[Takayasu's arteritis: towards less invasive management]

[Takayasu's disease in Morocco. Report of 47 cases]

PURPOSE

Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. We studied Moroccan patients to evaluate clinical, biological, radiological and evolution features of this disease in our country.

METHODS

Forty-seven patients with Takayasu's arteritis were studied retrospectively between 1988 et 1999.

RESULTS

In our series involvement of the aortic arch and its branches was more frequent than the abdominal aorta and its branches. Stenotic lesions of renal arteries were rare. Ultrasound was useful in the diagnosis and the monitoring of the disease. Treatment with glucocorticoids gave good results, with improvement in half of the patients and remission with stabilisation in 40% of cases. Tuberculosis occurred in 8.5% of patients.

CONCLUSION

The use of ultrasound and computed tomography angiography is helpful for the diagnosis and monitoring of the disease progression. Glucocorticoids help to induce long remission in about 80% of treated patients. We don't find any relationship between Takayasu's arteritis and tuberculosis.

[Takayasu's disease: interest in methotrexate treatment]

Takayasu's disease is a nonspecific aortic arteritis that affects mostly young women and sometimes children. Usual treatment consists of early and prolonged steroids. Some patients do not respond to this treatment, become steroid-dependent or suffer from side effects. We report a case in which methotrexate proved to be effective.

CASE REPORT

A 6-year-old girl presented with Takayasu's disease with elevated blood pressure of renovascular origin. Corticosteroids controlled the inflammatory syndrome but not the renal involvement and stopped the growth. Methotrexate (10 mg/m2/week) resulted in the control of the disease, the reduction of steroids and normal growth.

CONCLUSION

In Takayasu's disease, steroids should be given as first-line therapy. In case of failure, side effects or steroid dependency, small doses of methotrexate may facilitate the disease's control and weaning from the steroids.

[Cardiac manifestations of Takayasu's arteritis: apropos of 5 cases]

PURPOSE

Cardiac manifestations of Takayasu's arteritis are rarely reported in the literature. However, these symptoms are not rare and when they do occur, they determine the disease prognosis. Due to its frequency, its severe nature, and even sometimes diagnosis failure, high blood pressure is the major cause of cardiac manifestations. More specific cardiac manifestations of either coronary, valvular, or more rarely, myocardial origin may also occur.

METHODS

Analysis of five cases of Takayasu's arteritis and a literature review allowed evaluation of both the frequency and characteristics of this disease.

RESULTS

Four female and one male patients presenting with symptoms of Takayasu's arteritis, according to Fiessinger's score, were evaluated. Diagnosis of cardiac disease was based on clinical, echocardiographic and angiographic criteria. Four patients had related high blood pressure. Valvular manifestations were present in all the patients. They included mitral insufficiency (1 case); aortic insufficiency (2 cases), and both mitral and aortic insufficiency (2 cases). Two patients showed clinical manifestations of a myocardiac disease, and another showed coronary signs. Treatment did not involve surgery, including only antihypertensive drugs, nitrites, and diuretics associated with digitalin in case of cardiac failure. The disease outcome, including a 5-18 year follow-up, involved symptom decrease in all the patients.

CONCLUSION

Despite the rarity of cardiac manifestations in patients suffering from Takayasu's arteritis, symptoms of this disease should always be investigated, as these manifestations alter the prognosis. Aortic insufficiency is the most frequently encountered cardiac manifestation.