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引用次数: 0
摘要
高安动脉炎是一种罕见的慢性炎症性大血管炎,主要侵犯主动脉及其大分支。诊断依据的是 2022 年 ACR/EULAR 的高安动脉炎分类标准。这种血管炎的治疗具有挑战性。虽然它对皮质类固醇有反应,但复发和疾病进展很常见。因此,有可能将肿瘤坏死因子-α抑制剂、妥西珠单抗或 JAK 抑制剂作为二线药物,以替代传统的合成改善病情抗风湿药物和生物制剂。然而,在一些复杂的病例中,尽管采用了不同的治疗方案,但血管炎仍处于活跃期,而多靶点治疗方法可促使病情持续缓解。我们在此报告了一例 33 岁女性难治性高安动脉炎患者的病例,该患者在使用托西珠单抗(tocilizumab)、英夫利昔单抗(infliximab)和乌帕帕替尼(Upadacitinib)三种不同的治疗方案后仍处于活动期。最后,我们考虑采用英夫利昔单抗、乌帕帕替尼和甲氨蝶呤联合治疗的多靶点方法。
Difficult-to-treat Takayasu arteritis: a case-based review.
Takayasu arteritis is a rare chronic inflammatory large vessel vasculitis which affects the aorta and its large branches. The diagnosis is based on the 2022 ACR/EULAR classification criteria for Takayasu arteritis. The management of this vasculitis is challenging. Although it is corticosteroid-responsive, relapses and disease progression are common. Thus, it is possible to resort to alternative conventional synthetic disease-modifying anti-rheumatic drugs and biologics, as second-line such as tumor necrosis factor-alpha inhibitors, tocilizumab, or JAK inhibitors as second-line agents is possible. Nevertheless, in some complex cases, the vasculitis remains active despite different proposed therapeutic lines, and a multitarget approach could induce sustained remission. We report herewith a case of 33-female patient with a refractory Takayasu arteritis which remained active after three different therapeutic lines with tocilizumab, then infliximab, then Upadacitinib. Finally, we consider a successful multitarget approach with a combination of infliximab, Upadacitinib, and methotrexate.
期刊介绍:
RHEUMATOLOGY INTERNATIONAL is an independent journal reflecting world-wide progress in the research, diagnosis and treatment of the various rheumatic diseases. It is designed to serve researchers and clinicians in the field of rheumatology.
RHEUMATOLOGY INTERNATIONAL will cover all modern trends in clinical research as well as in the management of rheumatic diseases. Special emphasis will be given to public health issues related to rheumatic diseases, applying rheumatology research to clinical practice, epidemiology of rheumatic diseases, diagnostic tests for rheumatic diseases, patient reported outcomes (PROs) in rheumatology and evidence on education of rheumatology. Contributions to these topics will appear in the form of original publications, short communications, editorials, and reviews. "Letters to the editor" will be welcome as an enhancement to discussion. Basic science research, including in vitro or animal studies, is discouraged to submit, as we will only review studies on humans with an epidemological or clinical perspective. Case reports without a proper review of the literatura (Case-based Reviews) will not be published. Every effort will be made to ensure speed of publication while maintaining a high standard of contents and production.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.