title: [Treatment of large vessel vasculitis].
abstract: Large vessels vasculitis: Giant cells arteritis (GCA), and Takayasu's arteritis (TA) are a pair of systemic chronic inflammatory diseases characterized by specific involvement of large caliber, elastic-layered arteries. Presently, and derived from the paucity of clinical controlled trials approaching the issue, the management of GCA and TA is largely based on the clinical judgment of the treating physician. Glucocorticoids and immunosuppressive drugs are used when clear evidence of inflammatory activity is observed. The traditional management approach is to start with systemic glucocorticoid therapy at immunosuppressive dose, followed by cytotoxic immunosuppressive drugs (methotrexate, azatioprine, cyclophosphamide or mycofenolate mofetil) aimed at maintaining remission and decreasing corticosteroid therapy time. Recently, based on the potential pathogenic role of tumor necrosis factor α in these diseases, a series of reports addressing the benefic effect of αTNF-blockers in patients who have been resistant to the traditional management approach have been published. Non- reversible vascular lesions (such as occlusion or stenosis) may require surgical treatment (stent or bypass), however this must be done only when a complete control of the inflammatory activity has been reached.
authors.affiliation: Servicio de Reumatología, Hospital General de México, Secretaría de Salud, México, DF, México. everalvh@yahoo.com.mx
authors.forename: Everardo
authors.initials: E
authors.lastname: Alvarez-Hernández
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001167:Arteritis / Q000188:drug therapy* / Q000601:surgery; D001691:Biological Therapy; D019917:Blood Vessel Prosthesis Implantation; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D013700:Giant Cell Arteritis / Q000188:drug therapy / Q000601:surgery; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D013625:Takayasu Arteritis / Q000188:drug therapy / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha