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Treatments and drugs
By Mayo Clinic staffThe 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, disease activity may still continue, albeit "silently." In addition, by the time some people are diagnosed, it's possible that irreversible damage may already have occurred.
On the other hand, if your condition is relatively stable and uncomplicated, you may not need treatment at all.
Treatment usually consists of medications and, in some cases, surgery.
Medications
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 drug such as prednisone or methylprednisolone (Medrol). About half the people treated with corticosteroids respond well. You often start feeling better in just a few days, but you may 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 of corticosteroids you need to control inflammation. Some of your symptoms may return during this tapering period. Long-term side effects of corticosteroids include cataracts, high blood sugar, increased risk of infections, loss of calcium from bones, menstrual irregularities, suppressed adrenal gland hormone production, thin skin, obesity, easy bruising and slower wound healing.
- Cytotoxic drugs. If your condition doesn't respond well to corticosteroids or you have trouble tapering off the medication, you may need treatment with cytotoxic drugs, such as methotrexate (Rheumatrex) or azathioprine (Imuran). These drugs suppress the inflammation in your blood vessels, but they have risks. They can increase your susceptibility to infection, as well as your risk of developing lymph node tumors (lymphoma) and skin cancer.
- TNF-alpha inhibitors. In a small study, a group of medications called tumor necrosis factor-alpha (TNF-alpha) inhibitors were able to help some people who had difficult-to-treat Takayasu's arteritis. This class of medications helps to reduce inflammation by inhibiting the action of TNF-alpha protein, which plays an active role in initiating your body's inflammatory response. Given further confirmation of the drug's effectiveness, doctors hope it will be a useful addition to the treatment options for Takayasu's.
Surgery
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 symptoms such as high blood pressure and chest pain. In some cases, though, narrowing or blockage may recur, requiring a second procedure. Procedures used 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.
- 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.
- 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.
- Anton E. Large vessel arteritis: A diagnostic challenge in the elderly. Journal of Clinical Pathology. 2005;58(7):782.
- Vasculitis syndromes of the central and peripheral nervous systems fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/vasculitis/detail_vasculitis.htm. Accessed Aug. 8, 2008.
- Johnston SL, et al. Takayasu arteritis: A review. Journal of Clinical Pathology. 2002;55(7):481-486.
- Takayasu's arteritis. Merck Manuals Online Medical Library. http://www.merck.com/mmhe/sec05/ch069/ch069f.html. Accessed Aug. 8, 2008.
- Kis B, et al. Severe supraaortal atherosclerotic disease resembling Takayasu's arteritis. Vascular Health Risk Management. 2007;3(3):351-354.
- Kissin EY, et al. Diagnostic imaging in Takayasu arteritis. Current Opinion in Rheumatology. 2004;16(3):31-37.
- Liang P, et al. Advances in the medical and surgical treatment of Takayasu arteritis. Current Opinion in Rheumatology. 2005;17(1):16-24.
- de Franciscis S, et al. The management of Takayasu's arteritis: Personal experience. Annals of Vascular Surgery. 2007;21(6):754-760.
