eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Takayasu Arteritis: Follow-up

Author: Christine Hom, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Rheumatology, New York Medical College
Contributor Information and Disclosures

Updated: Oct 31, 2008

Follow-up

Further Outpatient Care

  • Monitor medications and adverse effects in patients with Takayasu arteritis (TA).
  • Monitor acute phase reactants as a limited measure of disease activity.
  • Perform regular imaging of affected vasculature as well as surveillance imaging for new lesions. Treatment may be monitored with MRI and/or magnetic resonance angiography (MRA) or CT scanning. Mural thickening is observed to decrease with corticosteroid treatment.
  • Recognizing that TA may progress in the absence of clinical findings is important. Patients with normal erythrocyte sedimentation rates who are undergoing graft placement have been found to have active aortitis in the resected segment. Periodic imaging may identify an active disease by the appearance of new areas of stenosis, despite normal erythrocyte sedimentation rate and the absence of clinical features. The presence of active disease requires treatment with corticosteroids; current markers of disease activity are inadequate to identify all patients with disease flare.
  • Serial MRI may reveal vessel wall edema, but whether this measures actual inflammation is unclear. Structural changes visible on imaging demonstrate disease progression, but reliable indicators of vessel inflammation prior to structural damage are yet to be identified.

Complications

  • Congestive heart failure due to aortic insufficiency, myocarditis, and/or hypertension
  • Aortic aneurysms, thrombus formation, and rupture
  • Ischemic stroke
  • Myocardial infarction
  • Hypertension
  • Clinically silent progressive disease and morbidity resulting from treatment medications (take into account with long-term treatment plans)

Prognosis

  • TA is a chronic relapsing disease. More than half of patients with TA achieve control on corticosteroids alone; however, their relapse rate is high and they require long periods of steroid treatment.
  • Overall prognosis in individuals with TA relates to the degree of vascular and end-organ damage, specifically retinal vasculopathy, aortic insufficiency, aortic aneurysms, and hypertension.
  • Survival rate at 15 years is as high as 95%.
  • Of patients with TA who are treated with glucocorticoids, 60% respond; however, as many as 40% relapse on tapering steroids. In the Cleveland Clinic series of 75 patients, 93% achieved remission; only 28% of patients were able to maintain 6 months of remission when steroids were tapered to 10 mg or less.6

Patient Education

  • Review signs of corticosteroid excess (ie, Cushing syndrome) with patient and family.
  • Refer patients for psychosocial counseling.
  • Reinforce medication compliance.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize underlying malignancy
  • Failure to recognize signs and symptoms of Takayasu arteritis (TA)

Special Concerns

  • Patients with ischemia in all 4 extremities may have falsely low peripheral blood pressures. Accurate blood pressure monitoring in such patients can be obtained reliably only by central systemic measurements.
  • Early diagnosis can be difficult due to nonspecific early symptoms; perform a thorough evaluation to eliminate other diagnoses.
 


More on Takayasu Arteritis

Overview: Takayasu Arteritis
Differential Diagnoses & Workup: Takayasu Arteritis
Treatment & Medication: Takayasu Arteritis
Follow-up: Takayasu Arteritis
Multimedia: Takayasu Arteritis
References
[ CLOSE WINDOW ]

References

  1. Miller JH, Gunarta H, Stanley P. Gallium scintigraphic demonstration of arteritis in Takayasu disease. Clin Nucl Med. Nov 1996;21(11):882-3. [Medline].

  2. Ozen S, Duzova A, Bakkaloglu A, Bilginer Y, Cil BE, Demircin M. Takayasu arteritis in children: preliminary experience with cyclophosphamide induction and corticosteroids followed by methotrexate. J Pediatr. Jan 2007;150(1):72-6. [Medline].

  3. Daina E, Schieppati A, Remuzzi G. Mycophenolate mofetil for the treatment of Takayasu arteritis: report of three cases. Ann Intern Med. Mar 2 1999;130(5):422-6. [Medline].

  4. Hoffman GS, Merkel PA, Brasington RD. Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum. Jul 2004;50(7):2296-304. [Medline].

  5. Haberhauer G, Kittl EM, Dunky A, Feyertag J, Bauer K. Beneficial effects of leflunomide in glucocorticoid- and methotrexate-resistant Takayasu's arteritis. Clin Exp Rheumatol. Jul-Aug 2001;19(4):477-8. [Medline].

  6. Maksimowicz-McKinnon K, Clark TM, Hoffman GS. Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients. Arthritis Rheum. Mar 2007;56(3):1000-9. [Medline].

  7. Arend WP, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. Aug 1990;33(8):1129-34. [Medline].

  8. Arora P, Kher V, Singhal MK, et al. Renal artery stenosis in aortoarteritis: spectrum of disease in children and adults. Kidney Blood Press Res. 1997;20(5):285-9. [Medline].

  9. Baumgartner D, Sailer-Hock M, Baumgartner C. Reduced aortic elastic properties in a child with Takayasu arteritis: case report and literature review. Eur J Pediatr. Nov 2005;164(11):685-90. [Medline].

  10. Chung JW, Kim HC, Choi YH, Kim SJ, Lee W, Park JH. Patterns of aortic involvement in Takayasu arteritis and its clinical implications: evaluation with spiral computed tomography angiography. J Vasc Surg. May 2007;45(5):906-14. [Medline].

  11. de Leeuw K, Bijl M, Jager PL. Additional value of positron emission tomography in diagnosis and follow-up of patients with large vessel vasculitides. Clin Exp Rheumatol. 2004;22(6 Suppl 36):S21-6. [Medline].

  12. de Pablo P, Garcia-Torres R, Uribe N, Ramon G, Nava A, Silveira LH. Kidney involvement in Takayasu arteritis. Clin Exp Rheumatol. Jan-Feb 2007;25(1 Suppl 44):S10-4. [Medline].

  13. Della Rossa A, Tavoni A, Merlini G, Baldini C, Sebastiani M, Lombardi M. Two Takayasu arteritis patients successfully treated with infliximab: a potential disease-modifying agent?. Rheumatology (Oxford). Aug 2005;44(8):1074-5. [Medline].

  14. Hoffman GS, Leavitt RY, Kerr GS, et al. Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum. Apr 1994;37(4):578-82. [Medline].

  15. Karageorgaki ZT, Mavragani CP, Papathanasiou MA, Skopouli FN. Infliximab in Takayasu arteritis: a safe alternative?. Clin Rheumatol. Jun 2007;26(6):984-7. [Medline].

  16. Karam EZ, Muci-Mendoza R, Hedges TR 3rd. Retinal findings in Takayasu's arteritis. Acta Ophthalmol Scand. Apr 1999;77(2):209-13. [Medline].

  17. Kern P, Kalden JR, Manger B. Inflammatory arterial stenosis: followup with color Doppler sonography. Arthritis Rheum. Jan 2000;43(1):238. [Medline].

  18. Kerr GS. Takayasu's arteritis. Rheum Dis Clin North Am. Nov 1995;21(4):1041-58. [Medline].

  19. Kissin EY, Merkel PA. Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol. Jan 2004;16(1):31-7. [Medline].

  20. Lambert M, Hatron PY, Hachulla E, Warembourg H, Devulder B. Takayasu's arteritis diagnosed at the early systemic phase: diagnosis with noninvasive investigation despite normal findings on angiography. J Rheumatol. Feb 1998;25(2):376-7. [Medline].

  21. Lamprecht P, Till A, Steinmann J, Aries PM, Gross WL. Current State of Biologicals in the Management of Systemic Vasculitis. Ann N Y Acad Sci. Sep 2007;1110:261-270. [Medline].

  22. Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol. Jan 2005;17(1):16-24. [Medline].

  23. Limsuwan A, Khowsathit P, Pienvichit P. Left main coronary occlusion from Takayasu arteritis in an 8-year-old child. Pediatr Cardiol. May-Jun 2007;28(3):234-7. [Medline].

  24. Martini A. Behcet's disease and Takayasu's disease in children. Curr Opin Rheumatol. Sep 1995;7(5):449-54. [Medline].

  25. Morales E, Pineda C, Martinez-Lavin M. Takayasu's arteritis in children. J Rheumatol. Jul 1991;18(7):1081-4. [Medline].

  26. Mwipatayi BP, Jeffery PC, Beningfield SJ. Takayasu arteritis: clinical features and management: report of 272 cases. ANZ J Surg. Mar 2005;75(3):110-7. [Medline].

  27. Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. Jul 2006;65(7):936-41. [Medline].

  28. Perniciaro CV, Winkelmann RK, Hunder GG. Cutaneous manifestations of Takayasu's arteritis. A clinicopathologic correlation. J Am Acad Dermatol. Dec 1987;17(6):998-1005. [Medline].

  29. Schmidt WA, Blockmans D. Use of ultrasonography and positron emission tomography in the diagnosis and assessment of large-vessel vasculitis. Curr Opin Rheumatol. Jan 2005;17(1):9-15. [Medline].

  30. Shetty AK, Stopa AR, Gedalia A. Low-dose methotrexate as a steroid-sparing agent in a child with Takayasu's arteritis. Clin Exp Rheumatol. May-Jun 1998;16(3):335-6. [Medline].

  31. Shinjo SK, Pereira RM, Tizziani VA, Radu AS, Levy-Neto M. Mycophenolate mofetil reduces disease activity and steroid dosage in Takayasu arteritis. Clin Rheumatol. Nov 2007;26(11):1871-5. [Medline].

  32. Sun Y, Yip PK, Jeng JS, Hwang BS, Lin WH. Ultrasonographic study and long-term follow-up of Takayasu's arteritis. Stroke. Dec 1996;27(12):2178-82. [Medline].

  33. Tanaka F, Kawakami A, Iwanaga N, Tamai M, Izumi Y, Aratake K. Infliximab is effective for Takayasu arteritis refractory to glucocorticoid and methotrexate. Intern Med. 2006;45(5):313-6. [Medline].

  34. Tyagi S, Kaul UA, Nair M, Sethi KK, Arora R, Khalilullah M. Balloon angioplasty of the aorta in Takayasu's arteritis: initial and long-term results. Am Heart J. Oct 1992;124(4):876-82. [Medline].

  35. Tyagi S, Sharma VP, Arora R. Stenting of the aorta for recurrent, long stenosis due to Takayasu's arteritis in a child. Pediatr Cardiol. May-Jun 1999;20(3):215-7. [Medline].

  36. Uthman IW, Bizri AR, Hajj Ali RA, Nasr FW, Khalil IM. Takayasu's arteritis presenting as fever of unknown origin: report of two cases and literature review. Semin Arthritis Rheum. Feb 1999;28(4):280-5. [Medline].

  37. Yamada I, Numano F, Suzuki S. Takayasu arteritis: evaluation with MR imaging. Radiology. Jul 1993;188(1):89-94. [Medline].

  38. Yamaoka K, Saito K, Nakayamada S, Yamamoto M, Tanaka Y. Clinical images: Takayasu arteritis diagnosed by positron emission tomography. Arthritis Rheum. Jul 2007;56(7):2466. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Takayasu arteritis, TA, Takayasu's arteritis, Takayasu disease, Takayasu's disease, Takayasu syndrome, Takayasu's syndrome, pulseless disease, nonspecific aortoarteritis, reverse coarctation, aortic arch syndrome, aortitis syndrome, vascular insufficiency, myocarditis, aortic regurgitation, thrombosis, hypertension, aortic root dilation, mesenteric ischemia, carotidynia, granulomatous vasculitis, tuberculosis, stroke, cardiac failure, ventricular fibrillation, erythema nodosum–like lesions, pyoderma gangrenosum, leukocytoclastic vasculitis, panniculitis, syncope

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Christine Hom, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Rheumatology, New York Medical College
Christine Hom, MD is a member of the following medical societies: American College of Rheumatology, American Medical Association, and Arthritis Foundation
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Thomas JA Lehman, MD, FAAP, FACR, Clinical Professor of Pediatrics, Department of Pediatrics, Division of Pediatric Rheumatology, Weill-Cornell University; Chief, Hospital for Special Surgery
Thomas JA Lehman, MD, FAAP, FACR is a member of the following medical societies: PM American Allergy Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Barry L Myones, MD, Associate Professor, Departments of Pediatrics and Immunology, Pediatric Rheumatology Section, Baylor College of Medicine; Director of Research, Pediatric Rheumatology Center, Texas Children's Hospital
Barry L Myones, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American College of Rheumatology, American Heart Association, American Society for Microbiology, Clinical Immunology Society, and Texas Medical Association
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.