What are the current guidelines for the long-term management and monitoring of patients with Takayasu arteritis?

Long-term management and monitoring of patients with Takayasu arteritis involves a multidisciplinary approach focused on controlling inflammation, preventing relapses, monitoring for vascular complications, and managing treatment side effects.

Glucocorticoids are the mainstay of treatment and should be tapered cautiously over 12–18 months or longer, depending on disease activity and relapse risk, to maintain remission and minimize toxicity. Adjunctive immunosuppressive agents such as methotrexate may be considered in patients at high risk of glucocorticoid toxicity or with relapsing disease.

Regular clinical assessment is essential to detect signs of relapse, which may present with symptoms of vascular ischemia, systemic inflammation, or constitutional features. Relapse can occur even with normal inflammatory markers, so clinical vigilance is critical.

Long-term monitoring should include imaging to assess for late vascular complications such as aneurysms or stenoses, although the optimal imaging modality and frequency remain uncertain and should be individualized based on clinical judgment.

Patients should be counselled on the risks of prolonged corticosteroid therapy, including increased infection susceptibility, and advised to avoid exposure to infections such as chickenpox and shingles if not immune. Live vaccines are contraindicated during high-dose glucocorticoid therapy.

A shared care model involving specialists and primary care clinicians is recommended to ensure timely access to expertise, appropriate monitoring, and patient support.