Difficult-to-treat Takayasu arteritis: a case-based review.

Autor: Belfeki N; Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France. nabil.belfeki@ghsif.fr., Ghriss N; Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France., Guedec-Ghelfi R; EVESIO Department of Nuclear Medicine, Melun, France., Kammoun S; Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France., Abisror N; Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine Paris, Paris, France., Mekinian A; Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine Paris, Paris, France.; Sorbonne University, UMPC University Paris 06, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
Jazyk: angličtina
Zdroj: Rheumatology international [Rheumatol Int] 2024 Dec; Vol. 44 (12), pp. 3151-3156. Date of Electronic Publication: 2024 Oct 23.
DOI: 10.1007/s00296-024-05741-y
Abstrakt: Takayasu arteritis is a rare chronic inflammatory large vessel vasculitis which affects the aorta and its large branches. The diagnosis is based on the 2022 ACR/EULAR classification criteria for Takayasu arteritis. The management of this vasculitis is challenging. Although it is corticosteroid-responsive, relapses and disease progression are common. Thus, it is possible to resort to alternative conventional synthetic disease-modifying anti-rheumatic drugs and biologics, as second-line such as tumor necrosis factor-alpha inhibitors, tocilizumab, or JAK inhibitors as second-line agents is possible. Nevertheless, in some complex cases, the vasculitis remains active despite different proposed therapeutic lines, and a multitarget approach could induce sustained remission. We report herewith a case of 33-female patient with a refractory Takayasu arteritis which remained active after three different therapeutic lines with tocilizumab, then infliximab, then Upadacitinib. Finally, we consider a successful multitarget approach with a combination of infliximab, Upadacitinib, and methotrexate.
Competing Interests: Declarations. Informed consent: The authors obtained written consent from the patient for their photographs and medical information to be published in print and online. Patient consent form is retained by the authors. Conflict of interest: Authors declare that they have no conflict of interest. We are interested in publishing our work in an open access format. The draft did not have any industry support.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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