Analysis of evidence to determine the link between Takayasu's arteritis and Tuberculosis

Abstract

ObjectiveThe relationship of Takayasu's arteritis (TA) and Tuberculosis (TB) has been suggested for decades but convincing evidence is lacking. The aim of this study is to assess the published evidence for an association between TA and TB. MethodWe performed a systematic search of the MEDLINE database through PubMed using MeSH headings and keywords for “Takayasu's arteritis” and “Tuberculosis”. ResultsThirty seven publications were analysed. The sites of TB lesions in these TA cases were mainly found in lymph nodes and lungs and occasionally in the internal organs and skin. One histopathological study did not support the direct role of mycobacterium TB in the pathogenesis of arterial lesions while the other suggested that the arterial damage could occur due to previous TB infection. Regional differences in the prevalence of TB may have influenced the validity of the results. The laboratory studies support the idea of molecular mimicry between mycobacterium heat shock protein (mHSP65) and its human homologue (hHSP60) driving immune response in TA. Based on the epidemiological, immunological and genetic factors, three hypotheses have been proposed to explain the TA and TB link. ConclusionsThe mycobacterium theory can neither be confirmed nor excluded with certainty. The proposed hypotheses require future confirmatory studies. Randomised controlled trials are needed to ascertain safety of biologics in TA cases with associated TB infection.