Background Takayasu’s arteritis (TA) is a chronic inflammatory large-vessel vasculitis of unknown cause, which involves the aorta and its major branches. Glucocorticosteroids (GC) and methotrexat (MTX) are the primary treatment to reduce the activity of vascular inflammation in TA. A subset of TA patients (<15%) has chronic, unremittive disease and is unresponsive to GC + MTX therapy. Herein we describe our benefit experience with Leflunomide (LEFLU) therapy in patient with GC- and MTX-resistant TA.
Objectives Case Report: A 28-year old Turkish female with (biopsy proved) TA, markedly elevated ESR of 96 mm/h, and elevated C-reactive protein (CRP) 73 mg/dl (normal
Postoperative, after 6 month, MTX therapy was withdrawn and replaced by LEFLU (30 mg/day). Within the next 2 month GC was slowly tappered to 2 mg/day and then withdrawn.
Six month after initiating LEFLU therapy, ESR (22 mm/h), CRP (12 mg/dl), SAA (8 mg/dl) and IL-6 (16 pg/ml) significantly decreased near to normal ranges. Even sCD44v5 decreased to 9 ng/ml.
Blood pressure measurements were now 110/70 mmHg in the right arm, 90/55 mmHg in the left arm and radial pulses were palpable in both arms. The patient reported no syncopes, headache or any limitations of activities of daily living. ESR, CRP, SAA, IL-6 and sCD44v5 still remained in the last mentioned low ranges during the next two month of observation.
Conclusion In this case of GC+MTX resistant TA, LEFLU appears to be an effective (slow acting) and well tolerated agent to reduce the activity of inflammation. Extensive and long-term studies will be required to assess our single observation.
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