L’artérite de Takayasu : mise au point à propos d’une série monocentrique de 82 patients

Takayasu arteritis (TA) is an uncommon large-vessel arteritis. We report our French single-center experience in the management of patients with TA (Pitié-Salpêtrière Hospital, Paris). TA is diagnosed in patients presenting with a large-vessel arteriopathy, in whom several inflammatory and non-inflammatory differential diagnoses are ruled out by appropriate investigations. Treatment of active disease is primarily based on corticosteroids but other immunosuppressive drugs are frequently needed. Anti-platelets agents, statins and antihypertensive drugs are frequently considered. There is no validated disease activity criterion in TA; thus, we generally consider the disease as being active in the presence of the following criteria: firstly, the presence of constitutional or ischemic symptoms; secondly, the increased acute phase reactants; thirdly, the mural contrast enhancement in CT-scan or fourthly, the mural contrast enhancement or signal abnormalities in MRI; fifthly, the abnormal vascular uptake in PET-scan. When TA is active, our follow-up recommendation is to perform an ultrasonography of the supra-aortic vessels and an aortic MRI or CT-scan twice a year. When TA appears to be inactive, we recommend to perform these investigations once a year. Surgical treatment of TA is limited to a few indications. The overall prognosis of TA is good but the quality of life is altered. Management of TA patients is difficult because of the lack of reliable diagnostic criteria, consensual therapeutic strategies and validated disease activity criteria. Further studies should focus on the pathogenesis of the disease and help define better disease activity criteria.