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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 "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 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 usually 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 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 (Trexall, Rheumatrex) or azathioprine (Imuran, Azasan). 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.
- Transplant medications. Some people respond well to medications that were developed for people receiving organ transplants. These drugs, including mycophenolate (Cellcept), work by suppressing the immune system, and they have effectively reduced blood vessel inflammation in people with Takayasu's arteritis. Side effects include abdominal pain, fever, constipation, headache and swelling. These drugs may not be taken during pregnancy.
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. Also, if you develop large aneurysms, surgery may be needed to prevent them from rupturing. These procedures, best performed when inflammation of the arteries is sufficiently suppressed, 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.
- Takayasu's arteritis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/takayasusartritis.asp. Accessed Sept. 9, 2010.
- Ogino H, et al. Overview of late outcome of medical and surgical treatment for Takayasu arteritis. 2008;118:2738.
- Hunder GG. Classification of and approach to vasculitis in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 10, 2010.
- Hunder GG. Clinical features and diagnosis of Takayasu arteritis. http://www.uptodate.com/home/index.html. Accessed Sept. 10, 2010.
- Hunder GG. Treatment of Takayasu arteritis. http://www.uptodate.com/home/index.html. Accessed Sept. 10, 2010.
- Takayasu's arteritis. Vasculitis Foundation. http://www.vasculitisfoundation.org/takayasusarteritis. Accessed Sept. 14, 2010.
- Hauenstein E, et al. Takayasu's arteritis in pregnancy: Review of literature and discussion. Journal of Perinatal Medicine. 2010;38:55.
- McBane RD (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 26, 2010.
- Anderson CF (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 17, 2010.
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