(The Merck Manual)

Acute phase symptoms are often dramatically relieved by adrenal corticosteroids, eg, prednisone 60 to 100 mg/day. The drug should be tapered as rapidly as possible when symptoms subside, although treatment may be necessary for several months. Cyclophosphamide can be given for corticosteroid-resistant cases. The usual dose is 2 mg/kg/day, adjusted as necessary to keep the leukocyte count > 3000/µL. There is some evidence that early and vigorous treatment of the acute phase with corticosteroids or cyclophosphamide may lessen the long-term vascular complications. Warfarin or a related drug or platelet inhibitor (eg, aspirin 325 mg/day) is recommended for transient ischemic attacks. Hypertension should be treated aggressively. The angiotensin converting enzyme inhibitors (captopril, enalapril, lisinopril) may be particularly effective because the hypertension is frequently of renovascular origin.

Surgery plays a major role in the late stages of the disease, serving to reestablish flow through occluded arteries by endarterectomy or bypassing the obstructions. Balloon angioplasty has also been successfully used in properly selected cases. Arterial and aortic aneurysms may require surgical resection.

In patients with major complications (eg, stroke, myocardial infarction, severe hypertension, heart failure, aneurysm), the 5-yr survival rate is in the range of 50 to 70%. However, in many patients with Takayasu's arteritis, the disease eventually burns out without producing major complications, and such individuals may do well for years. Indeed, the 5-yr survival in the absence of serious complications is > 95%.

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