Role of immunosuppressive therapy on clinical, immunological, and angiographic outcome in active Takayasu's arteritis.

OBJECTIVE: To evaluate the role of an immunosuppressive regimen consisting of azathioprine and prednisolone on the clinical, immunological, and angiographic outcome in patients with active Takayasu's arteritis (TA).

METHODS: Between January 1996 and January 2001, of 65 consecutive newly diagnosed patients with TA not previously treated by any immunosuppressive therapy, 15 fulfilled the criteria for disease activity. Detailed clinical and laboratory evaluation was carried out in these patients. They were treated with a combination of azathioprine and prednisolone for one year, and aortography was carried out in all patients before and after completion of the treatment.

RESULTS: All patients had improvement in systemic symptoms and laboratory measures of disease activity within a period of 3 months of onset of treatment. Erythrocyte sedimentation rate decreased from a mean of 55.5 +/- 14.7 mm/h to 21.9 +/- 9.5 mm/h within 3 months (p < 0.001) and further to 20.8 +/- 15.2 at one year (p = NS). C-reactive protein concentrations fell from 4.8 +/- 5.2 mg/dl to 0.5 +/- 0.2 mg/dl at 3 months (p = 0.004) and remained at 0.5 +/- 0.3 mg/dl at one year (p = NS). No changes in the peripheral pulses or differences in limb blood pressures were noted. Repeat angiograms revealed no significant changes compared to baseline. No new lesion appeared in any patient. The immunosuppressive therapy was well tolerated with no notable side effects.

CONCLUSION: An immunosuppressive regimen of azathioprine and prednisolone is safe, well tolerated, and effective in ameliorating systemic symptoms and laboratory measures of disease activity in TA, and at least halts progression in angiographic lesions at one year of followup, although it does not seem to lead to a regression of the arterial lesions.