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What is the treatment for Takayasu's aorto-arteritis?

Q: I am suffering from Takayasu's arteritis since 4 years. I have been married for 3 years, but have no children. I am very worried about this disease and its impact on pregnancy. I even had a miscarriage earlier. How safe is it to proceed with pregnancy again? What precautions do I need to take? I am on steroid (Omnacortil 10 mg) and other calcium and iron tablets. I even take Amlovas 5mg and Ecosprin 75 mg. My steroid dosage has been reduced from 40 mg to 10 mg based on improvement. My ESR and CBP keep fluctuating (some times high and sometimes normal). I have done an MRI three times and it revealed that I have aorto-arteritis with narrowing of bilateral common carotid arteritis, left clavian artery and right in nominate arteries and aneurysum of descending aorta. My colour doppler test and ECG are normal. Please advise.

A:The answer to the query is as follows: The Takayasus Aorto-arteritis is an unusual type of disease, which is still not very well understood. The fact that it affects predominantly young Asian women makes its management difficult due to the patients being women of child-bearing age. Also that the cause of the disease is not yet known and the pattern not fully understood the planning of its management including the pregnancy is difficult. The information given in the letter makes it obvious that the lady has disease in the active phase, hence need of steroid treatment. Also that the involvement is extensive (Type II/ Type IV), Aortic arch branches and abdominal aorta makes the impact on target organs severe and unpredictable. The disease being in the active phase also means that the dose of steroids may need to be increased. In the event of failed response to the steroids therapy the other drugs may need to be prescribed, e.g. Methotrexate, Cyclphosphamide, cyclosporine. These drugs have a deleterious effect on the immune system and are not advisable for pregnant women. There is also the danger of causing birth defects in the foetus. This is an unacceptable risk. There is an added dimension to the Takayasus disease sufferer that she may need repeated angiography and angioplasty, which in pregnancy would pose a radiation risk to the foetus. I personally feel that the lady in question and her husband, though keen to have a baby should not take the risks lightly and discuss with her physicians and gynaecologists before planning pregnancy.

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