pub Date : 2023-03-01 DOI:10.1016/j.berh.2023.101826

Durga Prasanna Misra , Kritika Singh , Upendra Rathore , Chengappa G. Kavadichanda , Manish Ora , Neeraj Jain , Vikas Agarwal

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引用次数: 9

Abstract

This review overviews the challenges in the assessment of disease activity, damage, and therapy of Takayasu arteritis (TAK). Recently developed disease activity scores for TAK are more useful for follow-up visits and require validation of cut-offs for active disease. A validated damage score for TAK is lacking. Computed tomography angiography (CTA), magnetic resonance angiography (MRA), and ultrasound enable the evaluation of vascular anatomy and arterial wall characteristics of TAK. 18-fluorodeoxyglucose (18-FDG) positron emission tomography (PET) visualizes arterial wall metabolic activity and complements the information provided by circulating C-reactive protein (CRP) levels. ESR and CRP alone moderately reflect TAK disease activity. TAK is corticosteroid-responsive but relapses upon tapering corticosteroids. Conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) are the first-line maintenance agents, and tumor necrosis factor-alpha inhibitors, tocilizumab, or tofacitinib are second-line agents for TAK. Revascularization procedures for TAK should be used judiciously during periods of inactive disease.

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高安动脉炎的治疗

本综述概述了评估高安动脉炎（TAK）的疾病活动性、损害和治疗所面临的挑战。最近开发的TAK疾病活动性评分对随访更有用，但需要对活动性疾病的临界值进行验证。目前还没有经过验证的 TAK 损伤评分。计算机断层扫描血管造影术（CTA）、磁共振血管造影术（MRA）和超声波检查可评估TAK的血管解剖和动脉壁特征。18-氟脱氧葡萄糖（18-FDG）正电子发射断层扫描（PET）可观察动脉壁的代谢活动，并补充循环C反应蛋白（CRP）水平提供的信息。仅血沉和 CRP 可适度反映 TAK 的疾病活动。TAK 对皮质类固醇有反应，但皮质类固醇减量后会复发。传统合成的改善病情抗风湿药（DMARDs）是一线维持治疗药物，肿瘤坏死因子-α抑制剂、托西珠单抗或托法替尼是治疗TAK的二线药物。在疾病处于非活动期时，应慎用TAK的血管重建手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Best Practice & Research in Clinical Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

0.00%

发文量

审稿时长

27 days

期刊介绍： Evidence-based updates of best clinical practice across the spectrum of musculoskeletal conditions. Best Practice & Research: Clinical Rheumatology keeps the clinician or trainee informed of the latest developments and current recommended practice in the rapidly advancing fields of musculoskeletal conditions and science. The series provides a continuous update of current clinical practice. It is a topical serial publication that covers the spectrum of musculoskeletal conditions in a 4-year cycle. Each topic-based issue contains around 200 pages of practical, evidence-based review articles, which integrate the results from the latest original research with current clinical practice and thinking to provide a continuous update. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. The review articles seek to address the clinical issues of diagnosis, treatment and patient management. Management is described in practical terms so that it can be applied to the individual patient. The serial is aimed at the physician in both practice and training.