Takayasuss arteritis is a chronic granulomatous vasculitis involving the aorta and its main branches. Monitoring disease activity and the choice for the best therapy has been major challenger faced by all physicians who treat these patients. Corticosteroids and immunosuppressive therapy have been used in daily medical practice, but results have not always been encouraging. Although there are no controlled studies evaluating the treatment of Takayasus arteritis, observational studies have described the response to the use of corticosteroids, methotrexate, azathioprine and cyclophosphamide. The emerging of biological therapy has brought new perspective for Takayasus patients who are refractory to conventional therapy.