Vasculitis syndromesAdvances in the medical and surgical treatment of Takayasu arteritisLiang, Patricka; Hoffman, Gary SbAuthor Information aUniversité de Sherbrooke, Sherbrooke, Quebec, Canada, and bCleveland Clinic Foundation, Cleveland, Ohio, USA Dr. Hoffman is supported by the Center for Vasculitis Care and Research of the Cleveland Clinic Foundation and the Harold C. Schott Foundation. Correspondence to Gary S. Hoffman, Departments of Rheumatic and Immunologic Diseases and Medicine, Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA Tel: 216 445 6996; fax 216 445 7569; e-mail: [email protected] Current Opinion in Rheumatology: January 2005 - Volume 17 - Issue 1 - p 16-24 doi: 10.1097/01.bor.0000146607.65808.37 Buy Metrics Abstract Purpose of review Takayasu arteritis remains a therapeutic challenge. In spite of current treatments, progression of vascular lesions is observed frequently. The purpose of this article is to describe advances in therapeutic strategies for Takayasu arteritis. Recent findings Immunosuppressive agents including methotrexate, mycophenolate mofetil, and azathioprine added to corticosteroids can bring Takayasu arteritis into remission in many patients. Unfortunately, relapse is common when prednisone is tapered to dosages of 15 mg/day or less. A better understanding of pathogenesis has lead to trials with anti-tumor necrosis factor-α agents in patients with refractory disease. Preliminary results are encouraging. For patients who require revascularization intervention, both surgical and endovascular procedures can be performed that are safe, with low morbidity and mortality. The best long-term outcomes are achieved with conventional bypass grafts. Percutaneous transluminal angioplasty provides good results for short lesions. In contrast to the results in treating atherosclerosis, the use of conventional stents may not yield long-term vessel patency in Takayasu arteritis. Persistent inflammation and endothelial dysfunction may put patients with Takayasu arteritis at risk for premature atherosclerosis. Summary In the future, greater therapeutic success may be achieved by addressing both the inflammatory and the myointimal proliferative components of Takayasu arteritis. New drugs that target intimal hyperplasia, as well as drug-eluting stents, deserve to be studied for possible utility as adjuncts to present treatments. © 2005 Lippincott Williams & Wilkins, Inc.