What are the dangers of Takayasu arteritis? Can it be cured?

Author: Du Juan, attending physician at Beijing Anzhen Hospital, Capital Medical University

Reviewer: Pan Lili, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

Takayasu arteritis is a systemic vasculitis that affects the aorta and its first-order branch arteries, which can lead to thickening of the walls of the affected arteries, stenosis of the lumen, or aneurysm formation, causing ischemic changes in the organs supplied.

As Takayasu arteritis progresses, the number of affected blood vessels will gradually increase. If not treated actively, it can be extremely harmful, especially when the blood vessels of important organs are affected. For example, if the coronary arteries are affected, myocardial infarction will occur; if the carotid arteries on both sides are affected, cerebral infarction will occur; if the renal arteries are affected, the renal arteries will narrow, causing recurrent and difficult-to-control hypertension; if the blood supply arteries to the eyes are affected, blindness can occur.

Takayasu arteritis is an inflammatory disease of the aorta. When the aorta is damaged by inflammation, it will cause vascular stenosis on the one hand, and on the other hand, it will damage the elastin or elastic fiber structure of the tunica media of the blood vessel wall. When the elastic fibers are broken, this part will become weaker, just like a balloon. If you blow it up, a bag will bulge out of this part. The pressure in the aorta itself is very high, so it can cause aneurysms. Aneurysms are relatively common, especially in children, which may be related to the immature development of the blood vessel wall. In adults, vascular stenosis and occlusion are the main problems.

Aneurysms caused by Takayasu arteritis are mainly true aneurysms. A true aneurysm is a dilation of the entire blood vessel wall without any damage. However, once an aneurysm is found, it needs to be evaluated by a surgeon, because if the diameter of the aneurysm exceeds a certain range, it needs surgical treatment because there is a risk of rupture.

Figure 1 Original copyright image, no permission to reprint

Takayasu arteritis is difficult to detect in its early stages. For many patients, it may take as long as ten or even twenty years from the initial onset of pulselessness to the final medical attention. Some patients do not realize that pulselessness is a problem, and since it has no significant impact on daily life, it is easily overlooked. Early detection and early treatment are crucial for Takayasu arteritis.

Whether Takayasu arteritis can be cured is a question that everyone is concerned about. Takayasu arteritis is an autoimmune disease, and the cause is not very clear at present. Almost all autoimmune diseases cannot be cured, but they can be controlled.

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If the disease can be detected in the early stage, the disease can be controlled through active and regular treatment and regular follow-up examinations. Patients without major organ vascular involvement can achieve such a state without even affecting their normal life. Whether Takayasu arteritis requires lifelong treatment needs to be evaluated regularly. Generally, when the inflammation is more serious, vascular imaging examinations are basically performed every 6 months. After the condition is relatively stable, it is evaluated at least once a year. The evaluation can help us understand the overall situation of Takayasu arteritis and whether the disease has progressed.

The treatment of Takayasu arteritis mainly relies on medical means, and commonly used drugs include glucocorticoids and immunosuppressants. Glucocorticoids have a strong anti-inflammatory effect and can quickly control the inflammatory response. Therefore, they are the first-line drugs for the treatment of Takayasu arteritis both domestically and internationally. When the condition stabilizes, you can consider adjusting the dose of glucocorticoids. However, during the reduction process, the disease is prone to relapse. At this time, immunosuppressants need to be added to assist in controlling the inflammatory response and support the gradual reduction of glucocorticoids. Usually, patients with Takayasu arteritis need to take glucocorticoids and immunosuppressants for a long time.

In addition, patients with Takayasu arteritis should first pay attention to whether the disease recurs in their daily lives. Fever, fatigue, muscle and bone pain that cannot be explained by other reasons; abnormal increase in erythrocyte sedimentation rate and C-reactive protein; ischemic symptoms, such as leg weakness after walking for a period of time and needing to stop and rest (intermittent claudication); frequent angina pectoris; imaging examinations show that the original vascular stenosis has worsened or new lesions have appeared. If two or more of the above four items appear, it means that the disease may be in the active stage, indicating the risk of recurrence, and medical treatment should be sought in time.

During the period when patients with Takayasu arteritis take immunosuppressants, the body's immunity will decrease. They should pay attention to avoid infection, try to avoid crowded places, and wear masks when going out; pay attention to clean and hygienic diet and avoid gastrointestinal infections. It is very important to prevent infection.

Patients with Takayasu arteritis are advised not to engage in strenuous exercise, because Takayasu arteritis itself can cause ischemia, and strenuous exercise may aggravate ischemic symptoms. For example, coronary artery ischemia can be life-threatening. In daily life, you should also pay attention to monitoring your blood pressure.

Most patients with Takayasu arteritis can consider pregnancy if their disease is under control. However, if blood vessels of important organs are affected, pregnancy is risky. Before preparing to have a baby, you must ask your doctor to evaluate your condition to see if you are suitable for pregnancy. In addition, some drugs have the risk of causing fetal malformation or developmental delay. Patients who plan to have a baby must communicate with their doctor in a timely manner to see if they need to adjust their drugs and avoid using drugs that may affect the fetus.