TAKAYASU ARTERITIS AND ITS THERAPY1:
Annals of Internal Medicine. 1985 July;103(1):121-6
http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed&cmd=Retrieve&list_uids=2860834Shelhamer JH,
Volkman DJ,
Parrillo JE,
Lawley TJ,
Johnston MR,
Fauci AS.
Twenty patients with Takayasu's arteritis were followed prospectively for an average of 4.6 years. Sixteen patients with active inflammatory Takayasu's arteritis were treated with glucocorticosteroids; eight responded to therapy. Six patients had clinical or angiographic progression of their vasculitis on daily corticosteroid therapy. These patients were then given cyclophosphamide together with prednisone on alternate days. Four of these 6 patients had no progression of vascular lesions while receiving cyclophosphamide; two had progression of vascular lesions after 30 and 48 months of therapy. Vascular reconstructive surgery was successful in 7 patients who tolerated a total of 13 vascular surgical procedures without major complications. One bypass graft occluded after 13 months and was revised. With corticosteroid therapy, cytotoxic therapy, and surgery, no deaths due to Takayasu's arteritis or its treatment have occurred.
PMID: 2860834 [PubMed - indexed for MEDLINE]
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TAKAYASU'S ARTERITIS -- COURSE, DIAGNOSIS AND LONG TERM RESULTS OF TREATMENT2:
Polish Archives of Medicine Wewn. 1994 Jun;91(6):451-60.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=7971466&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1[Article in Polish]
Cybulska I.
Kliniki Nadciśnienia Tetniczego Instytutu Kardiologii w Warszawie.
Nonspecific aortoarteritis (Takayasu's arteritis) is a systemic disease of unknown cause. No characteristic symptoms may delay diagnosis and treatment as well as deteriorate prognosis.
The aim of the study was analysis of prevalence, course, diagnosis and treatment of Takayasu's arteritis. 10 patients (9 female, 1 male) with inflammatory phase of Takayasu's arteritis were seen at the Department of Hypertension of Institute of Cardiology between 1981 and 1992 (0.1% of all patients). The diagnosis was performed on the basis of typical arteriographic picture and laboratory investigations such as elevated of erythrocyte sedimentation rate and increase of immunoglobins, especially G fraction levels. Three patients were in poor general condition (fever, tachypnea, progressive weakness and severe arthralgia); in the remaining the symptoms were less severe, consisting mainly of weakness and arthralgia. All patients had multiple sites of arterial involvement (clinically and angiographically). Hypertension occurred in 9, aortic valve disease in 4, mitral valve disease in 2 and angina pectoris in 3 persons. All patients were treated with prednisone in initial dose of 1-1.5 mg/kg daily. After normalization of inflammatory indices (in average after 3 weeks therapy) this dose was gradually diminished to maintenance dose 5-15 mg daily. 4 patients were treated with prednisone in monotherapy, 6 received combined therapy--prednisone and cyclophosphamide or prednisone and azathioprine. Responses to immunosuppressive treatment were usually very good. In follow-up period (43.4 +/- 30.7 months) in 9 patients the regression of symptoms of inflammatory phase was observed (all patients were treated with maintenance dose of prednisone). Immunosuppressive therapy was ineffective in one woman, despite long term treatment with prednisone combined alternately with cyclophosphamide, azathioprine or methotrexate. She died of progressive heart and renal failure.
CONCLUSIONS: 1. Takayasu's arteritis is serious systemic disease with considerable risk of death. 2. Early and proper management of Takayasu's arteritis can improve prognosis of this disease. 3. In every case with multiple sites of arterial involvement, especially with associated symptoms of unidentified inflammatory disease it is necessary to consider diagnosis of Takayasu's arteritis, which prevalence seems to be underestimated.
PMID: 7971466 [PubMed - indexed for MEDLINE]
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THE CLINICAL SPECTRUM OF TAKAYASU'S ARTERITIS3:
Surgery. 1988 November;104(5):905-10.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=2903563&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1Sise MJ,
Counihan CM,
Shackford SR,
Rowley WR.
Department of Surgery, Naval Hospital, San Diego, Calif. 92134-5000.
Takayasu's arteritis is a rare inflammatory disease of the aorta, its major branches, and the pulmonary artery in which the varying anatomic involvement, the time course, and the periodicity of exacerbations give rise to a wide variety of signs and symptoms. We have recently encountered five patients with Takayasu's arteritis whose symptoms and findings demonstrate the clinical spectrum of this disease. All five patients are women, with a current mean age of 41 years. Although findings at initial evaluations included systemic manifestations and elevation of the erythrocyte sedimentation rate in four patients, the fifth patient had a normal erythrocyte sedimentation rate and signs of abdominal aortic occlusion. Two patients had a history of hypertension, and four patients complained of upper- or lower-extremity claudication. Arteriographic examination revealed aortic arch branch vessel involvement (type I) in two patients who also had aortic valvular insufficiency; three patients had combined arch vessel and distal aortic disease (type III). All patients have been maintained on steroid medications, and one patient has undergone a trial of cytotoxic agents. Three patients underwent surgical procedures: aortic valve replacement in two patients, and aortorenal bypass in one patient. Takayasu's arteritis gives rise to a variety of symptoms and findings resulting from the distribution and severity of the inflammatory process. With adequate immunosuppression and selective application of surgical therapy, there is a good prognosis for survival and a return to functional status.
PMID: 2903563 [PubMed - indexed for MEDLINE]
