5 Large vessel vasculitis (giant cell arteritis, Takayasu arteritis)

doi:10.1016/S0950-3579(97)80047-7

Baillière's Clinical Rheumatology

Volume 11, Issue 2, May 1997, Pages 285-313

https://doi.org/10.1016/S0950-3579(97)80047-7 Get rights and content

Giant cell arteritis and Takayasu arteritis are separate but similar idiopathic diseases clinically characterized by constitutional symptoms, shared surrogate markers of systemic inflammation and indistinguishable granulomatous panarteritis of large vessels. This review emphasizes and analyses changing perceptions about the diseases. Recent series suggest that aortic involvement in giant cell arteritis may be more common than was previously appreciated. The case for and against inflammatory arthritis in giant cell arteritis is discussed. Ethnic and geographical variation in Takayasu arteritis-disease expression is reviewed. New philosophies of treatment are presented for both diseases. Prognosis in giatn cell arteritis and its relationship to treatment is analysed. The utility of the laboratory for diagnosis and monitoring disease activity is appraised for each.

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Cited by (30)

Updates in Pathophysiology, Diagnosis and Management of Takayasu Arteritis
2016, Annals of Vascular Surgery
Citation Excerpt :
TA has been reported all over the world, with wide variation in its prevalence in different geographical areas. It is a rare disease, with an annual incidence of 0.4–2.6 cases/million population in different countries, but most commonly seen in Japan, South East Asia, India, and Mexico, with a 100-times higher incidence in East Asia countries.160–162 TA is the most common primary vasculitis in Japan and has a registry with >5,000 cases over the period of 3 years (1982–1984).163
Takayasu arteritis (TA) is a rare, systemic, inflammatory vasculitis of granulomatous nature, and still of unknown etiology. It mainly involves the aorta and its major branches and is more commonly seen in women of childbearing age and Asians. TA leads to stenosis, occlusion, or aneurysmal degeneration of large arteries, and its pathogenesis seems to be mainly due to an abnormal cell-mediated immunity, although other molecular and genetic abnormalities may contribute. The diagnosis and treatments lie on clinical and arteriographic findings. Because of its fluctuating course, both clinical scores and biomarkers are currently evaluated. The aim of this review is to report a comprehensive and methodologically robust state of the art about Takayasu arteritis, including the latest data and evidences in the definition, epidemiology, pathogenesis and etiology, clinical manifestations and classification, diagnosis, assessment of disease activity and progression, biomarkers, and treatment.
We searched all publications addressing definition, epidemiology, pathogenesis, etiology, classification, diagnosis, biomarkers, and treatment of TA. Randomized trials, cohort studies, and reviews were contemplated to give a breadth of clinical data. PubMed and Scopus were searched from August 2010 to November 2015.
Of the 3,056 records found, 267 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 169 articles because of the following reasons: (1) no innovative or important content; (2) no multivariable analysis; (3) insufficient data; (4) no clear potential biases or strategies to solve them; (5) no clear end-points; and (6) inconsistent or arbitrary conclusions. The final set included 98 articles.
This review presents the last updates in all fields of Takayasu arteritis. Still today, large areas of TA pathogenesis and disease-activity assessment need to be further investigated to better treat patients with TA.
Anaesthetic management in a parturient with Takayasu arteritis
2012, Egyptian Journal of Anaesthesia
Citation Excerpt :
The exact etiology remains unknown but it may have an autoimmune basis. Because it is more prevalent in women of childbearing age, sex hormones may be involved in the pathogenesis [8]. It has been classified on the basis of distribution of affected vessels [9,10].
We report the anaesthetic management of a parturient suffering from Takayasu's arteritis scheduled for elective caesarean section. A full term 29-year-old female weighing 50 kg, height 152 cm, gravida3, para 1 with previous lower segment caesarean section (LSCS) was scheduled for elective LSCS. Patient had suffered a right sided frontoparietal infarct 14 years back for which she underwent treatment in the form of medication from some higher centre She was advised tablet aspirin 75 mg and prednisolone 40 mg once a day. Digital subtraction angiography showed complete occlusion of origin of both subclavian and carotids and reformation of collaterals. Echocardiography revealed mild concentric left ventricular hypertrophy, trivial AR and normal left ventricular systolic function. Caesarean section was planned under regional anaesthesia with monitoring gadgets placed on lower limb. Subarachnoid block (SAB) was administered with 7.5 mg hyperbaric bupivacaine along with 25 μg fentanyl at lumbar 4–5 interspace, using a 25-G Quincke Babcock needle. Intra-operative period was uneventful with minimal fall in blood pressure which was managed accordingly. Parturient was stable in the postoperative period and was moved to a ward after being monitored for 24 h in ICU.
Takayasus's Arteritis in Pregnancy. Case Report and Literature Review
2011, Revista Brasileira de Anestesiologia
Takayasus's Arteritis (TA) is a chronic, inflammatory, progressive, idiopathic disease that causes narrowing, occlusion, and aneurysms of systemic and pulmonary arteries affecting especially the aorta and its branches. During pregnancy, one should pay special attention to these patients. The objective of this report was to present the peripartum anesthetic care of a patient with TA and a review of the literature.
This is a 31-year old gravida who underwent exchange of the aortic arch and placement of a metallic aortic valve for TA four years ago. She had no complications during pregnancy, and she was admitted at 34 weeks of pregnancy for anticoagulation management. Elective cesarean section was performed at 39 weeks with continuous epidural anesthesia. Fractionated doses of local anesthetic were administered to guarantee slow installation of the blockade. The patient remained hemodynamically stable and was transferred to the ICU in the postoperative period.
Several complications can affect gravidas with TA. Careful patient evaluation, treatment of TA complications, and anestheticsurgical planning are fundamental. Maintenance of perfusion is the main concern in these patients, and neuraxial blocks may be used without harming the mother and fetus. In patients with compensated TA complications, monitoring does not differ from that routinely used in cesarean sections. Continuous epidural anesthesia with slow installation maintains hemodynamic stability and allows monitoring cerebral perfusion through the level of consciousness. To avoid postoperative hypoperfusion or hypertensive complications patients should be monitored in an intensive or semi-intensive care unit for 24 hours.
A Arterite de Takayasu (AT) é uma doença idiopática, crônica, inflamatória e progressiva que causa estreitamento, oclusão e aneurismas das artérias sistêmicas e pulmonares, afetando principalmente a aorta e seus ramos. Durante a gestação deve-se estar atento à condução dessas pacientes. O objetivo foi relatar um caso de condução anestésica periparto de uma paciente com AT e fazer uma revisão da literatura.
Gestante de 31 anos com troca de arco aórtico e prótese metálica em válvula aórtica por AT há 4 anos. A gestação prosseguiu sem complicações e a paciente foi internada com 34 semanas para adequação da anticoagulação. Realizou-se cesariana eletiva com 39 semanas de gestação com anestesia peridural contínua. Doses fracionadas de anestésico local foram administradas para garantir a instalação lenta do bloqueio. Paciente permaneceu estável hemodinamicamente e foi encaminhada para pós-operatório na UTI.
Muitas complicações podem ocorrer na gestante com AT. Avaliação cuidadosa da paciente, tratamento das complicações da AT e planejamento anestésico cirúrgico são fundamentais. Manutenção da perfusão orgânica é a principal preocupação nessas pacientes e bloqueios neuroaxiais podem ser utilizados sem prejuízo para mãe ou recém-nato. Na paciente com as complicações da AT compensadas, a monitoração não difere da utilizada rotineiramente em cesarianas. Anestesia peridural contínua de instalação lenta mantém a estabilidade hemodinâmica e permite monitorar a perfusão cerebral através do nível de consciência da gestante. Para evitar hipoperfusão orgânica ou complicações hipertensivas no pós-operatório, a paciente deve permanecer monitorada em unidade intensiva ou semi-intensiva por 24 horas.
La Artritis de Takayasu (AT), es una enfermedad idiopática, crónica, inflamatoria y progresiva, que causa el estrechamiento, la oclusión y los aneurismas de las arterias sistémicas y pulmonares, afectando principalmente a la aorta y a sus ramas. Durante el embarazo, debemos estar atentos al seguimiento de esas pacientes. El objetivo fue relatar un caso de seguimiento anestésico periparto de una paciente con AT y hacer una revisión de la literatura.
Embarazada de 31 años con cambio del arco aórtico y prótesis metálica en válvula aórtica por AT hacía 4 años. El embarazo continuó sin complicaciones y la paciente fue ingresada con 34 semanas para la adecuación de la anticoagulación. Se realizó la cesárea electiva con 39 semanas de embarazo con anestesia epidural continua. Se administraron dosis fraccionadas de anestésico local para garantizar la instalación lenta del bloqueo. La paciente permaneció estable hemodinámicamente y fue derivada al postoperatorio en la UCI.
Muchas complicaciones pueden sobrevenir en la embarazada con AT. La evaluación cuidadosa de la paciente, el tratamiento de las complicaciones de la AT y la planificación anestésica quirúrgica son fundamentales. El mantenimiento de la perfusión orgánica es la principal preocupación en esas pacientes, y los bloqueos neuroaxiales pueden ser utilizados sin miedo de perjudicar a la madre o al recién nacido. En la paciente con las complicaciones de la AT compensadas, la monitorización no es diferente de la utilizada como rutina en cesáreas. La anestesia epidural continua de instalación lenta, mantiene la estabilidad hemodinámica y permite monitorizar la perfusión cerebral a través del nivel de conciencia de la embarazada. Para evitar la hipoperfusión orgánica o las complicaciones hipertensivas en el postoperatorio, la paciente debe permanecer monitorizada en una unidad de cuidados intensivos o semi-intensivos durante 24 horas.
The clinical spectrum of primary renal vasculitis
2005, Seminars in Arthritis and Rheumatism
The vasculitides are potentially severe and often difficult to diagnose syndromes. Many forms of vasculitis may involve the kidneys. This review will focus on the clinical and histopathological aspects of renal involvement in the systemic vasculitides.
We searched the MEDLINE database using as key terms the MeSH terms and textwords for different forms of vasculitis and for renal involvement, creating a database of more than 2200 relevant references.
The frequency of renal involvement in vasculitis varies among different syndromes. It is more frequent in Wegener’s granulomatosis and microscopic polyarteritis, while it is uncommon to rare in other forms of vasculitis such as Behçet’s disease and relapsing polychondritis. The vessels affected include the renal artery in Takayasu arteritis, medium-size renal parenchymal artery in classic polyarteritis nodosa, and glomerular involvement in Wegener’s granulomatosis and microscopic polyarteritis. The clinical expression of renal vasculitis depends on the size of the affected vessels and includes renovascular hypertension, isolated nonnephrotic proteinuria, interstitial nephritis, and glomerulonephritis, which can be rapidly progressive. Diagnosis is established by a combination of history, clinical manifestations, laboratory findings (eg, urine sediment, urine protein, antineutrophil cytoplasmic antibodies), imaging techniques (renal angiography, especially when there is a suspicion of medium-to-large vessel disease, and chest radiograph), and finally, renal biopsy. Prognosis varies from unfavorable in the rapidly progressive glomerulonephritis of microscopic polyarteritis, which can lead to renal failure, chronic dialysis, and renal transplantation, to benign, as in the case of Henoch Schonlein purpura, in which the majority of patients recover.
The manifestations and prognosis of renal vasculitis range widely. Renal involvement greatly influences prognosis and dictates the need for early and prompt immunosuppressive therapy. Thus, the clinician should be alert for the timely diagnosis and treatment of renal vasculitis.
<sup>18</sup>F-Fluorodeoxyglucose-positron emission tomography: A new explorative perspective
2003, Experimental Gerontology
¹⁸F-Fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG-PET) is a new functional imaging technique available for clinical and experimental use. ¹⁸F-FDG-PET studies can be used for screening, localization and follow-up of hypermetabolic processes including malignancies, infections and autoimmune processes. For several years it has been applied in oncological, cardiological and neurological patients, but nowadays an increasing number of studies favours its use in patients with autoimmune diseases including large vessel arteritis. From the experimental view, this technique has even become more important since the introduction of a small PET scanner for the use in animal models. This review focuses on technical aspects, clinical experiences and experimental and future perspectives of ¹⁸F-FDG-PET, with a special emphasis on large vessel vasculitis and other autoimmune diseases.
Epidural anaesthesia for Caesarean section in a patient with severe Takayasu's disease
1999, British Journal of Anaesthesia
Takayasu's arteritis or disease is a rare, idiopathic, chronic inflammatory disease which causes narrowing, occlusion or aneurysms of blood vessels. It preferentially affects large arteries such as the aorta and its branches and hence its alternative names of pulseless disease, occlusive thromboaortopathy or aortic arch syndrome. Although most commonly found in oriental women, it occurs sporadically throughout the world. We present the case of an elderly primigravida with long-standing Takayasu's disease complicated by hospital and needle phobia who underwent a successful Caesarean section under epidural anaesthesia. Her management is discussed in the light of current opinion regarding pregnancy and Takayasu's disease.

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5 Large vessel vasculitis (giant cell arteritis, Takayasu arteritis)

International Journal of Cardiology

American Journal of Medicine

Rheumatic Disease Clinics of North America

International Journal of Cardiology

Rheumatic Disease Clinics of North America

International Journal of Cardiology

Rheumatic Disease Clinics of North America

International Journal of Cardiology

Seminars in Arthritis and Rheumatism

American Journal of Medicine

American Journal of Medicine

International Journal of Cardiology

American Journal of Medicine

Long-term survival in giant cell arteritis including temporal arteritis and polymyalgia rheumatica

Acta Medica Scandinavia

The American College of Rheumatology 1990 Criteria for the Classification of Takayasu's Arteritis

Arthritis and Rheumatism

Vasculitic syndromes associated with other rheumatic conditions and unclassified systemic vasculitis

Current Opinion in Rheumatology

Evolution, traitement et pronostic de la maladie de Horton

Annales de Medecine Interne (Paris)

Polymyalgia rheumatica and corticosteroids: how much for how long?

Annals of Rheumatic Disease

An alternate-day corticosteroid regimen in maintenance therapy of giant cell arteritis

Acta Medica Scandinavia

An evaluation of criteria for polymyalgia rheumatica

Annals of Rheumatic Disease

Excess mortality in giant cell arteritis

Journal of Internal Medicine

Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a Danish county: a prospective investigation, 1982–1985

Arthritis and Rheumatism

Articular and vascular manifestations of polymyalgia rheumatica

Annals of Rheumatic Disease

Neurologic disease in biopsy-proven giant cell (temporal) arteritis

Neurology

Lack of sensitivity of indium-111 mixed leukocyte scans for active disease in Takayasu's arteritis

Journal of Rheumatology

Clinical and pathologic studies of synovitis in polymyalgia rheumatica

Arthritis and Rheumatism

Polymyalgia rheumatica. A ten-year epidemiologic and clinical study

Annals of Internal Medicine

Temporal arteritis: occurrence of ocular complications 7 years after diagnosis

British Journal of Ophthalmology

Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study

Annals of Rheumatic Disease

Percutaneous transluminal angioplasty for reno-vascular hypertension in arteritis: experience in China

Radiology

Polymyalgia rheumatica: an arthroscopic study of the shoulder joint

Annals of Rheumatic Disease

The use of dapsone in the treatment of giant cell arteritis and polymyalgia rheumatica

Arthritis and Rheumatism

The ESR in the diagnosis of polymyalgia rheumatica/giant cell arteritis syndrome

Annals of Rheumatic Disease

Increase incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis

Annals of Internal Medicine

Thoracic aortic aneurysm and rupture in giant cell arteritis. A descriptive study of 41 cases

Arthritis and Rheumatism

Novel magnetic resonance imaging (MRI) techniques for evaluating active arterial inflammation in Takayasu's disease (TD)

Arthritis and Rheumatism

Takayasu's arteritis: frequency of systemic manifestations (study of 22 patients) and favorable response to maintenance steroid therapy with an adrenocorticosterosteroid (12 patients)

Arthritis and Rheumatism

Giant-cell chronic arteritis

Journal of Pathology and Bacteriology

Seronegative polyarthritis in giant cell arteritis

Arthritis and Rheumatism

Aspect clinique, evolution et pronositic de la maladie de Horton

Annales de Medecine Interne (Paris)

Polymyalgia rheumatica. A clinical study of 21 cases

Quarterly Journal of Medicine

Survival in giant cell arteritis: a 14-year survey of 87 patients

Journal of Rheumatology

Prognosis in giant cell arteritis

British Medical Journal

Takayasu's arteritis: a study of 32 North American patients

Medicine

Giant cell arteritis: including temporal arteritis and polymyalgia rheumatica

Medicine

Temporal arteritis in Rochester, Minnesota, 1951 to 1957

Polymyalgia rheumatica and the ARA criteria for rheumatoid arthritis