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Jovicic Z, Dragasevic S, Petkovic A, Plesinac S, Sokic Milutinovic A, Stojanovic M. Successful pregnancies in a patient with Takayasu arteritis and antiphospholipid syndrome, maintained on infliximab corticosteroid-free regimen: case-based review. Rheumatol Int 2024; 44:1359-1367. [PMID: 37653060 DOI: 10.1007/s00296-023-05440-0] [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: 07/28/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis affecting predominantly females below the age of 40. Patients with TA seem to be at increased risk for adverse pregnancy outcomes, resulting in mother or child complications. Although few studies analyzed the presence of antiphospholipid antibodies (APLA) in TA patients, an association between antiphospholipid syndrome (APS) and TA is rarely reported in the literature, mainly in the form of case reports. In fact, very few data regarding pregnancy outcomes in patients with TA and APS are available. An active form of Crohn's disease (CD) might be another risk factor strongly affecting the fertility rate. Here, we would like to present a 33-year-old woman with TA, double-positive APS and Crohn's disease (CD). The report is followed by the literature review of the association of APLA and/or APS with TA, focusing on analyzing the pregnancy outcomes. To our knowledge, this is the first case describing two successful, naturally occurring pregnancies, in a patient suffering from TA, APS and CD, and maintained on infliximab, azathioprine, and a corticosteroid-free regimen.
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Affiliation(s)
- Zikica Jovicic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Koste Todorovica 2, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Dragasevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Petkovic
- Department of Radiology, Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Snezana Plesinac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandra Sokic Milutinovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Maja Stojanovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Koste Todorovica 2, 11000, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Wen D, Feng L, Du X, Dong JZ, Ma CS. Biomarkers in Takayasu arteritis. Int J Cardiol 2023; 371:413-417. [PMID: 36067923 DOI: 10.1016/j.ijcard.2022.08.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
Takayasu arteritis (TA) is a rare large vasculitis with unknown etiology, which affects the aorta and its primary branches, as well as the pulmonary and coronary arteries. Cellular and humoral immunity, chronic inflammation, and genetic factors are involved into TA pathogenesis. Several biomarkers, such as MMPs, TIMPs, cytokines, cell adhesion molecules, autoantibodies, complements, PTX3, sRAGE, NT-proBNP, 8-isoPGF2α, NO2-, acute-phase and immunology-related proteins, thrombogenicity markers, ghrelin leptin and adipokines, endothelial damage and repair factors, genetic markers etc., related to the pathogenesis could be observed in patients with TA. These biomarkers have revealed great values in early diagnosis, evaluating disease activity, guiding clinical treatment options, and thus demonstrated significant clinical application values in TA. The combination of biomarkers assay and imaging examination may detect TA more accurately. The aim of this review is to systemically observe the clinical significance of these biomarkers in TA.
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Affiliation(s)
- Dan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Li Feng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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Padiyar S, Manikuppam P, Kabeerdoss J, Rathore S, Danda D. Update on pregnancy in Takayasu arteritis-A narrative review. Int J Rheum Dis 2021; 24:758-765. [PMID: 33870620 DOI: 10.1111/1756-185x.14109] [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: 12/11/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
Takayasu arteritis (TA) is a chronic, idiopathic large-vessel vasculitis that affects women of reproductive age, and has significant maternal and fetal implications. Although there are contrasting data on the effect of TA on fertility, most studies have shown that fertility outcomes remain unaffected. The disease activity of TA usually either remains stable or decreases during pregnancy. The important fetomaternal complications are maternal hypertension, pre-eclampsia, prematurity, and intrauterine growth restriction. To reduce maternal and fetal morbidity, controlling the disease before conception is important. This review article discusses the various implications, challenges, and medical and endovascular management of TA during pregnancy.
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Affiliation(s)
- Shivraj Padiyar
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Prathyusha Manikuppam
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Jayakanthan Kabeerdoss
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Swati Rathore
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
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Abstract
Childhood-onset Takayasu arteritis (c-TA) is the third most common systemic vasculitic disorder in children. Vascular stenosis is the main complication, and aneurysms are reported in 19-65% of cases, often in combination with stenotic lesions. Management of patients with c-TA is largely based on studies involving predominantly patients with adult-onset TA (a-TA). More widely used criteria for patients with c-TA have been devised by the joint European League Against Rheumatism, Pediatric Rheumatology International Trials Organization, and Pediatric Rheumatology European Society. Of the available imaging modalities, those that do not use radiation (color Doppler ultrasound and magnetic resonance angiogram) are preferred over 18F-labeled fluoro-2-deoxyglucose (18F-FDG) positron-emission tomography, computed tomography (CT), and CT angiogram in children. Remission rates have been reported to be lower in c-TA than in a-TA, and published mortality rates in c-TA range from 16 to 40%, which is much higher than reported in patients with a-TA. The usual drug therapy options include steroids plus steroid-sparing second-line immunosuppressants, such as mycophenolate, azathioprine, methotrexate, cyclophosphamide, and cyclosporine, along with antiplatelet agents. Interleukin-6 inhibitors such as tocilizumab, as well as the tumor necrosis factor inhibitors, are other aggressive therapeutic options. As yet, no randomized controlled trials have been conducted in c-TA.
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Affiliation(s)
- Ruchika Goel
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - T Sathish Kumar
- Department of Child Health, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.
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Podgorska D, Podgorski R, Aebisher D, Dabrowski P. Takayasu arteritis - epidemiology, pathogenesis, diagnosis and treatment. J Appl Biomed 2019; 17:20. [PMID: 34907753 DOI: 10.32725/jab.2018.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/05/2022] Open
Abstract
Takayasu disease belongs to the group of autoimmune vasculitis which most often affects the aorta and its branches. It is rare, and it mainly affects young women. Recent epidemiologic studies suggest that Takayasu arteritis is being increasingly recognized in Europe. The first symptoms are non-specific and an early diagnosis is difficult and requires clinical awareness and suspicion. Patients with Takayasu arteritis often present increased inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, but systemic inflammatory response does not always show a positive correlation with inflammatory activity in the vessel wall. Therefore, imaging studies play a principal role in diagnosis and control of the disease. Glucocorticoids remain the most effective and serve as a cornerstone first line treatment. Immunosuppressive drugs play an important role as well, and biological therapy is increasingly being included in the treatment. This article describes the epidemiology, pathophysiology, diagnostics and treatment of this rare disease, so as to alert clinicians because disease left untreated can lead to narrowing and even closure of vital blood vessels. The most common Takayasu arteritis complications include pulmonary thrombosis, aortic regurgitation, congestive heart failure, cerebrovascular events, vision degeneration or blindness, and hearing problems.
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Affiliation(s)
- Dominika Podgorska
- Clinical Provincial Hospital No. 2, Department of Rheumatology, Rzeszow, Poland
| | - Rafal Podgorski
- University of Rzeszow, Centre for Medical and Natural Sciences Research and Innovation, Rzeszow, Poland.,University of Rzeszow, Faculty of Medicine, Department of Biochemistry, Rzeszow, Poland
| | - David Aebisher
- University of Rzeszow, Faculty of Medicine, Department of Human Immunology, Rzeszow, Poland
| | - Piotr Dabrowski
- Clinical Provincial Hospital No. 2, Department of Rheumatology, Rzeszow, Poland
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Zanwar A, Jain A, Gupta L, Chaurasia S, Kumar S, Misra DP, Misra R. Serum BAFF and APRIL levels in Indian patients with Takayasu arteritis. Clin Rheumatol 2018; 37:3439-3442. [PMID: 29998368 DOI: 10.1007/s10067-018-4207-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 01/23/2023]
Abstract
Despite many studies focused on involvement of T cell in pathogenesis of Takayasu arteritis (TaK), very few have explored the role of B cells. Hence, we sought evidence of B cell involvement in a large cohort of TaK by measuring serum levels of B cell survival factors activation factor (BAFF) and A proliferation inducing ligand (APRIL). Serum BAFF and APRIL levels were measured by ELISA in 50 patients and 48 healthy individuals, and further assessed for correlation with outcome measures, such as Indian Takayasu Clinical Activity Score-ESR (ITAS-ESR) and Takayasu arteritis Damage score (TADS). Forty women and ten men of median age 26 (11-52) and disease duration of 3 years (0.1-22) were studied. Type V disease was the most common subset (n = 31), while type I, II, III, and IV was seen in ten, four, three, and two patients respectively. Serum APRIL levels were raised in patients as compared to healthy controls [2087.5 pg/ml (1480.0-2279.0) vs. 1288.64 pg/ml, (844.2-1632.9) p = 0.01]. Median serum APRIL level was also raised in patients with active disease (n = 24) as compared to inactive disease (n = 26) 2098.79 pg/ml, (1930.75-2768.75) vs. 1802.5 pg/ml, (1066.75-2098); p = 0.03). Serum BAFF levels were not raised in patients with TaK when compared to healthy Individuals. Neither BAFF, nor APRIL levels correlated with disease activity (ITAS-ESR) or TADS. Elevated APRIL levels in active TaK suggest probable role of B cells in pathogenesis.
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Affiliation(s)
- Abhishek Zanwar
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Avinash Jain
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Latika Gupta
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Smirti Chaurasia
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Kumar
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ramnath Misra
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
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Mirault T, Guillet H, Messas E. Immune response in Takayasu arteritis. Presse Med 2017; 46:e189-e196. [DOI: 10.1016/j.lpm.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/20/2017] [Accepted: 07/05/2017] [Indexed: 01/01/2023] Open
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Updates in Pathophysiology, Diagnosis and Management of Takayasu Arteritis. Ann Vasc Surg 2016; 35:210-25. [PMID: 27238990 DOI: 10.1016/j.avsg.2016.02.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Takayasu arteritis (TA) is a rare, systemic, inflammatory vasculitis of granulomatous nature, and still of unknown etiology. It mainly involves the aorta and its major branches and is more commonly seen in women of childbearing age and Asians. TA leads to stenosis, occlusion, or aneurysmal degeneration of large arteries, and its pathogenesis seems to be mainly due to an abnormal cell-mediated immunity, although other molecular and genetic abnormalities may contribute. The diagnosis and treatments lie on clinical and arteriographic findings. Because of its fluctuating course, both clinical scores and biomarkers are currently evaluated. The aim of this review is to report a comprehensive and methodologically robust state of the art about Takayasu arteritis, including the latest data and evidences in the definition, epidemiology, pathogenesis and etiology, clinical manifestations and classification, diagnosis, assessment of disease activity and progression, biomarkers, and treatment. METHODS We searched all publications addressing definition, epidemiology, pathogenesis, etiology, classification, diagnosis, biomarkers, and treatment of TA. Randomized trials, cohort studies, and reviews were contemplated to give a breadth of clinical data. PubMed and Scopus were searched from August 2010 to November 2015. RESULTS Of the 3,056 records found, 267 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 169 articles because of the following reasons: (1) no innovative or important content; (2) no multivariable analysis; (3) insufficient data; (4) no clear potential biases or strategies to solve them; (5) no clear end-points; and (6) inconsistent or arbitrary conclusions. The final set included 98 articles. CONCLUSIONS This review presents the last updates in all fields of Takayasu arteritis. Still today, large areas of TA pathogenesis and disease-activity assessment need to be further investigated to better treat patients with TA.
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Misra DP, Shenoy SN. Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk. Rheumatol Int 2016; 37:151-167. [DOI: 10.1007/s00296-016-3435-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022]
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Fukui S, Hirota S, Iwamoto N, Karata H, Kawakami A. Takayasu Arteritis With Antiphosphatidylserine/Prothrombin Antibody-Positive Antiphospholipid Syndrome: Case Report and Literature Review. Medicine (Baltimore) 2015; 94:e2345. [PMID: 26705229 PMCID: PMC4697995 DOI: 10.1097/md.0000000000002345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A relationship between Takayasu arteritis (TA) and positive antiphospholipid antibody states has been pointed out, but patients with TA complicated with antiphospholipid antibody syndrome (APS) are rare. Here we report the case of a 17-year-old Japanese man diagnosed with TA based on pulselessness of the left brachial artery, discrepancy of blood pressure between the upper extremities, and arterial wall thickening and narrowing of artery in contrast computed tomography. He was also diagnosed with provisional APS based on a pulmonary infarction without narrowing of the pulmonary artery and positive antiphosphatidylserine/prothrombin antibody. The patient also had concurrent Crohn's disease (CD) based on histopathological findings, which may have been associated with TA. We started high-dose corticosteroid therapy and anticoagulation therapy, and his symptoms including fever, dizziness, chest pain, and lower-right uncomfortable abdomen improved.We reviewed 9 cases of TA with APS including our patient by conducting a PubMed search. Based on past reports, we considered the relationship among TA, APS, and CD.Clinicians should bear in mind that many etiologies can exist in 1 patient, and differential diagnoses are essential.
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Affiliation(s)
- Shoichi Fukui
- From the Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki (SF, SH, NI, AK); and Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan (HK)
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Misra DP, Chowdhury AC, Lal H, Mohindra N, Agarwal V. Gangrene in Takayasu’s arteritis: a report of two cases and review of literature. Rheumatol Int 2015; 36:449-53. [PMID: 26563339 DOI: 10.1007/s00296-015-3392-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
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Association of ferritin antibodies with Takayasu arteritis. Clin Rheumatol 2014; 33:1523-6. [PMID: 25178778 DOI: 10.1007/s10067-014-2764-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Abstract
Takayasu arteritis (TA) is difficult to diagnose because diagnostic biomarkers have not yet been established. In a previous study, we detected autoantibodies against the human ferritin heavy chain protein (HFC) in the sera of patients with giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR). The aim of this study is to evaluate the frequency of autoantibodies against HFC in TA. We established seven ELISA assays for the detection of autoantibodies against HFC. We used the full-length recombinant HFC expressed in Escherichia coli or one of six different HFC peptides as autoantigens: 1-18Aa (98.8 % purity), 19-45Aa (98.8 % purity), 52-78Aa (98.3 % purity), 79-104Aa (98.8 % purity), 105-143Aa (98.4 % purity) and 145-183Aa (98.5 % purity). We collected sera from 48 patients with TA, 36 patients with systemic lupus erythematosus (SLE), 35 patients with arteriosclerosis, 133 patients with febrile diseases, which are known to generate unspecific autoantibodies, and 50 blood donors, which served as controls. The best results were obtained using the ferritin peptides as antigens. By combining the results from the different ELISAs that detect autoantibodies against the HFC peptides 19-44A, 79-104A and 105-144A, we were able to detect ferritin peptide antibodies in 30/48 (62 %) of the TA patients. The frequency was lower than in early GCA and PMR (previous study showed up to 92 %). Positive results were observed in 0/50 (0 %) of the control blood donors, 10/36 (28 %) of the SLE patients, 4/35 (11 %) of the arteriosclerosis patients and 27/133 (20 %) of the fever patients. Considering the lack of biomarkers for TA, autoantibodies against HFC peptides could act as useful markers for TA.
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Affiliation(s)
- Chikashi Terao
- Center for Genomic Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology; Kyoto University Graduate School of Medicine; Kyoto Japan
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Gao S, Wang R. Takayasu arteritis presenting with massive cerebral ischemic infarction in a 35-year-old woman: a case report. J Med Case Rep 2013; 7:179. [PMID: 23830048 PMCID: PMC3707746 DOI: 10.1186/1752-1947-7-179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/01/2013] [Indexed: 11/29/2022] Open
Abstract
Introduction Takayasu arteritis is a relatively rare type of large-vessel arteritis that primarily affects the aorta and its major branches, the coronary arteries, and the pulmonary arteries. Depending on the different groups of blood vessels involved in the disease process, the clinical presentation of Takayasu arteritis varies. Here we report a case of a woman presenting with a debilitating massive cerebral ischemic infarct that turned out to be a relatively rare first presentation of Takayasu arteritis. Case presentation A 35-year-old Chinese woman presented to the Emergency Department with left hemiparesis, pain and numbness of her arms and weak radial pulses. Her laboratory results showed an elevated C-reactive protein and erythrocyte sedimentation rate, and subsequent digital subtraction angiography demonstrated narrowing and occlusion of the major branches of her aortic arch. We report the case of a patient with Takayasu arteritis presenting with a massive cerebral ischemic infarct and review the current literature on this topic. Conclusion Takayasu arteritis is a relatively rare disease with various and sometimes devastating clinical manifestations, such as massive cerebral ischemic infarction as in our case. Currently, there are multiple diagnostic tools and treatment options available, and more under investigation. Early, appropriate diagnosis and initiation of proper therapy could avoid further progression and reduce complications of the disease.
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Affiliation(s)
- Shan Gao
- Intensive Care Unit, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xinsongjiang Road, Shanghai 201620, China.
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Pathogenesis of Takayasu's arteritis: a 2011 update. Autoimmun Rev 2011; 11:61-7. [PMID: 21855656 DOI: 10.1016/j.autrev.2011.08.001] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 08/01/2011] [Indexed: 11/23/2022]
Abstract
While our knowledge of the pathogenesis of Takayasu's arteritis (TA) has considerably improved during the last decade, the exact pathogenic sequence remains to be elucidated. It is now hypothesised that an unknown stimulus triggers the expression of the 65kDa Heat-shock protein in the aortic tissue which, in turn, induces the Major Histocompatibility Class I Chain-Related A (MICA) on vascular cells. The γδ T cells and NK cells expressing NKG2D receptors recognize MICA on vascular smooth muscle cells and release perforin, resulting in acute vascular inflammation. Pro-inflammatory cytokines are released and increase the recruitment of mononuclear cells within the vascular wall. T cells infiltrate and recognize one or a few antigens presented by a shared epitope, which is associated with specific major Histocompatibility Complex alleles on the dendritic cells, these latter being activated through Toll-like receptors. Th1 lymphocytes drive the formation of giant cells through the production of interferon-γ, and activate macrophages with release of VEGF resulting in increased neovascularisation and PDGF, resulting in smooth muscle migration and intimal proliferation. Th17 cells induced by the IL-23 microenvironnement also contribute to vascular lesions through activation of infiltrating neutrophils. Although still controversial, dendritic cells may cooperate with B lymphocytes and trigger the production of anti-endothelial cell auto-antibodies resulting in complement-dependent cytotoxicity against endothelial cells. In a near future, novel drugs specifically designed to target some of the pathogenic mechanisms described above could be expanding the physician's therapeutic arsenal in Takayasu's arteritis.
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Parakh R, Yadav A. Takayasu's arteritis: an Indian perspective. Eur J Vasc Endovasc Surg 2007; 33:578-82. [PMID: 17383909 DOI: 10.1016/j.ejvs.2006.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 12/28/2006] [Indexed: 11/19/2022]
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Arnaud L, Kahn JE, Girszyn N, Piette AM, Bletry O. Takayasu's arteritis: An update on physiopathology. Eur J Intern Med 2006; 17:241-6. [PMID: 16762772 DOI: 10.1016/j.ejim.2005.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 12/11/2005] [Accepted: 12/19/2005] [Indexed: 11/22/2022]
Abstract
Takayasu's arteritis (TA) is a chronic large vessel vasculitis. The physiopathology of TA has not been completely elucidated, but it appears to be multifactorial and to mainly involve cellular immunity. The pathologic sequence could implicate stimulation from an antigen that triggers heat shock protein (HSP)-65 expression in aortic tissue which, in turn, induces MHC class I-related chain A (MICA). T-cells and natural killer (NK) cells expressing NKG2D receptors could recognize MICA, resulting in acute inflammation. Pro-inflammatory cytokines released from these infiltrating cells induce matrix metalloproteinases and amplify the inflammatory response, inducing more MHC antigen and costimulatory molecule expression on vascular cells and, thus, recruiting more mononuclear cells. Alpha-beta T-cells then infiltrate and specifically recognize one or a few autoantigens presented by a shared epitope associated with specific MHC on the dendritic cells (DC). These DC simultaneously cooperate to some extent with B-cells and determine a humoral immunity mainly constituted by anti-endothelial cell autoantibodies that could trigger complement-dependent cytotoxicity against endothelial cells. The use of corticosteroids and of other immunosuppressive agents can bring TA into remission in most patients. A better understanding of the immunological mechanisms responsible for the vascular injury has led to trials of anti-TNF-alpha agents with encouraging results. In the near future, new drugs specifically designed to target some of the mechanisms described above may be able to expand the physician's therapeutic arsenal in TA.
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Affiliation(s)
- Laurent Arnaud
- Department of Internal Medicine, Foch Hospital, 40 rue Worth, F-92150 Suresnes, France
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Morović-Vergles J. Takayasu’s arteritis associated with antiphospholipid antibodies. Rheumatol Int 2005; 26:773-4. [PMID: 16231120 DOI: 10.1007/s00296-005-0065-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 09/09/2005] [Indexed: 11/26/2022]
MESH Headings
- Adult
- Anti-Inflammatory Agents/therapeutic use
- Antibodies, Antiphospholipid/blood
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Common/pathology
- Carotid Artery, External/diagnostic imaging
- Carotid Artery, External/pathology
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/pathology
- Cyclophosphamide/therapeutic use
- Fatal Outcome
- Female
- Follow-Up Studies
- Humans
- Immunosuppressive Agents/therapeutic use
- Lupus Coagulation Inhibitor/blood
- Methotrexate/therapeutic use
- Middle Cerebral Artery/diagnostic imaging
- Middle Cerebral Artery/pathology
- Posterior Cerebral Artery/diagnostic imaging
- Posterior Cerebral Artery/pathology
- Prednisolone/therapeutic use
- Subclavian Artery/diagnostic imaging
- Subclavian Artery/pathology
- Subclavian Steal Syndrome/diagnostic imaging
- Subclavian Steal Syndrome/pathology
- Takayasu Arteritis/blood
- Takayasu Arteritis/diagnostic imaging
- Takayasu Arteritis/drug therapy
- Takayasu Arteritis/physiopathology
- Time Factors
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Transcranial
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Meyer MF, Schnabel A, Schatz H, Gross WL. Lack of association between antiphospholipid antibodies and thrombocytopenia in patients with Wegener's granulomatosis. Semin Arthritis Rheum 2001; 31:4-11. [PMID: 11503134 DOI: 10.1053/sarh.2001.25060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE In patients with Wegener's granulomatosis (WG), thrombocytopenia is less common than thrombocytosis. An increased prevalence of antiphospholipid antibodies (aPL), which is associated with thrombocytopenia, has been noted in patients with WG. The aim of this study was to examine the relationship between thrombocytopenia and aPL in patients with WG. METHODS Thrombocytopenic episodes were searched for in a random sample of 83 patients with WG. Stored sera obtained during thrombocytopenia, which was defined as platelet count below 130 x 10(9)/L, were examined by 2 different enzyme-linked immunosorbent assays (ELISA) for IgG and IgM anticardiolipin antibodies (aCL) and for IgG antiphosphatidylserine antibodies (aPS). Screening for lupus anticoagulant was performed by use of activated partial thromboplastin time (aPTT). Results were compared with the prevalence of aPL in 20 consecutive nonthrombocytopenic patients with WG. RESULTS Six cases with thrombocytopenic episodes were found in the group of 83 patients with WG. Increased IgG and IgM aCL were detected in 1 patient, who also had elevated IgG aPS. A positive test result solely for IgM aCL was found in another patient. These findings were consistent in both ELISA for aPL. Five patients were being treated with cyclophosphamide when thrombocytopenia occurred. In the group of nonthrombocytopenic patients with WG, elevated IgG aCL and IgG aPS were consistently detected in 1 patient in both ELISA. Three other patients had positive results in single tests, which were not confirmed by the second assay. In all patients, aPTT was normal. CONCLUSIONS Thrombocytopenia is a rare finding in patients with WG. A similar prevalence of aPL in thrombocytopenic and nonthrombocytopenic patients with WG provides no evidence that aPL play a major role in the pathogenesis of these events. Thrombocytopenia in WG is more likely caused by the myelotoxic effect of preceding cyclophosphamide treatment. We found a frequency of aPL in WG that exceeds frequencies seen in the general population but does not approximate those detected in systemic lupus erythematosus and closely related disorders. Semin Arthritis Rheum 31:4-11.
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Affiliation(s)
- M F Meyer
- Department of Rheumatology, Medical University of Lübeck, Germany
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22
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Nava A, Senécal JL, Bañales JL, Raymond I, Reyes PA. Absence of antiphospholipid/co-factor antibodies in Takayasu arteritis. Int J Cardiol 2000; 75 Suppl 1:S99-S104. [PMID: 10980345 DOI: 10.1016/s0167-5273(00)00177-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED There are anecdotal reports and small series describing the presence of anticardiolipin antibodies in patients with Takayasu Arteritis. This communication describes a systematic study searching for non-organ specific autoantibodies which includes antinuclear antibodies, anticardiolipin and anti-beta(2) GP(1) antibodies in a cohort of 28 Mexicans with angiographic definitive diagnostic of Takayasu Arteritis. MATERIAL AND METHODS Twenty-eight consecutive patients, who fulfilled classification and diagnostic criteria for Takayasu Arteritis and had a diagnostic panaortogram, were bled to study the presence of circulating autoantibodies in a cross-sectional design. RESULTS There were no antinuclear antibodies, although a few sera had faint cytoplasm fluorescent deposit and reacted with cell extract. We did not recognize a distinct pattern. Also, there was no IgG nor IgM anticardiolipin antibodies nor anticofactor antibodies of clinical interest. DISCUSSION AND CONCLUSIONS The presence of circulating non-organ specific autoantibodies is not a characteristic feature in Takayasu Arteritis when strict diagnostic criteria are applied. The occasional presence of such immune markers could be due to technical differences in sample management, less strict diagnosis or biological variability in certain cases, but has no diagnostic value.
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Affiliation(s)
- A Nava
- Autoimmunity Research Laboratory, Hôpital Notre Dame, Centre Hospitalier de l'Université de Montréal, Quebec, Montreal, Canada
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23
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Fearfield LA, Ross JR, Farrell AM, Costello C, Bunker CB, Staughton RC. Pyoderma gangrenosum associated with Takayasu's arteritis responding to cyclosporin. Br J Dermatol 1999; 141:339-43. [PMID: 10468813 DOI: 10.1046/j.1365-2133.1999.02989.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 33-year-old caucasian woman with pyoderma gangrenosum associated with Takayasu's arteritis responded to treatment with cyclosporin. This patient is unusual in that both ulcerative and vesiculopustular forms of pyoderma gangrenosum were present. This has not previously been reported with Takayasu's arteritis.
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Affiliation(s)
- L A Fearfield
- Department of Dermatology, Chelseaand Westminster Hospital, Imperial School of Medicine, London, UK.
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24
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Abstract
Takayasu's arteritis (TA) is a rare, chronic, and idiopathic vasculitis of the aorta and/or its main branches. There have been case reports of this disease associated with immune hypercoaguable states, namely raised antiphospholipid antibodies. Investigations of the thrombotic nature of Takayasu's arteritis have shown elevated levels of B-thromboglobulin, platelet factor 4, thrombin-antithrombin III complex, and fibrinopeptide A. We report the first case of TA associated with the Factor V Leiden gene defect (Activated Protein C Resistance). The patient is a 30-year-old female who presented with six months of bilateral lower and upper extremity claudication, carotid artery tenderness, diminished brachial pulse and no measurable blood pressure in the left arm, an erythrocyte sedimentation rate (Westergren) of 62 mm/hr, and an angiogram meeting the clinical criteria for TA. Her symptoms showed a dramatic response to high-dose oral glucocorticosteroids and she was also maintained on long-term anticoagulation. This case illustrates that hereditary hypercoagulable states can coexist with acquired vasculitidies and that further investigation into these associations and their pathophysiologic interaction is warranted.
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Affiliation(s)
- D D Shin
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA
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25
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Abstract
A search for antibodies reactive against a total human aorta extract and its main protein components such as elastin, fibronectin and collagen was attempted by electroimmunetransference and ELISA. Thirty five sera from clinically and angiographically proven diagnosis of Takayasu Arteritis patients were compared with 32 sera from people without abnormalities. Non specific binding was found on electroimmune transference and no difference was shown in optical density readings in ELISA, therefore, we did not demonstrate the presence of antiaorta specific antibodies in this vasculitic condition. Our findings are in agreement with several authors, the contribution of humoral immunity to pathogenesis of Takayasu Arteritis has not been proved yet.
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Affiliation(s)
- M Baltazares
- Instituto Nacional de Enfermedades Respiratorias, México D.F., Mexico
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27
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Abstract
The clinical features of 106 patients of Takayasu arteritis (TA) seen over a period of 16 years are documented (65 females and 41 males). The mean age was 27.3 +/- 9.2 years. Hypertension was the commonest mode of presentation (51.3%) and was detected in 82 patients (77.4%) at the time of presentation. Vascular bruits were heard in 72 patients (67.9%) and 13 patients (12.3%) were in congestive heart failure. Aortography was performed in 95 patients. Based on the extent of involvement, Type I (branches of aortic arch) was seen in 7 (6.6%) patients, Type II (aortic arch, its branches and descending thoracic aorta) in 7 (6.6%) patients, Type III (descending thoracic aorta and abdominal aorta) in 4 (3.8%) patients, Type IV (abdominal aorta only) in 29 (27.3%) patients and Type V (aortic arch, descending thoracic aorta and abdominal aorta) in 59 (55.7%) patients. Therapeutic modalities included antihypertensive drug therapy in 81 patients, antitubercular drugs in 8 patients, steroids in 16 patients and cyclophosphamide in one patient. Response to steroids was satisfactory in 5 of these 16 patients while the lesions of vasculitis healed in the patient who was treated with cyclophosphamide. Surgical interventions included nephrectomy and autotransplantation of kidney in 3 patients each and revascularization in 4 patients and angioplasty in 4 patients. In the area of pathogenesis of this disease, a high activity of protein kinase C(PKC), an increased intracellular calcium and inositol 1,4,5 triphosphate in both unstimulated and stimulated T cells of TA was observed. These findings suggest an activation of PKC-calcium pathway in TA.
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Affiliation(s)
- S Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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29
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 4-1995. A 26-year-old woman with recurrent angina after a triple-coronary-artery bypass graft. N Engl J Med 1995; 332:380-6. [PMID: 7824001 DOI: 10.1056/nejm199502093320608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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