EFFICACITY OF COMBINATION ACID ACETYLSALICYLIC AND GLUCOCORTICOID IN TAKAYASU ATERITIS TREATMENT: A CASE CLINIC TAKAYASU ARTERITIS IN VIET NAM

Abstract

Objective: This brings up the potential of medical management for patients who are diagnosed with Takayasu arteritis, instead of using invasive methods such as aortic stent placement or operations. Design and method: A young female 14 years old was diagnosed with Takayasu arteritis. Initial symptoms include fever, loss of appetite, weight loss, muscle pain, followed by palpitations and abdominal pain, and loose stools. The test showed an increased hypersensitive C-reactive protein level (CRPhs: 28.7 mg/L). Computed tomography angiography (CTA) chest with contrast shows two segments of thoracic aneurysms involving descending aorta, the aortic diameter of the superior and inferior segment aneurysms is #1.6-1.8 cm, #2x 2.1cm, respectively, and the length is #2.5cm, # 3.2cm, respectively. According to the American College Rheumatology 1994, we classified this patient as type III. The patient was treated with corticosteroid therapy consisting of: prednisolone at an initial dose of 20 mg/day, reduced to a dose of 10 mg/day at month 3, and reduced to a dose of 5 mg/day after 6 months until now. In addition, we also added low-dose aspirin (81mg/day), ACE inhibitors, and beta-blockers to increase the effectiveness of treatment Results: After 3 months, Hs-CRP levels returned to normal (from 28.7 mg/L to 1.23 mg/L) and remained below the 3 mg/L thresholds during the next 15 months. After 12 months of combined treatment with corticosteroids and aspirin as described above, the patient's aortic diameter had returned to almost normal on CTA. After that, we have reduced the patient's corticosteroid dose (prednisolone 5 mg/day) and are going to finish the treatment after 18 months. Conclusions: This successful case high value on the role of pharmacological therapy in cases of Takayasu arteritis. It also brings up a debate regarding the concept of surgery required in cases of Takayasu arteritis complicated with dilatation, aneurysm, or stenosis. The combination of glucocorticoid therapy with aspirin can reduce the cost of treatment as well as avoids the side effects of the combination of glucocorticoid with immunosuppressive drugs. This opens up great treatment opportunities for Takayasu arteritis patients in low-economic countries like Vietnam.