{'fraction_non_alphanumeric': 0.02302742973247545, 'fraction_numerical': 0.011852353538774127, 'mean_word_length': 5.004065040650406, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A successful pregnancy in a patient with Takayasu's arteritis under tocilizumab treatment: A longitudinal case study

Dear Editor, Takayasu's arteritis (TA) is a chronic disease characterized by inflammation of large vessels.1,2 TA is eight times more common in women and the mean time of onset is between the 2nd and 3rd decades. It is possible to observe TA at the age of 10 but rarely occurs after age 40.2,3 The six American College of Rheumatology (ACR) TA classification criteria are as follows: age of onset <40, claudication of an extremities, decreased brachial artery pulse, difference in systolic blood pressure between arms greater than 10 mm Hg, a bruit over the subclavian arteries or the aorta, and typical angiography findings (Table 1). The presence of three of these six criteria is sufficient to meet the ACR classification.4 Methotrexate or azathioprine as well as corticosteroids are the first and most commonly used agents in treatment. Other than these standard treatments, a few studies showed that cyclophosphamide, leflunomide, mycophenolate mofetil and cyclosporin could be effective in some cases.5-10 Today, tumor necrosis factor-α blockers (anti-TNF-α) are more frequently selected for resistant cases.11 In recent years, tocilizumab (TCZ) has been used as an alternative option in patients who are unresponsive or intolerant to anti-TNF-α treatment due to potential side effects.12 Similar to systemic lupus erythematosus (SLE), TA is a disease occurring especially in women of reproductive age and also sometimes patients may want to be pregnant or have established pregnancy when they come to the hospital. As it is a less common disease compared to SLE, data on the progress and treatment of TA during pregnancy are limited.13 There are very few published studies on patients who became pregnant while they were receiving TCZ therapy in clinical settings. In their study on four pregnant patients with active RA refractory to anti-TNF agents, Kaneko et al used TCZ for their patients. They reported that three patients delivered full-term infants without any adverse outcomes and one patient had a partial molar pregnancy and miscarried in the gestational week.14 In another research, Nakajima et al presented research outcomes on 50 pregnant patients who used TCZ during conception, pregnancy or lactation and TCZ was continued during lactation in two patients, and no adverse events were reported in new-born infants. Their findings revealed that the rates of natural abortion, congenital abnormalities, and other pregnancy outcomes were similar to those seen in the general population in the previous studies.15,16 To our knowledge, there is no research that showed a case of pregnancy in a patient with TA diagnosis who was on TCZ treatment and had healthy delivery. We present a case of pregnancy in a patient with TA diagnosis who was on TCZ treatment, followed up for 12 years and had a healthy delivery outcome.