Treatment of Takayasu's arteritis focuses on controlling the inflammation with medications and preventing further damage to your blood vessels. The disease can sometimes be difficult to treat because even if you appear to be in remission the disease might still be active. In addition, by the time some people are diagnosed, it's possible that irreversible damage has already 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.
Talk with your doctor about the drug or drug combinations that are options for you and what the possible side effects are. Your doctor may prescribe:
Corticosteroids to control inflammation. The first line of treatment is usually with a corticosteroid, such as prednisone. Even if you soon start feeling better, you may need to continue taking the drug long term. 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.
Possible side effects of corticosteroids include weight gain, increased risk of infections, bone thinning (osteoporosis) and menstrual irregularities.
- Other drugs that suppress the immune system. If your condition doesn't respond well to corticosteroids or you have trouble tapering off the medication, your doctor may prescribe immunosuppressant drugs. Examples are methotrexate (Trexall) and azathioprine (Azasan, Imuran). Some people respond well to medications that were developed for people receiving organ transplants. These drugs, including mycophenolate mofetil (CellCept), work by suppressing the immune system, and there is some evidence that they may be helpful with corticosteroids in effectively reducing blood vessel inflammation in people with Takayasu's arteritis. The most common side effect is an increased risk of infection.
- Medications to regulate the immune system. If you don't respond to standard treatments, your doctor may suggest drugs that correct abnormalities in the immune system (biologics). Examples are etanercept (Enbrel) and infliximab (Remicade). Small studies have found these medications effective at controlling signs and symptoms, as well as at reducing the need for corticosteroid treatments. In addition, tocilizumab (Actemra) has been reported to be beneficial in treating Takayasu's arteritis. More research is needed. The most common side effect with these drugs an increased risk of infection.
If your arteries become severely narrowed or blocked, you may need surgery 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. Your doctor may suggest holding off surgery until your condition is in remission.
Surgical options, which are best performed when inflammation of the arteries has been reduced, include:
- 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.
- Aortic valve surgery. Surgical repair or replacement of the aortic valve may be needed if the valve is leaking significantly (aortic valve regurgitation).