https://orcid.org/0000-0002-7723-0977
Takayasu arteritis (TA) is a systemic vasculitis that mainly involves the aorta and its branches. The main clinical manifestations are a systemic inflammatory reaction and abnormal organ function related to the affected blood vessels (Citation1). Tocilizumab is a human antibody against interleukin-6 (IL-6) receptors. Tocilizumab has certain advantages in treating patients with TA (Citation2).
Eight children (three males and five females) with TA admitted to the Department of Rheumatology and Immunology of Baoding Children’s Hospital, Baoding, China, from January 2020 to June 2022, were selected for this study. The age of onset was 56 days to 10 months, with an average time (mean ± sd) from onset to diagnosis of 21 ± 9.8995 days. All children met the European diagnostic criteria for paediatric TA (Citation3). After admission, each child underwent routine blood tests, cytokine examination, erythrocyte sedimentation rate (ESR) measurement, B-mode ultrasound, and vascular enhanced computed tomography (CT) examination to obtain a clear diagnosis and to identify affected vessels. The cytokine examination was performed by immunofluorescence flow cytometric analysis in the hospital laboratory. All of the children were treated with a combination of methylprednisolone, methotrexate, and tocilizumab, the effects of which were evaluated by reviewing routine blood tests, ESR, B-mode ultrasound, and vascular enhanced CT.
Before the drug intervention, all eight children started with fever, with body temperature fluctuating between 37.5 and 40.0°C. At the same time, one case had respiratory symptoms (12.5%), mainly cough, without sputum; one case had gastrointestinal symptoms (12.5%), mainly loss of appetite and diarrhoea; and two cases had a rash (25%), which appeared transiently during the course of the disease. All of the children had fever and elevated white blood cell (WBC) count, C-reactive protein (CRP), and ESR (). Through ultrasound examination, wall thickening and lumen stenosis of affected vessels were found in all patients to varying degrees, and confirmed by vascular enhanced CT examination. The most affected vessels in the eight children were the subclavian artery and abdominal aorta, followed by the common carotid artery, and this finding is consistent with the characteristics of TA. We also found that each child had multiple artery involvement.
Table 1. Clinical manifestations and laboratory results of eight children from the time of diagnosis.
As all of the children had significantly elevated IL-6 levels (), they were started on methylprednisolone, methotrexate, and the IL-6 receptor antagonist tocilizumab. Tocilizumab was administered intravenously at 10 mg/kg, and the frequency was determined according to the child’s leucocytes, ESR, and arterial involvement. After 4 weeks of tocilizumab, the inflammatory indicators CRP and ESR gradually reduced to normal in all patients. The coronary arteries were more sensitive to tocilizumab therapy compared with the subclavian arteries, renal arteries, and iliac arteries. Four children had coronary artery dilation at the time of diagnosis; after two, 10, and 13 rounds of tocilizumab treatment, cardiac ultrasound suggested that the internal diameter and wall thickness were normal. No other vascular lesions persisted after treatment. The growth and height of the patients at follow-up in October 2022 were the same as those of children of the same age ().
Table 2. Summary of children’s growth data at follow-up in October 2022.
Hormones and immune preparations are the first line drugs in the treatment of joint TA. Hormones combined with immunosuppressants can induce disease remission (Citation4–6). Here, we found that early application of methylprednisolone and methotrexate combined with tocilizumab significantly improved the clinical symptoms of TA and improved vascular stenosis.
Authors’ contributions
M Zhao conceived of the study; T-J Gao, Y-H Fu, and N-N Chen participated in the design, data analysis, statistics; and J Liu, M-M Yao, and T Liu helped to draft the manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Baoding Children’s Hospital. Written informed consent was obtained from the parents or guardians of all participants.
Disclosure statement
No potential conflict of interest was reported by the authors.
Data availability statement
All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.
References
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