TAKAYASU ARTERITIS - LESSONS FROM THE AMERICAN NATIONAL-INSTITUTES-OF-HEALTH EXPERIENCE

Investigators from the National Institutes of Health (NIH), in the Uni ted States, have prospectively studied 60 patients with Takayasus's ar teritis over a period of 20 years. Unique observations resulted from t he requirement that all patients be part of Institutional Review Board -approved standardized protocols that required periodic complete clini cal, laboratory and angiographic evaluations, regardless of degree of disease activity. Patients judged to have active disease received prot ocol defined treatment that always included prednisone, and to which c ytotoxic agents were added in the event that relapse followed tapering or withdrawal of corticosteroids. The prospective standard approach a pplied to this cohort has provided new insights into the presentation, course and treatment-responsiveness of Takayasu's arteritis. This art icle will focus on the questions raised by this study and implications for patient care.