As Chandhu, Danda Debashish
Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital.
Int Heart J. 2023;64(4):519-534. doi: 10.1536/ihj.23-195.
Takayasu arteritis (TA or TAK) is a chronic large vessel vasculitis with predilection to affect the aorta and its branches. The new 2022 ACR/EULAR classification criteria for Takayasu arteritis incorporated imaging characteristics as an absolute requirement. ESR and CRP fails in accuracy as disease activity markers. Pentraxin 3 appears to be a relatively superior biomarker, which correlates with ITAS 2010 as per several studies. PET-CT is also increasingly being studied for assessing disease activity with variable results. The management of TAK involves use of steroids with upfront steroid sparing immunosuppressive agents. MMF is one such conventional DMARD/immunosuppressant with good efficacy and better safety profile, as reported in various cohort studies. Tocilizumab is proved to be a rapid remission inducing agent in refractory Takayasu arteritis in observational studies. TNF inhibitors in many uncontrolled studies showed good responses, and there is a need for good RCTs for confirmation. JAK inhibitors have also been used with success in a few reports.
高安动脉炎（TA或TAK）是一种慢性大血管血管炎，易累及主动脉及其分支。2022年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）发布的高安动脉炎新分类标准将影像学特征列为绝对必要条件。红细胞沉降率（ESR）和C反应蛋白（CRP）作为疾病活动标志物准确性欠佳。多项研究表明，血清淀粉样蛋白P（Pentraxin 3）似乎是一种相对更优的生物标志物，与2010年印度Takayasu动脉炎研究组（ITAS 2010）标准相关。正电子发射断层扫描-计算机断层扫描（PET-CT）在评估疾病活动方面的研究也日益增多，结果不一。TAK的治疗包括使用类固醇药物以及早期联合使用可减少类固醇用量的免疫抑制剂。如各项队列研究报道，霉酚酸酯（MMF）是一种传统的改善病情抗风湿药/免疫抑制剂，疗效良好且安全性更佳。在观察性研究中，托珠单抗被证明是难治性高安动脉炎的快速缓解诱导剂。在许多非对照研究中，肿瘤坏死因子（TNF）抑制剂显示出良好疗效，因此需要高质量的随机对照试验（RCT）加以证实。在一些报道中，Janus激酶（JAK）抑制剂的使用也取得了成功。
