Takayasu's arteritis.

The cause of Takayasu's arteritis is still obscure. However, certain aspects of the disease have been greatly clarified over the past decade. The disease is worldwide in distribution, with no ethnic group being totally free from risk of the condition. The inflammatory and stenotic phases of the disease frequently coexist, and it is important that the condition be diagnosed before it has progressed to the phase of extensive, severe vascular occlusion. Corticosteroid therapy is effective in ameliorating both the more inflammatory aspects of the condition (fever, arthritis, myocarditis) and the hemodynamic problems of vascular stenoses, in some cases allowing return of previously absent pulses. The role of adjunctive cytotoxic therapy is less certain, although there is probably a place for it in cases characterized by corticosteroid resistance or severe consequences of hypercortisolism. Vascular reconstruction is safe and effective once the inflammatory phase of the disease has remitted or been controlled with drug therapy. Prognosis is related to specific disease complications associated with longer duration of disease. Therefore, treatment intervention may modify the natural history of the disease over the long term.