Takayasu's arteritis

Abstract

Takayasu's arteritis is an uncommon condition with a unique constellation of clinical findings that continues to fascinate clinicians and researchers. Advances in the techniques used for classifying lymphocytes, recognizing markers of cellular activity, and detecting the presence of cytokines has produced more evidence that Takayasu's arteritis is a cell-mediated immune condition. The etiology(ies) or triggering mechanism(s) of the disease remains elusive. Alternatives to standard angiography for vascular imaging, such as digital subtraction angiography, duplex ultrasonography, and magnetic resonance imaging, have improved the facility with which the diagnosis and management of Takayasu's arteritis can be safely accomplished. Percutaneous transluminal angioplasty of the aorta and renal arteries is a safe and effective means to dilate symptomatic stenoses. In the short term, this technique provides relief from claudication, hypertension, and ischemia. Long-term follow-up suggests that restenosis at the angioplasty site occurs in a substantial number of patients. Whether this represents a fibrotic healing process or continued inflammation is unclear. Attempts to control the inflammation with anti-inflammatory and immunosuppressive agents continue to be reported. Prednisone plus methotrexate is a promising combination for use in this life-threatening condition of young people.