@article{Porter:2020:rheumatology/kez616,
author = {Porter, A and Youngstein, T and Tombetti, E and Mason, J},
doi = {rheumatology/kez616},
journal = {Rheumatology},
pages = {iii28--iii32},
title = {Biologic therapy in supra-aortic Takayasu arteritis can improve symptoms of cerebral ischaemia without surgical intervention},
url = {http://dx.doi.org/10.1093/rheumatology/kez616},
volume = {59},
year = {2020}
}

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TY  - JOUR
AB  - Background:  Takayasu  arteritis  typically  results  in  severe  arterial  injury  with  stenoses, occlusions and occasionally aneurysms. Involvement of the supra-aortic arteries is common, and in its most severe form may compromise cerebral blood supply, resulting in signs of cerebral  ischaemia  including  visual  impairment,  dysphasia,  hemiparesis,  loss  of consciousness and stroke. In addition to combination immunosuppression, the management paradigm for symptomatic cerebral ischaemia includes revascularisation. The invasive nature of this surgery, the risk of complications and the relatively high rate of re-stenosis is of concern to patients and physicians alike.The aim of this study was to determine whether combined immunosuppression with early escalation to biologic therapy improved outcomes and reduced the need for high risk surgical intervention Methods: A retrospective review of 145 Takayasu arteritis patients attending Imperial College Healthcare  between  2010-2018  was  conducted  to  identify  those  with  cerebral  ischaemia secondary to supra-aortic disease and to analyse their treatment and outcomes.  Results:  Eight  patients  (5.5%)  were  identified.  Seven  received  long-term  combined immunosuppressive therapy and six were prescribed biologics. The data revealed a higher than expected comprehensive response to therapy, with significant falls in disease activity, cerebral ischaemia score and prednisolone dose required, over a median follow-up of 37 months. Serial imaging analysis detected no arterial disease progression after the initiation of optimal therapy. Only one patient required surgical intervention for persistent neurological symptoms.  Conclusion:  Early  use  of  biologic  therapy  in  those  with  supra-aortic  Takayasu  arteritis presenting with cerebral ischaemia may reduce the numbers of patients requiring surgical intervention and improve outcomes.
AU  - Porter,A
AU  - Youngstein,T
AU  - Tombetti,E
AU  - Mason,J
DO  - rheumatology/kez616
EP  - 32
PY  - 2020///
SN  - 0080-2727
SP  - 28
TI  - Biologic therapy in supra-aortic Takayasu arteritis can improve symptoms of cerebral ischaemia without surgical intervention
T2  - Rheumatology
UR  - http://dx.doi.org/10.1093/rheumatology/kez616
UR  - https://academic.oup.com/rheumatology/article/59/Supplement_3/iii28/5826902
UR  - http://hdl.handle.net/10044/1/75318
VL  - 59
ER  - 

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