The goal of treatment is to control inflammation and prevent further damage to your blood vessels with the fewest long-term side effects. Takayasu's arteritis can sometimes be difficult to treat because even if you appear to be in remission the disease may still be active. In addition, by the time some people are diagnosed, it's possible that irreversible damage may already have occurred.
On the other hand, if you don't have a lot of signs and symptoms or serious complications, you may not need treatment at all.
Treatment usually consists of medications and, in some cases, surgery.
Many of these medications have serious long-term side effects, so your doctor will try to balance their benefits against their potential risks by controlling dosing of medications and the length of time you take them.
- Corticosteroids. The first line of treatment is usually with a corticosteroid, such as prednisone or methylprednisolone (Medrol). You often start feeling better in just a few days, but you usually need to continue taking medication for an extended period of time. After the first month, your doctor may gradually begin to lower the dose until you reach the lowest dose you need to control inflammation. Some of your symptoms may return during this tapering period. Long-term side effects of corticosteroids include weight gain, high blood sugar, increased risk of infections, osteoporosis, menstrual irregularities and slower wound healing.
- Immune-suppressing medications. If your condition doesn't respond well to corticosteroids or you have trouble tapering off the medication, you may need treatment with drugs that suppress immune system function, such as methotrexate (Trexall, Rheumatrex) or azathioprine (Imuran, Azasan). Some people respond well to medications that were developed for people receiving organ transplants. These drugs, including mycophenolate (CellCept), work by suppressing the immune system, and they have effectively reduced blood vessel inflammation in people with Takayasu's arteritis. The most common side effect is an increased risk of infection.
- Drugs that regulate the immune system. In people who don't respond to standard treatments, drugs that correct abnormalities in the immune system (biologics) may be used. Examples of these drugs include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) and tocilizumab (Actemra). Small studies have found these medications effective at controlling signs and symptoms, as well as at reducing the need for corticosteroid treatments. However, the studies have been small, and more research is needed. The most common side effect is an increased risk of infection.
If your arteries become severely narrowed or blocked, surgery may be necessary to open or bypass these arteries to allow an uninterrupted flow of blood. Often this helps to improve certain symptoms, such as high blood pressure and chest pain. In some cases, though, narrowing or blockage may recur, requiring a second procedure. Also, if you develop large aneurysms, surgery may be needed to prevent them from rupturing. These procedures, which are best performed when inflammation of the arteries has been reduced, include:
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- Bypass surgery. In this procedure, an artery or a vein is removed from a different part of your body and attached to the blocked artery, providing a bypass for blood to flow through.
- Blood vessel widening (percutaneous angioplasty). During this procedure, a tiny balloon is threaded through a blood vessel and into the affected artery. Once in place, the balloon is expanded to widen the blocked area, then it's deflated and removed.
- Stenting. Tiny wire mesh coils called stents may be inserted into the area widened by angioplasty. The stents help to prop open the artery to prevent the blood vessel from narrowing again.
- Takayasu's arteritis. Vasculitis Foundation. http://staging.vasculitisfoundation.org/education/forms/takayasus-arteritis/ Accessed Jan. 22, 2013.
- Imboden JB, et al. Current Rheumatology Diagnosis & Treatment. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2007. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=38. Accessed Jan. 22, 2013.
- Minagar A, et al. Neurologic presentations of systemic vasculitides. Neurology Clinics. 2010;28:171.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Jan. 22, 2013.
- Takayasu's arteritis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/takayasusartritis.asp. Accessed Jan. 22, 2013.
- Mandal D, et al. Takayasu arteritis in pregnancy: An analysis from eastern India. Archives in Gynecology and Obstetrics. 2012;285:567.
- Ohigashi H, et al. Improved prognosis of Takayasu arteritis over the past decade. Circulation Journal. 2012;76:1004.
- Schmidt J, et al. Tumor necrosis factor inhibitors in patients with Takayasu arteritis: Experience from a referral center with long-term follow-up. Arthritis Care and Research. 2012;64:1079.
- Comarmond C, et al. Anti TNF-alpha in refractory Takayasu's arteritis: Cases series and review of the literature. Autoimmunity Reviews 2012;11:678.
- Salvarani C, et al. Tocilizumab:A novel therapy for patients with large-vessel vasculitis. Rheumatology. 2012;51:151.
- Shields RC (expert opinion). Mayo Clinic, Rochester, Minn., Feb. 10, 2013.