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Open Access Highly Accessed Case report

Role of inflammatory markers in Takayasu arteritis disease monitoring

Timothy E O’Connor1, Haley E Carpenter2, Sharatchandra Bidari4, Michael F Waters23 and Vishnumurthy Shushrutha Hedna3*

Author Affiliations

1 College of Medicine, University of Florida, Gainesville, FL, USA

2 Department of Neuroscience, University of Florida, Gainesville, FL, USA

3 Department of Neurology, University of Florida, Room L3-100, McKnight Brain Institute 1149 Newell Drive, Gainesville, FL 32611, USA

4 Department of Radiology, University of Florida, Gainesville, FL, USA

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BMC Neurology 2014, 14:62  doi:10.1186/1471-2377-14-62

Published: 28 March 2014

Abstract

Background

Takayasu arteritis (TA) is an idiopathic large-vessel vasculitis that can result in significant morbidity and mortality secondary to progressive stenosis and occlusion. Monitoring disease progression is crucial to preventing relapse, but is often complicated by the lack of clinical symptoms in the setting of active disease. Although acute phase reactants such as ESR and CRP are generally used as an indicator of inflammation and disease activity, mounting evidence suggests that these markers cannot reliably distinguish active from inactive TA.

Case presentation

We report a 24-year-old Hispanic female with a 5-year history of TA who presented with stroke-like symptoms and evidence of left MCA occlusion on imaging, despite a history of decreasing inflammatory markers. CTA revealed complete occlusion of the left common carotid artery, left subclavian, and left MCA from their origins. It also revealed a striking compensatory circulation supplying the left anterior circulation as well as the left subclavian as a response to progressive stenosis.

Conclusion

Monitoring ESR and CRP levels alone may not be a reliable method to evaluate disease progression in patients with TA, and should be taken in context with both patient’s clinical picture and the imaging. We recommend that serial imaging be performed regularly in the setting of active disease to monitor progression and allow for immediate therapy in response to evidence of disease advancement, with a relaxation of the imaging interval once the disease is presumed inactive.

Keywords:
Takayasu arteritis; ESR; CRP; Compensatory circulation; Subclavian steal