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Terribili R, Conticini E, Grazzini S, Cantarini L, Frediani B. Impact of non-immunosuppressive medical therapy on disease progression and complications of Takayasu arteritis: A narrative review. Autoimmun Rev 2024; 23:103656. [PMID: 39374636 DOI: 10.1016/j.autrev.2024.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/10/2024] [Accepted: 09/30/2024] [Indexed: 10/09/2024]
Abstract
Takayasu's arteritis is a rare large vessel vasculitis typically affecting young Asian women. It causes inflammation of the aorta and its major branches, leading to stenosis and aneurysmal dilations, and increasing cardiovascular morbidity due to accelerated atherosclerosis. Although glucocorticoids are effective for acute disease control and preliminary data on immunosuppressive drugs are promising, standardized treatment protocols are lacking. The use of prophylactic treatments with antihypertensives, antiplatelets, anticoagulants, and lipid-lowering drugs to prevent thrombotic and ischemic complications remains debated. This study reviews the evidence on the effectiveness of non-immunosuppressive medical therapy in Takayasu's arteritis. A search of the PubMed database identified eleven studies involving 204 patients. Antiplatelets: data on 68 patients were mixed, in fact low-dose aspirin did not prevent major cardiovascular events in 36 patients, but higher doses reduced ischemic complications in 24 patients. Anticoagulants: no data on new oral anticoagulants were available, and vitamin K antagonists in 9 patients did not alter cardiovascular complications. Antihypertensives: ACE-inhibitors controlled blood pressure in patients with renovascular hypertension but increased the risk of acute renal function decline, while β-blockers reduced the symptoms and the progression of myocardial hypertrophy in patients with heart failure and aortic regurgitation. Statins: data from two cohorts showed that while statins reduced the recurrence rate of arteritis in 30 patients, they did not affect recurrence rates or cardiovascular complications in 13 patients. Overall, current evidence, although not definitive, supports the use of non-immunosuppressive medical treatments to prevent long-term complications and damage in Takayasu's arteritis, considering the disease's pathophysiological mechanisms and increased cardiovascular risk. Further research is strongly encouraged.
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Affiliation(s)
- Riccardo Terribili
- Department of Rheumatology, Siena University Hospital, Viale Mario Bracci 16, 53100 Siena (SI), Italy
| | - Edoardo Conticini
- Department of Rheumatology, Siena University Hospital, Viale Mario Bracci 16, 53100 Siena (SI), Italy.
| | - Silvia Grazzini
- Department of Rheumatology, Siena University Hospital, Viale Mario Bracci 16, 53100 Siena (SI), Italy
| | - Luca Cantarini
- Department of Rheumatology, Siena University Hospital, Viale Mario Bracci 16, 53100 Siena (SI), Italy
| | - Bruno Frediani
- Department of Rheumatology, Siena University Hospital, Viale Mario Bracci 16, 53100 Siena (SI), Italy
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Hassold N, Dusser P, Laurent A, Lemelle I, Pillet P, Comarmond C, Mekinian A, Lambert M, Mirault T, Benhamou Y, Belot A, Jeziorski E, Reumaux H, Sibilia J, Desdoits A, Espitia O, Faye A, Quartier P, Saadoun D, Koné-Paut I. Clinical spectrum and outcome of Takayasu's arteritis in children. Joint Bone Spine 2024; 91:105735. [PMID: 38631524 DOI: 10.1016/j.jbspin.2024.105735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES We aimed to compare clinical spectrum and outcome between adults and children with Takayasu's arteritis (TAK) in a European population. METHODS We made a nationwide retrospective observational study between 1988 and 2019. All adult patients met the ACR diagnostic criteria for TAK and all children met the EULAR/PRINTO/PRES criteria for paediatric TAK. RESULTS We identified 46 children and 389 adults with TAK. The male to female ratio was 34/46 (0.74) in the paediatric group compared to 241/274 (0.88) in the adult group (P<0.05). Children presented with significantly more systemic symptoms; i.e., fever (P<0.05), fatigue (P<0.001), weight loss (P<0.001), abdominal pain (P<0.05), and myalgia (P<0.05) while adults had more upper limb claudication (P<0.01). Topography of the lesions differed significantly between the two groups: adults had more damage at the cerebral vasculature (P<0.01), upper and lower limbs (P<0.001) while children had more kidney lesions (P<0.05). Children TAK had more frequent (P<0.01) and higher (P<0.001) biological inflammation than adults. Children received higher dose-weight of corticosteroids (P=0.001) and less biotherapy (P<0.010) at diagnosis. Relapses (P<0.05) and death (8.6% vs 4.9%) were more frequent in children TAK than in adults. CONCLUSION Paediatric TAK seems more severe than adult TAK. Therefore, paediatrics patients may require closer monitoring and systemic use of biological treatment.
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Affiliation(s)
- Nolan Hassold
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France.
| | - Perrine Dusser
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France
| | - Audrey Laurent
- Department of paediatric rheumatology, Femme-Mère-Enfant Hospital, HCL, Lyon, France
| | - Irene Lemelle
- Department of paediatric oncology, Hôpitaux de Brabois, CHU, Nancy, France
| | - Pascal Pillet
- Department of paediatrics, Pellegrin Hospital, CHU, Bordeaux, France
| | - Cloé Comarmond
- Department of internal medicine, Lariboisière Hospital, AP-HP, Paris, France
| | - Arsene Mekinian
- Department of internal medicine, Saint-Antoine Hospital, AP-HP, Sorbonne université, Paris, France
| | - Marc Lambert
- Department of internal medicine, Claude-Huriez Hospital, CHU, Lille, France
| | - Tristan Mirault
- Department of vascular medicine, George-Pompidou Hospital, AP-HP, Paris, France
| | - Ygal Benhamou
- Department of internal medicine, Charles-Nicolle Hospital, CHU, Rouen, France
| | - Alexandre Belot
- Department of paediatric rheumatology, Femme-Mère-Enfant Hospital, HCL, Lyon, France
| | - Eric Jeziorski
- Department of paediatrics, Arnaud-de-Villeneuve Hospital, CHU, Montpellier, France
| | - Héloïse Reumaux
- Department of paediatrics, Jeanne-de-Flandre Hospital, CHRU, Lille, France
| | - Jean Sibilia
- Department of rheumatology, Arlin d'Alsace Hospital, CHU, Strasbourg, France
| | - Alexandra Desdoits
- Department of paediatrics, Hôpital de la Côte-de-Nacre, CHU, Caen, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, 44000 Nantes, France
| | - Albert Faye
- Department of general paediatrics, infectious diseases and internal medecine, Robert-Debré Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Pierre Quartier
- Department of paediatric rheumatology, Necker Hospital, AP-HP, Paris, France
| | - David Saadoun
- Department of internal medicine, La Pitié-Salpétrière Hospital, AP-HP, Sorbonne université, Paris, France
| | - Isabelle Koné-Paut
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France
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Misra DP, Singh K, Rathore U, Kavadichanda CG, Ora M, Jain N, Agarwal V. Management of Takayasu arteritis. Best Pract Res Clin Rheumatol 2023; 37:101826. [PMID: 37246052 DOI: 10.1016/j.berh.2023.101826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 05/30/2023]
Abstract
This review overviews the challenges in the assessment of disease activity, damage, and therapy of Takayasu arteritis (TAK). Recently developed disease activity scores for TAK are more useful for follow-up visits and require validation of cut-offs for active disease. A validated damage score for TAK is lacking. Computed tomography angiography (CTA), magnetic resonance angiography (MRA), and ultrasound enable the evaluation of vascular anatomy and arterial wall characteristics of TAK. 18-fluorodeoxyglucose (18-FDG) positron emission tomography (PET) visualizes arterial wall metabolic activity and complements the information provided by circulating C-reactive protein (CRP) levels. ESR and CRP alone moderately reflect TAK disease activity. TAK is corticosteroid-responsive but relapses upon tapering corticosteroids. Conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) are the first-line maintenance agents, and tumor necrosis factor-alpha inhibitors, tocilizumab, or tofacitinib are second-line agents for TAK. Revascularization procedures for TAK should be used judiciously during periods of inactive disease.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
| | - Kritika Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
| | - Upendra Rathore
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
| | - Chengappa G Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Manish Ora
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
| | - Neeraj Jain
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
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Askari G, Iraj B, Moravejolahkami A, Sami R, Riahinezhad M, Tasdighi Z, Toghyani A, Hosseini N, Niri F. Association of RASis and HMG-CoA reductase inhibitors with clinical manifestations in coronavirus disease 2019 patients: Results from the Khorshid Coronavirus Disease Cohort Study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:15. [PMID: 37064792 PMCID: PMC10098137 DOI: 10.4103/jrms.jrms_373_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 03/18/2023]
Abstract
Background Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEinhs) may deteriorate or improve the clinical manifestations in severe acute respiratory syndrome coronavirus 2 infection. A comparative, cross-sectional study was conducted to evaluate the association of ARBs/ACEinhs and hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (HMGRis) with clinical outcomes in coronavirus disease 2019 (COVID-19). Materials and Methods From April 4 to June 2, 2020, 659 patients were categorized according to whether they were taking ARB, ACEinh, or HMGRi drugs or none of them. Demographic variables, clinical and laboratory tests, chest computed tomography findings, and intensive care unit-related data were analyzed and compared between the groups. Results The ARB, ACEinh, and HMGRi groups significantly had lower heart rate (P < 0.05). Furthermore, a lower percent of O2 saturation (89.34 ± 7.17% vs. 84.25 ± 7.00%; P = 0.04) was observed in the ACEis group than non-ACEinhs. Mortality rate and the number of intubated patients were lower in patients taking ARBs, ACEinhs, and HMGRis, although these differences failed to reach statistical significance. Conclusion Our findings present clinical data on the association between ARBs, ACEinhs, and HMGRis and outcomes in hospitalized, hypertensive COVID-19 patients, implying that ARBs/ACEinhs are not associated with the severity or mortality of COVID-19 in such patients.
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As C, Danda D. Current Diagnosis and Management of Takayasu Arteritis. Int Heart J 2023; 64:519-534. [PMID: 37518335 DOI: 10.1536/ihj.23-195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Takayasu arteritis (TA or TAK) is a chronic large vessel vasculitis with predilection to affect the aorta and its branches. The new 2022 ACR/EULAR classification criteria for Takayasu arteritis incorporated imaging characteristics as an absolute requirement. ESR and CRP fails in accuracy as disease activity markers. Pentraxin 3 appears to be a relatively superior biomarker, which correlates with ITAS 2010 as per several studies. PET-CT is also increasingly being studied for assessing disease activity with variable results. The management of TAK involves use of steroids with upfront steroid sparing immunosuppressive agents. MMF is one such conventional DMARD/immunosuppressant with good efficacy and better safety profile, as reported in various cohort studies. Tocilizumab is proved to be a rapid remission inducing agent in refractory Takayasu arteritis in observational studies. TNF inhibitors in many uncontrolled studies showed good responses, and there is a need for good RCTs for confirmation. JAK inhibitors have also been used with success in a few reports.
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Affiliation(s)
- Chandhu As
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital
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Joseph G, Goel R, Thomson VS, Joseph E, Danda D. Takayasu Arteritis: JACC Focus Seminar 3/4. J Am Coll Cardiol 2022; 81:S0735-1097(22)07305-3. [PMID: 36599755 DOI: 10.1016/j.jacc.2022.09.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 01/03/2023]
Abstract
Takayasu arteritis is a rare idiopathic large-vessel vasculitis that typically affects young women. An early "prepulseless" stage is often missed, associated with nonspecific constitutional symptoms (fever, malaise, and weight loss) and elevated inflammatory markers. Unchecked disease progression leads to the "pulseless" stage, manifest clinically by missing pulses, vascular tenderness, and ischemic symptoms (limb claudication, dizziness, angina, and renovascular hypertension), and is characterized pathologically by arterial wall thickening and stenotic/occlusive lesions or aneurysm formation. Vascular complications (stroke, blindness, heart failure, and aneurysm rupture) could follow unless disease progression is halted by immunosuppressive therapy and critical lesions are palliated by timely endovascular therapy or open surgery. Early diagnosis, effective therapy, and lifelong surveillance for disease activity relapses and vascular disease progression are critical to successful long-term outcomes. The outlook for patients has improved significantly in recent years with the establishment of diagnostic and classification criteria, better investigational modalities, and more effective medical and invasive therapy.
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Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India.
| | - Ruchika Goel
- Department of Clinical Rheumatology, Christian Medical College, Vellore, India
| | - Viji S Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Elizabeth Joseph
- Department of Radiology, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Rheumatology, Christian Medical College, Vellore, India
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Henes JC, Saur S. Diagnostik und Therapie der
Großgefäßvaskulitiden – Wo stehen wir
aktuell? AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1931-3989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ZusammenfassungDie beiden Großgefäßvaskulitiden unterscheiden sich in
mehrfacher Hinsicht, vor allem aber durch das Alter der betroffenen Patienten
bei Erstmanifestation. Die Riesenzellarteriitis (RZA) ist eine Erkrankung des
älteren Patienten wohingegen die Takayasu Arteriitis per definitionem
vor dem 40 Lebensjahr auftritt. Die Diagnosen sind in den letzten Jahren durch
verbesserte Bildgebung und Therapieoptionen mehr ins Bewusstsein
gerückt. Neben der klassischen Steroidtherapie – welche bis
heute Mittel der ersten Wahl ist – steht uns mit Tocilizumab, einem
monoklonalen Antikörper gegen IL6-Rezeptor, zumindest für die
RZA, eine zusätzliche hocheffektive Therapie zur Verfügung.
Andere vielversprechende Substanzen befinden sich derzeit in Erprobung. Dieser
Artikel soll einen Überblick zu Diagnostik und Therapie, aber auch einen
Ausblick zu möglicherweise kommenden medikamentösen Optionen
bieten.
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Affiliation(s)
- Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and
Auto-inflammatory Diseases and Internal Medicine II, University Hospital
Tuebingen, Tuebingen, Germany
| | - Sebastian Saur
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and
Auto-inflammatory Diseases and Internal Medicine II, University Hospital
Tuebingen, Tuebingen, Germany
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Laurent C, Prieto-González S, Belnou P, Carrat F, Fain O, Dellal A, Cid MC, Hernández-Rodríguez J, Mekinian A. Prevalence of cardiovascular risk factors, the use of statins and of aspirin in Takayasu Arteritis. Sci Rep 2021; 11:14404. [PMID: 34257320 PMCID: PMC8277815 DOI: 10.1038/s41598-021-93416-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/16/2021] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to assess the prevalence of cardiovascular risk factors in TAK, to describe the use of aspirin and statins and the risk factors associated with vascular ischemic complications and relapses. We conducted a retrospective study on TAK patients diagnosed between 2010 and 2018. Demographic, clinical, laboratory data and treatments were evaluated at diagnosis and during the follow-up. We included fifty-two TAK patients with median age 37.5 years [range 16-53] and 43 (83%) women. At diagnosis, cardiovascular risk factors were present in 32 (62%) patients: hypertension (n = 20, 38%), hyperlipidemia (n = 8, 15%), tobacco use (n = 16, 31%). During the median 4-year follow-up [range 0.1-17 years], 17 (33%) patients had at least one ischemic event and 15 (29%) patients needed endovascular procedure. Whereas TAK patients with cardiovascular risk factors were more frequently on statins and anti-hypertensive drugs, they have higher rates of cumulative ischemic complications (5 (24%) versus 21 (67%); p = 0.004), but similar rates of aspirin-treated patients. Patients who have developed vascular ischemic events were more frequently smokers (53% versus 20%; p = 0.03). The vascular complication-free survival was not significantly different in TAK patients with or without statins or aspirin at diagnosis. During the follow-up, 27 (52%) patients had at least one relapse, and the relapse-free survival was not significantly different in patients treated with statins or aspirin. Cardiovascular risk factors in TAK have to be strictly controlled since these risk factors could be associated with increased risk of ischemic complications.
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Affiliation(s)
- Charlotte Laurent
- AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Hôpital Saint-Antoine, Sorbonne Université, 75012, Paris, France.
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pierre Belnou
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Université Paris 06, 75012, Paris, France
- Unité de Santé Publique, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 75012, Paris, France
| | - Fabrice Carrat
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Université Paris 06, 75012, Paris, France
- Unité de Santé Publique, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 75012, Paris, France
| | - Olivier Fain
- AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Hôpital Saint-Antoine, Sorbonne Université, 75012, Paris, France
| | - Azeddine Dellal
- Service de Rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Arsène Mekinian
- AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Hôpital Saint-Antoine, Sorbonne Université, 75012, Paris, France
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Goel R, Chandan JS, Thayakaran R, Adderley NJ, Nirantharakumar K, Harper L. Cardiovascular and Renal Morbidity in Takayasu Arteritis: A Population‐Based Retrospective Cohort Study From the United Kingdom. Arthritis Rheumatol 2021; 73:504-511. [DOI: 10.1002/art.41529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ruchika Goel
- University of Birmingham and Queen Elizabeth Hospital Birmingham Birmingham UK
| | | | | | | | | | - Lorraine Harper
- University of Birmingham and Queen Elizabeth Hospital Birmingham Birmingham UK
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Wei Y, Zhao C, Liang J, Jin Z, Hua B, Wang H, Zhang H, Feng X. Factors associated with event-free survival in Chinese patients with Takayasu's arteritis. Clin Rheumatol 2020; 40:1941-1948. [PMID: 33140238 DOI: 10.1007/s10067-020-05481-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/29/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate long-term outcomes of Takayasu's arteritis (TA) and explore the predictive factors associated with poor prognosis. METHODS We performed a retrospective study on consecutive TA patients admitted to the Nanjing Drum Tower Hospital during the period from July 2010 to March 2019. Potential factors contributing to adverse outcomes, including death, vascular complications, and vascular stenosis aggravation were assessed by Cox regression analysis. RESULTS Seventy-one individuals were enrolled, in which 90.1% were female. The mean onset age was 29.44 ± 11.75 years, and mean follow-up time was 3.42 ± 2.38 years. Adverse outcomes were observed in twenty-five (35.2%) patients, and the 1-, 5-, and 8-year event-free survival was 94.2%, 61.8%, and 29.8% respectively. Univariable Cox regression revealed that pulmonary hypertension (PH) (HR 4.13), high total cholesterol levels (HR 4.49), high LDL cholesterol levels (HR 5.14), and low-dose cyclophosphamide (CTX) treatment (HR 0.53) were associated with adverse outcomes. Among them, only CTX treatment remained significant in multivariable Cox regression analysis (HR 0.62). Interestingly, compared to those ineffective to CTX, the responders had higher immunoglobulin A levels (p < 0.05) but lower CRP levels (p < 0.05). CONCLUSIONS Even with vigorous therapy, a large proportion of TA patients may present adverse outcomes along with the development of disease. Low-dose CTX treatment is helpful for a better prognosis. Key Points • The prognosis of Takayasu's arteritis is still poor. • Application of low-dose cyclophosphamide in high-risk patients helps to improve the outcome. • Abnormal lipid profiles may contribute to the development of this disease, which also deserves attention.
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Affiliation(s)
- Yu Wei
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Cheng Zhao
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Jun Liang
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Ziyi Jin
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Bingzhu Hua
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Hong Wang
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Huayong Zhang
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xuebing Feng
- Department of Rheumatology and Immunology, Nanjing Medical University Drum Tower Clinical Medical Hospital, 321 Zhongshan Road, Nanjing, 210008, China.
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Fan L, Yang L, Wei D, Ma W, Lou Y, Song L, Bian J, Zhang H, Cai J. Clinical Scenario and Long-Term Outcome of Childhood Takayasu Arteritis Undergoing 121 Endovascular Interventions: A Large Cohort Over a Fifteen-Year Period. Arthritis Care Res (Hoboken) 2020; 73:1678-1688. [PMID: 32702156 DOI: 10.1002/acr.24387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Evidence-based studies on endovascular approaches for childhood Takayasu arteritis (TAK) are limited. Our objective was to present the largest current real-world scenario for patients with childhood TAK undergoing interventions and their postinterventional outcomes. METHODS Data were collected for patients with childhood TAK admitted from 2002 to 2017. Complication/reintervention-free survival was projected by Kaplan-Meier methods. Associated factors for intervention and predictors for postinterventional complications/reinterventions were assessed via regression models. RESULTS Among 101 patients enrolled, 69 (68.3%) underwent 121 interventions (angioplasty 95, stenting 26) during a 3.1-year follow-up. Compared with the nonintervention group, the intervention group independently associated with a male population (odds ratio [OR] 0.27, P = 0.035) and type IV disease (OR 17.92, P = 0.001). Male sex also marginally indicated a risk for reintervention (hazard ratio [HR] 3.22, P = 0.05). Baseline retinopathy, delay in diagnosis, and descending thoracic aorta involvement were associated with stent insertion (P < 0.05). Hypertension secondary to renal artery stenosis (RAS; 59.4%) or mid-aorta stenosis (MAS; 14.5%), heart failure (21.7%), and claudication (21.7%) were leading clinical hints for interventions. The technical success rate was 96.7%. During a median 2.88-year of follow-up after intervention, 36 lesions occurred with complications in 28 patients, and 22 lesions in 17 patients, particularly on the renal artery or mid-aorta. The 5-year complication-free and reintervention-free survivals were 50.7% and 65.8%, respectively. Peri-interventional dual antiplatelet therapy (DAPT; HR 0.31), concurrent surgery (HR 26.5), and technical failure (HR 3.65) were independent predictors for complications (P < 0.05). Male sex (HR 2.52), retinopathy secondary to hypertension (HR 3.41), and pulmonary artery hypertension (PAH; HR 3.64) were baseline indicators for complications (P < 0.05). CONCLUSION Over two-thirds of patients with childhood TAK require interventions, and the 5-year complication-free survival is 50.7%. Male sex, retinopathy, and PAH at baseline indicate the possibility of unfavorable outcomes. Interventions on MAS or RAS in childhood TAK raise specific concerns. DAPT peri-intervention appears to protect patients with childhood TAK from postinterventional complications.
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Affiliation(s)
- Luyun Fan
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lirui Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongmei Wei
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjun Ma
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Lou
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Bian
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huimin Zhang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Cai
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Dehnavi S, Sohrabi N, Sadeghi M, Lansberg P, Banach M, Al-Rasadi K, Johnston TP, Sahebkar A. Statins and autoimmunity: State-of-the-art. Pharmacol Ther 2020; 214:107614. [PMID: 32592715 DOI: 10.1016/j.pharmthera.2020.107614] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
HMG-CoA reductase inhibitors, or statins, are potent plasma LDL-cholesterol (LDL-c) lowering agents. Since the introduction of the first statin, lovastatin, in 1987, accumulating evidence showed that non-cholesterol lowering effects play an important role in their efficacy to reduce atherosclerotic cardiovascular disease (ASCVD). Thus, these non-LDL-c lowering properties could benefit patients with immune-mediated diseases. Statins and their associated immune-modulating roles have recently received much attention. Different statins have been administered in various experimental and clinical studies focused on autoimmunity. The results indicate that statins can modulate immune responses through mevalonate pathway-dependent and -independent mechanisms. The anti-inflammatory and immune-modulating effects include cell adhesion, migration of antigen presenting cells, and differentiation, as well as activation, of T-cells. In various autoimmune diseases (e.g. rheumatoid arthritis, lupus, and multiple sclerosis), promising results have been obtained to date.
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Affiliation(s)
- Sajad Dehnavi
- Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrollah Sohrabi
- Department of Medical Laboratory Sciences, School of Paramedicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahvash Sadeghi
- Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peter Lansberg
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, Building 3226, Room 04.14, Internal Zip Code EA12, Antonius Deusinglaan 19713 AV, Groningen, The Netherlands
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Thomas P Johnston
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, United States.
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Yamaguchi M, Katsuno T, Iwagaitsu S, Nobata H, Kinashi H, Banno S, Ito Y. Association between statin use and incidence of relapse in anti-neutrophil cytoplasmic antibody-associated vasculitis: a single-center retrospective cohort study. Rheumatol Int 2020; 40:1291-1299. [PMID: 32222806 DOI: 10.1007/s00296-020-04562-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/21/2020] [Indexed: 11/24/2022]
Abstract
Several studies have shown the efficacy of statins for some autoimmune disorders caused by anti-inflammatory and immunomodulatory reactions. However, little information is available about the impact of statins on relapse in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). We performed the first investigation examining whether statin use has an effect on suppressing the first relapse of AAV in Japanese patients with AAV. This single-center retrospective cohort study included 98 consecutive patients with newly diagnosed AAV from Aichi Medical University Hospital, Japan between March 2009 and December 2017. Time to first relapse from the first remission was compared between 36 patients in the statin group and 62 patients in the non-statin group using multivariate Cox proportional hazard models, which were adjusted for clinically relevant factors. During the follow-up period (median, 24 months; interquartile range, 9-50 months), 35 (97.2%) patients in the statin group achieved remission, whereas 56 (90.3%) patients achieved remission in the non-statin group (P = 0.201). After achieving the first remission, 9 (25.7%) patients in the statin group and 29 (51.8%) patients in the non-statin group had at least one relapse. Multivariate Cox proportional hazard models revealed that statin use was significantly associated with a lower incidence of relapse compared with non-statin use (multivariate-adjusted hazard ratio = 0.41, 95% confidence interval: 0.18-0.92; P = 0.031). Patients with statin use were associated with a lower incidence of relapse in AAV. Our results should be assessed in well-designed randomized controlled trials.
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Affiliation(s)
- Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan
| | - Shiho Iwagaitsu
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan
| | - Hironobu Nobata
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan
| | - Shogo Banno
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan.
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15
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Challenging therapeutic goal in large vessel vasculitis: Comment on "Statins reduce relapse rate in Takayasu arteritis" published in the journal. Int J Cardiol 2019; 287:120. [PMID: 31079811 DOI: 10.1016/j.ijcard.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/04/2019] [Indexed: 12/30/2022]
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16
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Kwon OC, Oh JS, Park MC, Hong S, Lee CK, Yoo B, Kim YG. Reply to: Challenging therapeutic goal in large vessel vasculitis. Int J Cardiol 2019; 287:127. [PMID: 31079812 DOI: 10.1016/j.ijcard.2019.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Seon Oh
- Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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17
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Statin therapy for Takayasu Arteritis. Int J Cardiol 2019; 287:118-119. [DOI: 10.1016/j.ijcard.2019.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 02/04/2023]
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