Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; email:
Division of Rheumatology, Department of Medicine, University of California Los Angeles, Santa Monica, California, USA; email:
Annu Rev Med. 2024 Jan 29;75:427-442. doi: 10.1146/annurev-med-060622-100940. Epub 2023 Sep 8.
Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are large-vessel vasculitides affecting the aorta and its branches. Arterial damage from these diseases may result in ischemic complications, aneurysms, and dissections. Despite their similarities, the management of GCA and TAK differs. Glucocorticoids are used frequently but relapses are common, and glucocorticoid toxicity contributes to significant morbidity. Conventional immunosuppressive therapies can be beneficial in TAK, though their role in the management of GCA remains unclear. Tumor necrosis factor inhibitors improve remission rates and appear to limit vascular damage in TAK; these agents are not beneficial in GCA. Tocilizumab is the first biologic glucocorticoid-sparing agent approved for use in GCA and also appears to be effective in TAK. A better understanding of the pathogenesis of both conditions and the availability of targeted therapies hold much promise for future management.
巨细胞动脉炎（GCA）和 Takayasu 动脉炎（TAK）是影响主动脉及其分支的大血管血管炎。这些疾病引起的动脉损伤可能导致缺血性并发症、动脉瘤和夹层。尽管它们有相似之处，但 GCA 和 TAK 的治疗方法不同。糖皮质激素经常被使用，但复发很常见，糖皮质激素毒性会导致严重的发病率。传统的免疫抑制疗法对 TAK 有益，但它们在 GCA 治疗中的作用仍不清楚。肿瘤坏死因子抑制剂可提高缓解率，并似乎可限制 TAK 中的血管损伤；这些药物对 GCA 无益。托珠单抗是第一种被批准用于 GCA 的生物糖皮质激素节约剂，在 TAK 中似乎也有效。对这两种疾病发病机制的更好理解和靶向治疗的可用性为未来的治疗提供了很大的希望。
