Regression of vascular wall thickening with upadacitinib in a patient with clinically silent pediatric-onset takayasu arteritis and ulcerative colitis: case-based review.

The coexistence of Takayasu arteritis (TAK) and ulcerative colitis (UC) is rare; however, both are chronic inflammatory diseases that share immunopathogenic mechanisms. In clinical practice, TNF (tumor necrosis factor) inhibitors are often among the first-line biologic agents; nonetheless, treatment responses in both diseases can be heterogeneous, and some patients develop primary non-response or secondary loss of response.We report a case of refractory UC with coexisting TAK that was unresponsive to two different anti-TNF therapies, in whom treatment with the JAK1 (Janus kinase 1) inhibitor upadacitinib was associated with both clinical improvement and favorable follow-up vascular imaging findings. By month 3 of upadacitinib therapy, marked improvement was observed in clinical symptoms and inflammatory markers; by month 15, follow-up CT angiography demonstrated decreased mural thickness at the common carotid artery (2.73 mm to 1.10 mm), thoracic aorta (1.92 mm to 1.24 mm), and abdominal aorta (2.34 mm to 1.58 mm), and surveillance colonoscopy confirmed endoscopic remission. No adverse events were observed during treatment. These findings suggest that upadacitinib may have contributed to concurrent improvement in mucosal disease activity and vascular imaging findings in a patient with concomitant TAK and UC. We also performed a targeted case-based literature review of JAK inhibitors in UC/IBD-TAK overlap and summarized published cases.