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Lamessa A, Birhanu A, Mekonnen G, Mohammed A, Woyimo TG, Asefa ET. Ischemic stroke as the first clinical manifestation of an initially undiagnosed case of Takayasu arteritis in a young woman from Ethiopia: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241241190. [PMID: 38585421 PMCID: PMC10999126 DOI: 10.1177/2050313x241241190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Takayasu arteritis (TAK) is a rare large-vessel vasculitis of unknown etiology that leads to arterial wall thickening, stenosis, and occlusion, which may complicate cerebrovascular ischemic events. Ischemic stroke is a potentially devastating complication of TAK at a young age, but the occurrence is still rarely reported in Ethiopia. Although it occurs late in the course of the condition, it may be the initial presentation and suggest an unfavorable prognosis. Herein, we address the case of a 25-year-old woman who presented to a university hospital while on follow-up after 2 years of stroke with deterioration in clinical symptoms, absent brachial artery pulses, and unrecordable blood pressure in both arms. At the time of admission in 2021, the contrast brain computed tomography scan revealed an ischemic infarction in the right middle cerebral artery territory. However, the etiology of the stroke could not be defined at that time due to ambiguity in the clinical picture and the inability of clinicians to incorporate TAK into the differential diagnosis, resulting in a delay in the early diagnosis of the case. Two years later, in 2023, she underwent computed tomography angiography and was diagnosed to have TAK based on American College of Rheumatology criteria, with Numano type IIb angiographic extent of disease, ischemic stroke, and stage II systemic hypertension. The patient was treated by a field of experts. This case highlights the need to consider TAK in the differential diagnosis of stroke in young patients in the absence of traditional risk factors; appropriate tests should be performed to confirm or rule out this diagnosis, and management should be modified accordingly.
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Affiliation(s)
- Adugna Lamessa
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Romero-Sanchez G, Dabiri M, Mossa-Basha M. Primary Large Vessel Vasculitis: Takayasu Arteritis and Giant Cell Arteritis. Neuroimaging Clin N Am 2024; 34:53-65. [PMID: 37951705 DOI: 10.1016/j.nic.2023.07.002] [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] [Indexed: 11/14/2023]
Abstract
Takayasu arteritis (TA) and Giant cell arteritis (GCA) are large vessel vasculitides, with TA targeting the aorta and its branches, and GCA targeting both large and medium-sized arteries. Early diagnosis of TA and GCA are of great importance, since delayed, inappropriate or no treatment can result in severe and permanent complications. Imaging plays a central role in establishing diagnosis, targeting lesions for confirmational diagnostic biopsy, specifically for GCA, and longitudinal disease evolution. In this article, we discuss imaging diagnosis of large artery vasculitis and the value of different imaging modalities.
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Affiliation(s)
- Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Textitlan 21 Casa 11, Santa Ursula Xitla, Tlalpan, Mexico City 14420, Mexico
| | - Mona Dabiri
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Abi Avenue, Dolat St, Tehran 11369, Iran
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
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Dhanani U, Zhao MY, Charoenkijkajorn C, Pakravan M, Mortensen PW, Lee AG. Large-Vessel Vasculitis in Ophthalmology: Giant Cell Arteritis and Takayasu Arteritis. Asia Pac J Ophthalmol (Phila) 2022; 11:177-183. [PMID: 35533336 DOI: 10.1097/apo.0000000000000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
ABSTRACT Giant cell arteritis and Takayasu arteritis are large-vessel vasculitides that share multiple common features but also have significant differences in epidemiology, demographics, clinical presentation, evaluation, and treatment. Giant cell arteritis is more common in elderly patients of Caucasian descent versus Takayasu arteritis, which is more prevalent in younger patients of Asian descent. Although traditionally age has been the main criterion for differentiating the 2 etiologies, modifications in the diagnostic criteria have recognized the overlap between the 2 conditions. In this monograph, we review the diagnostic criteria for both conditions and describe the epidemiology, pathogenesis, histology, evaluation, and management for large-vessel vasculitis in ophthalmology. Additionally, we describe ocular imaging techniques that may be utilized by ophthalmologists to identify manifestations of large-vessel vasculiti- des in patients. Lastly, we compare and contrast the key clinical, laboratory, and pathologic features that might help ophthalmologists to differentiate the 2 entities.
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Affiliation(s)
- Ujalashah Dhanani
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, US
| | | | - Chaow Charoenkijkajorn
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Mohammad Pakravan
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Peter W Mortensen
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
- Departments of Ophthalmology, Neurology, and Neurosurgery, weill Cornell Medicine, New York, NY, US
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, US
- University of Texas MD Anderson Cancer Center, Houston, TX, US
- Texas A and M College of Medicine, Bryan, TX, US
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, US
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4
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Oliveira PM, Fereira P, Murteira F, Rato IR, Barbedo M. Takayasu Arteritis as a Secondary Cause of Arterial Hypertension. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sun Y, Yin MM, Ma LL, Dai XM, Lv LJ, Chen XX, Ye S, Li T, Chen J, Zhao DB, Kong RN, Wei QH, Yang GH, Gong SG, Yang CD, Liu HL, Xue Y, Tang JP, Feng R, Peng A, Qin L, Liu H, Su X, Huang HP, Guan JL, Luo D, Dai SM, Zhao FT, Zhu ZH, Zhang XY, Han J, Wang JY, Xiao CY, Xu HJ, Wu X, He DY, Mao JC, Zhu ZJ, Xue L, Li B, Lin J, Zou JZ, Sun XN, Ding J, Dong ZH, Wang XF, Jun-Ying, Jiang LD. Epidemiology of Takayasu arteritis in Shanghai: A hospital-based study and systematic review. Int J Rheum Dis 2021; 24:1247-1256. [PMID: 34314100 DOI: 10.1111/1756-185x.14183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/04/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Takayasu arteritis (TAK) is a rare large vessel vasculitis, and epidemiological data on TAK are lacking in China. Thus, we designed this study to estimate the TAK prevalence and incidence in residential Shanghai, China. METHODS Data on diagnosed TAK cases aged over 16 years were retrieved from 22 tertiary hospitals in Shanghai through hospital electronic medical record systems between January 1, 2015 and December 31, 2017 to estimate the prevalence and incidence. A systematic literature review based on searches in PubMed, Ovid-Medline, Excerpta Medica Database (EMBASE), Web of Science, and China National Knowledge Infrastructure (CNKI) was performed to summarize TAK distribution across the world. RESULTS In total 102 TAK patients, with 64% female, were identified. The point prevalence (2015-2017) was 7.01 (95% CI 5.65-8.37) cases per million, and the mean annual incidence was 2.33 (1.97-3.21) cases per million. The average age of TAK patients was 44 ± 16 years, with the highest prevalence (11.59 [9.23-19.50] cases per million) and incidence (3.55 [0.72 3.74] cases per million) in the 16 to 34 years population. Seventeen reports were included in the system review, showing that the epidemiology of TAK varied greatly across the world. The incidence and prevalence were both relatively higher in Asian countries, with the prevalence ranging 3.3-40 cases per million and annual incidence ranging 0.34-2.4 cases per million. CONCLUSIONS The prevalence and incidence of TAK in Shanghai was at moderate to high levels among the previous reports. The disease burden varied globally among racial populations.
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Affiliation(s)
- Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Meng-Meng Yin
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Li Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Min Dai
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang-Jing Lv
- Department of Rheumatology, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao-Xiang Chen
- Department of Rheumatology, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, Renji Hospital South Campus, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ting Li
- Department of Rheumatology, Renji Hospital South Campus, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jie Chen
- Department of Rheumatology, Renji Hospital South Campus, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Dong-Bao Zhao
- Department of Rheumatology and Immunology, Changhai Hospital, Second Military Medicine University, Shanghai, China
| | - Rui-Na Kong
- Department of Rheumatology and Immunology, Changhai Hospital, Second Military Medicine University, Shanghai, China
| | - Qiang-Hua Wei
- Department of Rheumatology, Shanghai General Hospital, Shanghai, China
| | - Guang-Hui Yang
- Department of Rheumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Su-Gang Gong
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cheng-de Yang
- Department of Rheumatology and Immunology, Shanghai JiaoTong University School of Medicine Affiliated Ruijin Hospital, Shanghai, China
| | - Hong-Lei Liu
- Department of Rheumatology and Immunology, Shanghai JiaoTong University School of Medicine Affiliated Ruijin Hospital, Shanghai, China
| | - Yu Xue
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Ping Tang
- Division of Rheumatology and Immunology, Tongji Hospital of Tongji University School of Medicine, Shanghai, China
| | - Run Feng
- Division of Rheumatology and Immunology, Tongji Hospital of Tongji University School of Medicine, Shanghai, China
| | - Ai Peng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ling Qin
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao Su
- Department of Rheumatology, Shanghai municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui-Ping Huang
- Department of Rheumatology, Shanghai municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Long Guan
- Department of Rheumatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Dan Luo
- Department of Rheumatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Sheng-Ming Dai
- Department of Rheumatology & Immunology, Shanghai JiaoTong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fu-Tao Zhao
- Department of Rheumatology and Immunology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Zhen-Hang Zhu
- Department of Rheumatology and Immunology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiao-Yan Zhang
- Department of Renal and Rheumatology, Xinhua Hospital Affiliated To Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jie Han
- Department of Rheumatology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jia-Yi Wang
- Department of Rheumatology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chun-Yuan Xiao
- Department of Rheumatology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Hu-Ji Xu
- Department of Rheumatology and Immunology, Changzheng Hospital, Secondary Military Medicine University, Shanghai, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Changzheng Hospital, Secondary Military Medicine University, Shanghai, China
| | - Dong-Yi He
- Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional and Western Medicine, Shanghai, China
| | - Jian-Chun Mao
- Department of Rheumatology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhu-Jing Zhu
- Department of Rheumatology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Luan Xue
- Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ben Li
- Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Zhou Zou
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Ning Sun
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi-Hui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiang-Fei Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun-Ying
- Fudan University Library, Shanghai, China
| | - Lin-di Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Evidence-Based Medicine Center, Fudan University, Shanghai, China
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Wang YJ, Ma LL, Liu Y, Yan Y, Sun Y, Wang YS, Dai XM, Ji ZF, Ma LY, Chen HY, Jiang LD. Risk assessment model for heart failure in Chinese patients with Takayasu's arteritis. Clin Rheumatol 2021; 40:4117-4126. [PMID: 34021842 DOI: 10.1007/s10067-021-05745-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to construct and validate a risk assessment model to identify risk factors for heart failure (HF) in patients with Takayasu's arteritis (TAK). METHODS Three hundred sixty-five patients with TAK were recruited in the East China Takayasu Arteritis Cohort from January 2012 to December 2019. Patients were assigned into training and validation sets following a 2:1 ratio according to the date of enrollment. Clinical characteristics were compared between heart failure (HF) and non-HF subgroups in the training set, and a risk assessment model for HF and its scoring algorithm was established based on logistic regression, which was tested in the validation set. RESULTS Among total of 74 (20.27%) TAK patients exhibited HF, and 55 cases (74.32%) were in the training set. The risk factors for HF of TAK patients included onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension. We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients in the training set with the score ≥ 3 appeared to be associated with an increased risk of HF with an area under curve (AUC) of 0.88 and 0.90 in Model 1 and Model 2 respectively. The AUC reached to 0.88 and 0.89 in the validation set that proved the accuracy of the model. CONCLUSIONS We presented a risk assessment model of HF in TAK, which may help clinicians alert the complication of HF in the patients with specifically cardiac impairments. Key Points • Heart failure was not rare in Chinese Takayasu's arteritis patients, and there were approximately 20% of patients with heart failure in ECTA cohort. • Cardiac involvements on echocardiography include pathological valvular and atrioventricular abnormalities. • The onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension were risk factors for heart failure in Takayasu's arteritis patients. • We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients with the risk assessment model score of ≥ 3 appeared to be associated with an increased risk of heart failure.
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Affiliation(s)
- Yu-Jiao Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Li-Li Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Evidence-base Medicine Center, Fudan University, Shanghai, People's Republic of China
| | - Yun Liu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yan Yan
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yong-Shi Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Min Dai
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Zong-Fei Ji
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ling-Ying Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hui-Yong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Lin-Di Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. .,Evidence-base Medicine Center, Fudan University, Shanghai, People's Republic of China.
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7
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Zhou B, Ye P, Wei S. Preliminary clinical analysis of neovascular glaucoma secondary to carotid artery disease. Clin Exp Optom 2021; 94:207-11. [PMID: 21175823 DOI: 10.1111/j.1444-0938.2010.00555.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Biye Zhou
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China E‐mail:
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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Limon M, Gülcemal S, Tezcan D, Yılmaz S. Tekrarlayan hemoptizi ile başvuran Takayasu arteritli bir erkek olgu. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.476319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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Chapelon-Abric C, Saadoun D, Marie I, Comarmond C, Desbois AC, Domont F, Savey L, Cacoub P. Sarcoidosis with Takayasu arteritis: a model of overlapping granulomatosis. A report of seven cases and literature review. Int J Rheum Dis 2017; 21:740-745. [PMID: 28791773 DOI: 10.1111/1756-185x.13137] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the features of exceptional coexisting Takayasu arteritis (TA) and sarcoidosis, two conditions of unknown cause associated with a common immunologic pattern. METHODS We report seven cases of concomitant sarcoidosis-Takayasu or Takayasu-like vasculitis, observed in two referral centers between 1995 and 2015. RESULTS All patients were female. The mean age at sarcoidosis diagnosis and TA diagnosis was 36 and 37 years, respectively. Sarcoidosis occurred in 86% of cases before or together with TA. Sarcoidosis always had a classic expression except for one renal localization. Sarcoidosis was not severe and mostly non-treated (86%). In all cases of TA, supra-aortic arteries were involved; in only two TA cases a more diffuse inflammatory arterial involvement was noted. In one case, Takayasu arteritis occurred despite immunosuppressive therapy given for sarcoidosis. All patients received for TA a treatment with corticosteroids associated with methotrexate (four cases), infliximab (one case) or tocilizumab (one case). After a mean follow-up of 89 months, TA always improved and no death was observed. CONCLUSIONS TA stands as pathology associated with sarcoidosis. TA occurred in three cases among 50. When sarcoidosis preceded TA, a recovery of sarcoidosis was achieved mostly without treatment. TA is a prognostic and therapeutic factor. Immunosuppressive treatment, including steroids, led to a good prognosis for TA as well as for sarcoidosis.
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Affiliation(s)
- Catherine Chapelon-Abric
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France
| | - Isabelle Marie
- Department of Internal Medicine, CHU Rouen-Bois Guillaume, Rouen cedex, France
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France
| | - Anne Claire Desbois
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,CNRS, FRE3632, Paris, France
| | - Léa Savey
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,CNRS, FRE3632, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France
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11
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Hinojosa CA, Anaya-Ayala JE, Gomez-Arcive Z, Laparra-Escareno H, Torres-Machorro A, Lizola R. Factors Associated With Need for Revascularisation in Non-coronary Arterial Occlusive Lesions Secondary to Takayasu's Arteritis. Eur J Vasc Endovasc Surg 2017; 54:397-404. [PMID: 28709561 DOI: 10.1016/j.ejvs.2017.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/31/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/BACKGROUND Takayasu's arteritis (TA) is rare inflammatory large vessel form of vasculitis. The objective of this study was to evaluate experience in the management of TA patients and to identify the influence of inflammatory markers and clinical variables associated with disease progression, worsening ischaemic symptoms, and the need for interventions. METHODS Demographics, and laboratory and clinical variables in patients that required revascularisation procedures were compared with those who had adequate symptomatic control with medical management. Categorical data were analysed with Fisher's exact test, continuous variables with two-sample t test, and a life table analysis was used to study the recurrence of symptoms in intervened patients. RESULTS From January 1995 to May 2016, 47 patients (mean age 30 years; range 14-59 years) were managed; 44 (94%) were female. During the mean follow-up period of 120 months, 21 (45%) underwent 23 procedures (17 of these [74%] open, six [26%] endovascular). From the intervened group, eight (38%) patients presented with transient ischaemic attacks, five (24%) with renovascular hypertension, and four (19%) with upper extremity and four (19%) lower extremity claudication. Comparative analysis demonstrated that elevation of erythrocyte sedimentation rate (ESR) at the time of the diagnosis (revascularisation group: median value 28 mm/hour; medical management group: median value 15 mm/hour) was associated with progression of the disease, worsening symptoms, and subsequent need for intervention (p = .04). Active smoking was a factor connected with the need for revascularisation (p = .05). Immediate symptomatic improvement occurred in 19 (90%) patients that underwent surgical or endovascular revascularisation. CONCLUSION Patients with TA who underwent interventions had higher ESR at the time of diagnosis; this factor and active smoking were associated with progression of the disease and worsening ischaemic symptoms despite medical therapy. Revascularisation procedures are effective at relieving symptoms; lifelong surveillance is necessary.
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Affiliation(s)
- C A Hinojosa
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico.
| | - J E Anaya-Ayala
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - Z Gomez-Arcive
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - H Laparra-Escareno
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - A Torres-Machorro
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - R Lizola
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
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12
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Soo-Hoo S, Seong J, Porten BR, Skeik N. Challenges of Takayasu Arteritis in Pregnancy: A Case Report. Vasc Endovascular Surg 2017; 51:195-198. [DOI: 10.1177/1538574417698904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Takayasu arteritis is a rare, chronic vasculitis of unknown etiology characterized by inflammation of the aorta and its main branches. Although Takayasu arteritis mostly affects women of childbearing age, there is a paucity in the literature on pregnancy associated with Takayasu arteritis. Pregnant patients are at increased risk of cardiovascular complications, including hypertension and congestive heart failure, which may jeopardize both maternal and fetal outcomes. Furthermore, optimal management has not yet been established for pregnant patients with Takayasu arteritis, posing a clinical challenge. We present a case of a young woman with Takayasu arteritis whose symptoms and disease activity improved during 2 pregnancies. Although her first pregnancy was complicated with preeclampsia, gestational diabetes, and preterm vaginal delivery, her second pregnancy was uneventful. This case provides a rare glimpse of Takayasu arteritis in pregnancy and highlights the challenges of medical management in gravid patients.
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Affiliation(s)
- Sarah Soo-Hoo
- Minneapolis Heart Institute Research Foundation, Minneapolis, MN, USA
| | - Jenny Seong
- Minneapolis Heart Institute Research Foundation, Minneapolis, MN, USA
| | - Brandon R. Porten
- Minneapolis Heart Institute Research Foundation, Minneapolis, MN, USA
| | - Nedaa Skeik
- Vascular Medicine, Minneapolis Heart Institute, Minneapolis, MN, USA
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13
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Park SJ, Kim HJ, Park H, Hann HJ, Kim KH, Han S, Kim Y, Ahn HS. Incidence, prevalence, mortality and causes of death in Takayasu Arteritis in Korea - A nationwide, population-based study. Int J Cardiol 2017; 235:100-104. [PMID: 28283361 DOI: 10.1016/j.ijcard.2017.02.086] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/03/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies investigating the epidemiology and mortality of Takayasu Arteritis (TA) are scarce. The objective of this study was to provide information regarding the epidemiology of TA, such as the incidence, prevalence, survival and cause of death in Korea. METHODS We used a national, population-based database maintained by the Rare Intractable Disease registration program and the Health Insurance Review and Assessment Service, which includes information on all TA patients, diagnosed based on uniform criteria. We also used data from Statistics Korea linked with RID database to confirm survival and cause of death. We analyzed data for the period 2008-2012. RESULTS During study period, there were 612 new patients with TA, with a female-to-male ratio of 4.3:1. The annual mean incidence was 0.24 per 105 people, and the prevalence was 2.82 per 105 people in 2012. The average annual mortality rate was 0.02 per 105 people, and the standardized mortality ratio was 3.1. The overall survival of patients with TA was 96.6%, which was significantly lower than that in the general population. Cardiovascular disease was the most common cause of death, accounting for 29 of the 64 deaths (45.3%), followed by neoplasms in 9 patients (14.1%). CONCLUSIONS The incidence and prevalence presented in this study are the highest ever reported. The survival of patients with TA was significantly lower than that of the general population, and the main cause of death was cardiovascular disease. This study reflects the need for greater awareness of TA, especially in Asian countries.
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Affiliation(s)
- Sang Jun Park
- Department of Surgery, University of Ulsan College of Medicine, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Republic of Korea
| | - Hojong Park
- Department of Surgery, University of Ulsan College of Medicine, Republic of Korea
| | - Hoo Jae Hann
- Medical Research Institute, Ewha Womans University, Republic of Korea.
| | - Kyoung Hoon Kim
- Department of Public Health, Graduate School, Korea University, Republic of Korea
| | - Seungjin Han
- Department of Public Health, Graduate School, Korea University, Republic of Korea
| | - Yuri Kim
- Department of Public Health, Graduate School, Korea University, Republic of Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Republic of Korea.
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Abstract
In this chapter we review the optimal imaging modalities for subacute and chronic stroke. We discuss the utility of computed tomography (CT) and multimodal CT imaging. Further, we analyze the importance of specific magnetic resonance imaging sequences, such as diffusion-weighted imaging for acute ischemic stroke, T2/fluid-attenuated inversion recovery for subacute and chronic stroke, and susceptibility imaging for detection of intracranial hemorrhages. Different ischemic stroke mechanisms are reviewed, and how these imaging modalities may aid in the determination of such. Further, we analyze how topographic patterns in ischemic stroke may provide important clues to the diagnosis, in addition to the temporal evolution of the stroke. Lastly, specific cerebrovascular occlusive diseases are reviewed, with emphasis on the optimal imaging modalities and their findings in each condition.
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15
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Hinojosa CA, Lizola R, Anaya-Ayala JE, Torres-Machorro A, Laparra-Escareno H. Left subclavian-carotid bypass in a 38-year old female with brain ischemic symptoms secondary to Takayasu's arteritis: A case report. Int J Surg Case Rep 2016; 26:159-62. [PMID: 27497039 PMCID: PMC4976603 DOI: 10.1016/j.ijscr.2016.07.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/26/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction Takayasu’s arteritis (TA) is a rare form of vasculitis that affects the aorta, its branches and pulmonary arteries. TA is primarily treated by pharmacologic therapy; however revascularization procedures may be required to treat organ ischemia. Evidence-based consensus regarding the indications for surgical or endovascular therapy for patients with supra-aortic vessels lesions remains unclear. Presentation of case We herein present a female patient with known TA since 2000, who experienced progressive and frequent episodes of amaurosis fugax in the left eye for 4 months. Computed tomography angiography (CTA) revealed focal stenotic segments in the right common carotid artery (CCA) and internal carotid artery (ICA) and near occlusion of the proximal left CCA. We opted to treat the left side first with open revascularization, and a subclavian-carotid bypass was performed using a 6 millimeters (mm) externally supported ePTFE graft. Patient recovered well from the surgery, her neurological exam was normal and she was discharged home in stable condition in postoperative day three. At three months she remains symptoms-free and her bypass is patent. Discussion/Conclusion This case illustrates the clinical presentation of TA affecting both carotid arteries; open revascularization via carotid subclavian bypass grafting was successfully performed with minimal morbidity, complete resolution of symptoms and improvement of the patient’s quality of life. Revascularization procedures when indicated should be performed while the disease is inactive and close surveillance is mandatory.
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Affiliation(s)
- Carlos A Hinojosa
- Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico.
| | - Rene Lizola
- Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - Adriana Torres-Machorro
- Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
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16
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Liu Q, Dang AM, Chen BW, Lv NQ, Wang X, Zheng DY. The association of red blood cell distribution width with anemia and inflammation in patients with Takayasu arteritis. Clin Chim Acta 2015; 438:205-9. [DOI: 10.1016/j.cca.2014.08.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/12/2014] [Accepted: 08/21/2014] [Indexed: 11/30/2022]
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17
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Liu Q, Dang A, Chen B, Lv N, Wang X, Zheng D. Function of N-terminal pro-brain natriuretic peptide in Takayasu arteritis disease monitoring. J Rheumatol 2014; 41:1683-8. [PMID: 25028376 DOI: 10.3899/jrheum.140113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Increased levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with cardiovascular morbidity and mortality. Inflammation may also affect levels of NT-proBNP. We investigated the relationship of NT-proBNP with inflammation, disease activity, disease severity, and progression of Takayasu arteritis (TA). METHODS Plasma levels of NT-proBNP were determined in 68 patients with TA and in 90 control subjects. Disease activity and disease severity in patients with TA were defined according to the National Institutes of Health and Ishikawa's criteria, respectively. RESULTS NT-proBNP levels were higher in patients with active disease (915.0 ± 328.0 pmol/l) and patients in remission (618.2 ± 243.4 pmol/l) than in controls (427.2 ± 81.4 pmol/l) (p < 0.001). Patients with severe TA showed significantly higher NT-proBNP levels than those with mild-moderate TA (924.0 ± 332.4 pmol/l vs 653.8 ± 269.1 pmol/l; p = 0.001). In patients with longitudinal data, NT-proBNP levels at the active phase were significantly higher than those at the stable phase (944.1 ± 216.7 pmol/l vs 552.1 ± 178.2 pmol/l; p = 0.001). Inflammatory markers, including C-reactive protein, erythrocyte sedimentation rate, and white blood cell count, were independently associated with NT-proBNP levels after adjustment for other confounding factors (R(2) adjusted = 0.307, p = 0.001). CONCLUSION NT-proBNP levels were significantly increased in patients with active TA exhibiting complications. NT-proBNP levels were independently associated with inflammation. These results indicate that NT-proBNP may be a useful marker to assess the status, severity, and progression of TA.
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Affiliation(s)
- Qing Liu
- From the Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Q. Liu, MD; A. Dang, MD, PhD; B. Chen, MD; N. Lv, MD, PhD; X. Wang, MD; D. Zheng, MD, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Aimin Dang
- From the Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Q. Liu, MD; A. Dang, MD, PhD; B. Chen, MD; N. Lv, MD, PhD; X. Wang, MD; D. Zheng, MD, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
| | - Bingwei Chen
- From the Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Q. Liu, MD; A. Dang, MD, PhD; B. Chen, MD; N. Lv, MD, PhD; X. Wang, MD; D. Zheng, MD, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Naqiang Lv
- From the Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Q. Liu, MD; A. Dang, MD, PhD; B. Chen, MD; N. Lv, MD, PhD; X. Wang, MD; D. Zheng, MD, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xu Wang
- From the Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Q. Liu, MD; A. Dang, MD, PhD; B. Chen, MD; N. Lv, MD, PhD; X. Wang, MD; D. Zheng, MD, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Deyu Zheng
- From the Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Q. Liu, MD; A. Dang, MD, PhD; B. Chen, MD; N. Lv, MD, PhD; X. Wang, MD; D. Zheng, MD, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
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Phulambrikar T, Kode M, Shrivastava M, Magar S, Singh SK, Gupta A, Johar N. Takayasu's arteritis--report of a case with masquerading jaw pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:16-21. [PMID: 24908595 DOI: 10.1016/j.oooo.2014.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 02/26/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
Abstract
Takayasu's arteritis (TA) often referred to as pulseless disease, is a chronic inflammatory disorder affecting the aorta and its main branches. While the first reported case was documented in Japan in 1908, it does occur worldwide, but is more prevalent in young oriental females from China and Southeast Asia. The main complications of the disease are due to occlusion of major branches of the aorta. During the initial stages, one of the presenting symptoms may be jaw pain. This may prove to be a diagnostic challenge for the dentist, since many diseases cause orofacial pain and the diagnosis must be established before final treatment. A literature review of TA is presented along with clinical presentation and treatment modalities. A case report is also presented.
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Affiliation(s)
- Tushar Phulambrikar
- Oral Medicine Diagnosis and Radiology, Sri Aurobindo College of Dentistry, Indore, India
| | - Manasi Kode
- Oral Medicine Diagnosis and Radiology, Sri Aurobindo College of Dentistry, Indore, India
| | - Mayank Shrivastava
- Oral Medicine Diagnosis and Radiology, Sri Aurobindo College of Dentistry, Indore, India.
| | - Shaliputra Magar
- Oral Medicine Diagnosis and Radiology, Sri Aurobindo College of Dentistry, Indore, India
| | - Siddharth Kumar Singh
- Oral Medicine Diagnosis and Radiology, Sri Aurobindo College of Dentistry, Indore, India
| | - Anjali Gupta
- Oral Medicine Diagnosis and Radiology, Sri Aurobindo College of Dentistry, Indore, India
| | - Navdeep Johar
- Oral Medicine Diagnosis and Radiology, Sri Aurobindo College of Dentistry, Indore, India
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Dogan S, Piskin O, Solmaz D, Akar S, Gulcu A, Yuksel F, Cakır V, Sari I, Akkoc N, Onen F. Markers of endothelial damage and repair in Takayasu arteritis: are they associated with disease activity? Rheumatol Int 2014; 34:1129-38. [PMID: 24413630 DOI: 10.1007/s00296-013-2937-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/26/2013] [Indexed: 12/12/2022]
Abstract
The current clinical and laboratory parameters of Takayasu arteritis (TA) are insufficient for proper assessment of disease activity. The aims of this study were to investigate the markers of endothelial injury and repair, including circulating endothelial cell (CEC), circulating endothelial progenitor cell (CEPC) and vascular endothelial growth factor (VEGF), and evaluate their associations with disease activity in patients with TA. Thirty-two patients with TA and 30 healthy age- and sex-matched controls were included in this study. Disease activity was assessed in TA patients using various tools, including Kerr's criteria, the Indian Takayasu's Arteritis Scoring (ITAS2010) and physician's global assessment (PGA). CECs and CEPCs were measured by flow cytometry, and VEGF was measured using an enzyme-linked immunosorbent assay. The CEC level was found to be higher in TA patients than in the healthy controls (HC) (p < 0.001). There was no significant difference in CEC level between the active and inactive patients, but its level was slightly correlated with C-reactive protein (CRP) level. CEPC and VEGF levels in TA patients with active disease were higher than those in the inactive patients and HC. CEPC and VEGF levels were positively correlated with ITAS-CRP and PGA scores. This study shows increased level of CEC in patients with TA. It also suggests that the CEPC and VEGF levels may be correlated with disease activity.
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Affiliation(s)
- Serkan Dogan
- Department of Internal Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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20
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CT angiography of the upper extremity arterial system: Part 2- Clinical applications beyond trauma patients. AJR Am J Roentgenol 2013; 201:753-63. [PMID: 24059364 DOI: 10.2214/ajr.13.11208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE CT angiography using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with pathologic abnormalities of the upper extremity arterial system. CONCLUSION Here we focus on the use of this modality in patients with nontraumatic vascular pathologic abnormalities.
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21
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Tombetti E, Franchini S, Papa M, Sabbadini MG, Baldissera E. Treatment of refractory Takayasu arteritis with tocilizumab: 7 Italian patients from a single referral center. J Rheumatol 2013; 40:2047-51. [PMID: 24187104 DOI: 10.3899/jrheum.130536] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the safety and the efficacy of tocilizumab (TCZ) for refractory Takayasu arteritis (TA). METHODS We retrospectively assessed the outcome of blocking interleukin (IL)-6 with TCZ in 7 consecutive patients with refractory TA using a combination of clinical and imaging assessment. RESULTS During a median followup visit at 14 months, 4 patients taking TCZ [including 2 nonresponders to tumor necrosis factor (TNF) inhibitors] achieved clinical response, suggesting a nonredundant role for IL-6 in TA. Inflammatory markers normalized in all patients treated with TCZ. However, vascular progression occurred in 4 patients, suggesting the involvement of other inflammatory pathways and confirming the limitations of erythrocyte sedimentation rate and C-reactive protein for disease activity assessment while taking TCZ. Three patients experienced adverse events and 2 suspended TCZ. CONCLUSION TCZ may be effective in a subset of patients with refractory TA, even in cases of unresponsiveness to TNF inhibitors. Inflammatory markers are not valid markers of TA activity on TCZ. Further studies are needed to confirm these preliminary observations.
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Affiliation(s)
- Enrico Tombetti
- From the Unit of Internal Medicine and Immunology, and the Unit of Radiology, San Raffaele University Hospital, Milan, Italy
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22
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Isobe M. Takayasu arteritis revisited: Current diagnosis and treatment. Int J Cardiol 2013; 168:3-10. [DOI: 10.1016/j.ijcard.2013.01.022] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/21/2012] [Accepted: 01/19/2013] [Indexed: 11/29/2022]
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Seyahi E, Ucgul A, Cebi Olgun D, Ugurlu S, Akman C, Tutar O, Yurdakul S, Yazici H. Aortic and coronary calcifications in Takayasu arteritis. Semin Arthritis Rheum 2013; 43:96-104. [DOI: 10.1016/j.semarthrit.2012.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
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Abstract
Thromboangiitis obliterans, or Buerger disease, is a chronic nonatherosclerotic endarteritis manifesting as inflammation and thrombosis of distal extremity small and medium-sized arteries resulting in relapsing episodes of distal extremity ischemia. Takayasu arteritis is a rare syndrome characterized by inflammation of the aortic arch, pulmonary, coronary, and cerebral vessels, presenting with cerebrovascular symptoms, myocardial ischemia, or upper extremity claudication in young, often female, patients. Kawasaki disease is a small- and medium-vessel acute systemic vasculitis of young children, with morbidity and mortality stemming from coronary artery aneurysms. Microscopic polyangiitis, Churg-Strauss syndrome, and Wegener granulomatosis are systemic small-vessel vasculitides, affecting arterioles, capillary beds and venules, and each presenting with variable effects on the pulmonary, renal and gastrointestinal systems.
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Affiliation(s)
- William Wu
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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26
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Kim HK, Lee JM, Cho MH, Huh S. Aortic stent and renal autotransplantation for the management of renovascular hypertension with Takayasu's arteritis: report of a case. Surg Today 2013; 44:944-7. [PMID: 23512530 DOI: 10.1007/s00595-013-0532-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/03/2012] [Indexed: 11/28/2022]
Abstract
Takayasu's arteritis (TA) is a rare inflammatory disease affecting the aorta and its major branches. In patients with TA, middle aortic syndrome with aortic and renal artery involvement causes severe hypertension that does not respond well to medical therapy. Currently, the optimal therapeutic options have not been established, and the reported results of different treatments vary widely. We herein present a case of middle aortic syndrome with renovascular hypertension caused by TA in a 12-year-old male treated by an aortic stent and renal autotransplantation as a two-staged procedure.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, 200, Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea
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Mirault T, Emmerich J. [How to manage Takayasu arteritis?]. Presse Med 2012; 41:975-85. [PMID: 22925996 DOI: 10.1016/j.lpm.2012.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 11/28/2022] Open
Abstract
Thorough clinical and imaging assessment of the arterial tree when a diagnosis of Takayasu arteritis is established. Glucocorticoïd as intiation therapy. Immunosuppresive agent should be considered as adjunctive therapy if resistance or dependance to glucocorticoïd therapy. Supportive care, antihypertensive drugs, glucocorticoïd induced osteoporosis preventive therapy, tuberculosis screening should not be forgiven. Monitoring of therapy should be clinical and supported by biological markers and imaging. Reconstructive surgery should be performed in the quiescent phase of disease.
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Affiliation(s)
- Tristan Mirault
- Pôle cardiovasculaire, hôpital européen Georges-Pompidou, université Paris-Descartes, unité de médecine vasculaire, Paris, France.
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Seo HW, Kim JH, Lee DH, Lee JH. Anterior Uveitis and Keratitis in Takayasu's Arteritis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.10.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hae Won Seo
- Department of Ophthalmology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | - Jin Hyoung Kim
- Department of Ophthalmology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | - Do Hyung Lee
- Department of Ophthalmology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | - Jong Hyun Lee
- Department of Ophthalmology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
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Villa I, Agudo Bilbao M, Martínez-Taboada VM. Avances en el diagnóstico de las vasculitis de vasos de gran calibre: identificación de biomarcadores y estudios de imagen. ACTA ACUST UNITED AC 2011; 7 Suppl 3:S22-7. [DOI: 10.1016/j.reuma.2011.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 09/28/2011] [Indexed: 11/26/2022]
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Horie N, Hayashi K, Morikawa M, So G, Takahata H, Suyama K, Nagata I. Restenosis after endovascular PTA/stenting for supra-aortic branches in Takayasu aortitis: report of three cases and review of the literature. Acta Neurochir (Wien) 2011; 153:1135-9; discussion 1139. [PMID: 21336809 DOI: 10.1007/s00701-010-0932-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/24/2010] [Indexed: 11/29/2022]
Abstract
Recently, endovascular management has been reported as a feasible option for Takayasu aortitis. However, few papers have focused on restenosis in the follow-up, and therefore, it is important to predict high-risk cases for restenosis after endovascular treatment. We herein report three cases with Takayasu aortitis showing repeated restenosis after endovascular percutaneous transluminal angioplasty (PTA)/stenting and discuss its clinical implications with a review of the literature. We should keep in mind that endovascular PTA/stenting for Takayasu aortitis does not always keep the patency of the affected vessels, and severity of the stenosis and/or uncontrollable systemic inflammation could be a risk factor for restenosis. Therefore, careful follow-up under strict control of inflammation is mandatory. Overall, this method is effective as an initial treatment since repeated PTA is available until collateral supply develops.
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Affiliation(s)
- Nobutaka Horie
- Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
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Diagnosis and Surgical Treatment of a Takayasu Disease on an Abdominal Aortic Dissection. Ann Vasc Surg 2011; 25:556.e1-5. [DOI: 10.1016/j.avsg.2010.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 11/22/2010] [Accepted: 12/27/2010] [Indexed: 11/21/2022]
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Qureshi MA, Martin Z, Greenberg RK. Endovascular Management of Patients with Takayasu Arteritis: Stents versus Stent Grafts. Semin Vasc Surg 2011; 24:44-52. [DOI: 10.1053/j.semvascsurg.2011.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zhu WH, Shen LG, Neubauer H. Clinical characteristics, interdisciplinary treatment and follow-up of 14 children with Takayasu arteritis. World J Pediatr 2010; 6:342-7. [PMID: 21080146 DOI: 10.1007/s12519-010-0234-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 02/09/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric patients with Takayasu arteritis were studied by analyzing clinical presentation, diagnostic images, response to multimodal therapy, and long-term outcome. METHODS Fourteen consecutive children and adolescents (mean age: 10 years) were diagnosed with Takayasu arteritis at our institution between 1995 and 2007. They were subjected to clinical and diagnostic studies including color ultrasonography, MRI and angiography, and received interdisciplinary treatment. RESULTS The median time lag between the first onset of symptoms and diagnosis was 7.7 weeks. The majority of patients presented with acute severe clinical symptoms and extensive vascular lesions. Hypertension was the most common finding on first presentation (93%), followed by headache (64%), nausea (64%) and palpitation (50%). Ten patients (71%) had reduced or absent carotid, brachial or femoral pulses in one or more locations. C-reactive protein was elevated in 79% of the patients and erythrocyte sedimentation rate in 64%. Cardiovascular imaging showed extensive vasculitis of both sides of the diaphragm in 86%. Complications included renal artery stenosis (n=7), aortic dissection, thoracic aortic aneurysm and infrarenal aneurysm (all n=1). Conservative drug treatment was effective in 50%. Interventional dilatation of stenosis and surgical therapy, including aortic bypass, resection of aneurysms and nephrectomy, were necessary in the remaining patients. Follow-up for 25 months to 12 years showed that all children are well without disease-related mortality. CONCLUSIONS Takayasu arteritis is a rare and potentially life-threatening disease in children, likely with a prolonged subclinical course. Rapid diagnosis and interdisciplinary management help to prevent life-threatening complications.
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Affiliation(s)
- Wei-Hua Zhu
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
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Seibel S, Gaa J, Küchle C, Frank H. Severe Renovascular Hypertension in a Patient With Takayasu Arteritis. Am J Kidney Dis 2010; 56:595-8. [DOI: 10.1053/j.ajkd.2010.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 03/23/2010] [Indexed: 11/11/2022]
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Jales-Neto LH, Levy-Neto M, Bonfa E, de Carvalho JF, Pereira RMR. Juvenile-onset Takayasu arteritis: peculiar vascular involvement and more refractory disease. Scand J Rheumatol 2010; 39:506-10. [DOI: 10.3109/03009741003742730] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ma J, Luo X, Wu Q, Chen Z, Kou L, Wang H. Circulation levels of acute phase proteins in patients with Takayasu arteritis. J Vasc Surg 2010; 51:700-6. [DOI: 10.1016/j.jvs.2009.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/08/2009] [Accepted: 09/12/2009] [Indexed: 10/19/2022]
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Vista EGS, Santos Estrella PV, Lichauco JJT. Flourine-18 flourodeoxyglucose positron emission tomography as a non-invasive test of disease activity in Takayasu's arteritis--a report of four cases. Autoimmun Rev 2010; 9:503-6. [PMID: 20152937 DOI: 10.1016/j.autrev.2010.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Takayasu's arteritis (TA) is a rare disease affecting the large arteries, particularly the aorta. Standard test to demonstrate abnormal vascular anatomy is angiography. This invasive procedure is limited in differentiating inflammatory and fibrotic lesions. Acute phase reactants have shown to have poor sensitivity and specificity in confirming disease activity in TA patients. Fluorine-18 flourodeoxyglucose Positron Emission Tomography (FDG-PET) scan has been utilized to detect areas of active inflammation in neoplastic, infectious and recently, vasculitic conditions. OBJECTIVE To describe the FDG-PET scan findings of patients with Takayasu's arteritis. METHODS This is a case series of four patients fulfilling the American College of Rheumatology classification criteria for TA. They were evaluated with FDG-PET scan to establish disease activity in correlation with other clinical and laboratory features. RESULTS Three out of four patients showed evidence of increased radiotracer uptake in the aorta. Of these three patients, one had increased radiotracer uptake in the lungs secondary to active pulmonary tuberculosis. CONCLUSION PET scan is a promising but non-specific tool that provides clinicians with a non-invasive measure of disease activity in TA patients. Further studies confirming its utility in monitoring disease activity and response to treatment is recommended.
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Tyagi S, Gupta MD, Singh P, Shrimal D, Girish M. Percutaneous Revascularization of Sole Arch Artery for Severe Cerebral Ischemia Resulting from Takayasu Arteritis. J Vasc Interv Radiol 2008; 19:1699-703. [DOI: 10.1016/j.jvir.2008.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 09/05/2008] [Accepted: 09/14/2008] [Indexed: 10/21/2022] Open
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Panico MDB, Spichler ES, Rodrigues LCD, Oliveira F, Buchatsky D, Porto C, Alves MR, Spichler D. Arterite de Takayasu: aspectos clínicos e terapêuticos em 36 pacientes. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000200006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
CONTEXTO: A arterite de Takayasu é uma vasculite crônica, geralmente com diagnóstico tardio devido à pouca especificidade dos sintomas durante a fase inicial do acometimento vascular. A terapêutica de eleição é o uso de imunossupressores. O procedimento cirúrgico, quando necessário, é sempre evitado na fase aguda. OBJETIVO: Descrever alterações clínicas, laboratoriais e vasculares de arterite de Takayasu no período de 1977 a 2006. MÉTODO: A amostra compreendeu 36 pacientes - 10 brancos, 35 mulheres, idade média de 31,7 anos (±13,7), com prevalência significante na quarta década (p < 0,005). Evolução de 3 anos e período até o diagnóstico de 7,9 anos. Velocidade de hemossedimentação (VHS) e proteína C reativa (PCR) avaliaram atividade da doença, e o duplex scan aferiu a espessura médio- intimal da artéria carótida. RESULTADOS: Hipertensão arterial sistêmica e claudicação de membros superiores e inferiores foram ressaltados em 85,2, 69,5 e 30,5%, respectivamente. O resultado da VHS foi > 60 mm em 50% da amostra (p < 0,005). PCR mg/dL foi realizado em 18, variando de 0,4-25 na admissão para 0,11-1,9 na evolução. Doença auto-imune, tuberculose e HIV correlacionaram-se em 19,4, 8,3 e 2,7%, respectivamente. Lesões aórticas foram significativas em 22% (quatro oclusões, dois aneurismas infra-renais, um torácico). Em 19,4%, foram acometidas artérias renais e subclávias uma oclusão bilateral de carótidas, e em 25% os membros inferiores. A espessura médio-intimal da carótida comum foi estratificada em: > 3 mm, < 3 e > 1,7, < 1,7 e > 1,2 e < 1,2 mm, representando 41,6, 19,4, 8,37 e 30,50%, respectivamente (p < 0,005). Glicocorticóides foram utilizados em 61,1%, azatioprina em 16.6%, e associada a ciclofosfamida em 8,3%. Procedimento cirúrgico ou endovascular foi realizado em 30,5% com dois óbitos por complicações cardiovasculares. CONCLUSÕES: A VHS, PCR, e a espessura médio-intimal nas carótidas são importantes marcadores de acompanhamento da arterite de Takayasu. O período entre os sintomas e o diagnóstico deve ser abreviado, com redução da morbimortalidade.
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Takayasu's arteritis. COR ET VASA 2008. [DOI: 10.33678/cor.2008.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vasculitides. PRIMER ON THE RHEUMATIC DISEASES 2008. [PMCID: PMC7193731 DOI: 10.1007/978-0-387-68566-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite the spatial closeness of blood vessels and inflammatory cells, blood vessel walls are infrequently targeted by inflammation. Giant cell arteritis (GCA) and Takayasu’s arteritis (TA) are characterized by inflammation directed against the vessel wall. GCA and TA display stringent tissue tropism and affect defined vascular territories in a preferential manner. GCA predominantly affects the second- to fifth-order aortic branches, often in the extracranial arteries of the head. The aorta itself may also be affected in GCA, albeit less often than other regions. In contrast, in TA, the aorta and its major branches are the prime disease targets.
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Adajar MA, Painter T, Woloson S, Memark V. Isolated celiac artery aneurysm with splenic artery stenosis as a rare presentation of polyarteritis nodosum: A case report and review of the literature. J Vasc Surg 2006; 44:647-50. [PMID: 16950448 DOI: 10.1016/j.jvs.2006.04.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 04/19/2006] [Indexed: 10/24/2022]
Abstract
Polyarteritis nodosum (PAN) is a vasculitic disease that affects small to medium arteries. It often presents as a systemic and multiorgan disease that affects the skin, joints, gastrointestinal tract, kidneys, and nervous system. Nonspecific signs and symptoms are the hallmarks of PAN. It rarely affects single vessels, although there have been case reports of PAN involving single intra-abdominal vessels. The authors present a case of a 42-year-old white man who presented with mild epigastric pain but was otherwise asymptomatic. The workup ultimately revealed a rare case of an isolated celiac artery aneurysm with a concomitant stenosis of the splenic artery secondary to PAN. The patient was treated with high-dose steroid therapy, with resultant resolution of the vasculitis and a decreased size of the aneurysm.
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Affiliation(s)
- Marc A Adajar
- Department of Surgery, Illinois Masonic Medical Center, Chicago, 60657, USA.
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Chauhan SK, Tripathy NK, Nityanand S. Antigenic targets and pathogenicity of anti–aortic endothelial cell antibodies in Takayasu arteritis. ACTA ACUST UNITED AC 2006; 54:2326-33. [PMID: 16802373 DOI: 10.1002/art.21921] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Anti-endothelial cell antibodies are considered to have an important role in the pathogenesis of Takayasu arteritis (TA). Previously, these antibodies were detected using human umbilical vein endothelial cells, which do not completely represent the antigenicity/functions of aortic endothelial cells, the specific targets in TA. To delineate the precise role of antigenic targets, we investigated such targets as well as the pathogenic mechanism of antibodies directed against aortic endothelial cells (AAECAs) in TA. METHODS AAECAs were detected using a cellular enzyme-linked immunosorbent assay (ELISA), and their antigenic targets were detected by immunoblotting. AAECA-mediated induction of endothelial adhesion molecule expression and cytokine production was studied by ELISA, and apoptosis was studied using the TUNEL method. RESULTS AAECAs were detected in 86% of patients with TA and in 9% of controls. Sera obtained from AAECA-positive patients with TA recognized a total of 9 antigens ranging in size from 18 kd to 200 kd, of which the 60-65-kd triplet was recognized most often. The aortic endothelial cell reactivity of Hsp60-absorbed sera was reduced by approximately 50% as compared with that of unabsorbed sera (mean +/- SD 0.488 +/- 0.08 versus 0.838 +/- 0.116). Sera from AAECA-positive patients with TA, compared with sera from AAECA-negative patients with TA and that from controls, induced increased expression of E-selectin (mean +/- SD 0.833 +/- 0.063 versus 0.217 +/- 0.081 and 0.221 +/- 0.101 optical density [OD] units, respectively) and vascular cell adhesion molecule 1 (0.620 +/- 0.144 versus 0.165 +/- 0.005 and 0.177 +/- 0.055 OD units, respectively) and increased production of interleukin-4 (IL-4) (6.8 +/- 2.4 versus 1.2 +/- 1.6 and 1.3 +/- 2.5 pg/ml, respectively), IL-6 (24.3 +/- 2.4 versus 4.5 +/- 6.7 and 5.9 +/- 5.1 pg/ml, respectively), and IL-8 (36.8 +/- 10.3 versus 10.1 +/- 6.7 and 7.8 +/- 2.1 pg/ml, respectively). Sera from AAECA-positive patients with TA induced 29 +/- 6% (median +/- SEM) apoptosis of aortic endothelial cells. CONCLUSION Our data show that the AAECAs that are present in patients with TA are directed mainly against 60-65-kd antigen(s) and may cause vascular dysfunction by inducing expression of endothelial adhesion molecules, cytokine production, and apoptosis.
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Affiliation(s)
- Sunil Kumar Chauhan
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India
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Manfrini O, Bugiardini R. Takayasu's Arteritis: A Case Report and a Brief Review of the Literature. Heart Int 2006. [DOI: 10.1177/182618680600200110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Olivia Manfrini
- Department of Internal Medicine, Cardioangiology, Hepatology, Alma Mater Studiorum University of Bologna - Italy
| | - Raffaele Bugiardini
- Department of Internal Medicine, Cardioangiology, Hepatology, Alma Mater Studiorum University of Bologna - Italy
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Park MC, Lee SW, Park YB, Lee SK, Choi D, Shim WH. Post-interventional immunosuppressive treatment and vascular restenosis in Takayasu's arteritis. Rheumatology (Oxford) 2005; 45:600-5. [PMID: 16352637 DOI: 10.1093/rheumatology/kei245] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the outcome of vascular interventions and the effect of post-interventional immunosuppressive treatment on the occurrence of vascular restenosis in patients with Takayasu's arteritis (TA). METHODS Forty-two patients with TA who had undergone vascular intervention and had serial angiographies before and after intervention were enrolled. The demographic and clinical data were collected at the time when the interventions were performed, and the intervention modalities and post-interventional medical treatments were evaluated. RESULTS Sixty-three interventions were performed in 42 patients. Twenty (31.7%) interventions restenosed 24.0 +/- 21.9 months after intervention; the likelihood decreasing as time passed. Estimates of arterial patency after intervention were 90.1% at 1 yr, 75.5% at 2 yr, 68.4% at 3 yr, 61.6% at 5 yr and 49.3% at 10 yr. According to the log rank test, interventions that were performed during the stable stage of the disease (P = 0.039) and those that were followed by treatment with glucocorticoids and immunosuppressive agents (P = 0.044) were independent variables for the maintenance of arterial patency. Their hazard ratios were 0.30 and 0.41, respectively. CONCLUSION Restenosis occurred in 31.7% of TA patients after intervention. A lower restenosis rate was observed when the vascular interventions were performed at the stable stage and when post-interventional immunosuppressive treatment was implemented.
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Affiliation(s)
- M C Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul 120-752, Korea
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Park MC, Lee SW, Park YB, Chung NS, Lee SK. Clinical characteristics and outcomes of Takayasu's arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scand J Rheumatol 2005; 34:284-92. [PMID: 16195161 DOI: 10.1080/03009740510026526] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate the clinical characteristics and outcomes of Takayasu's arteritis (TA) using standardized criteria for diagnosis, disease activity, and angiographic classification, and to identify the predictive factors for remission, angiographic progression, and mortality in patients with TA. METHODS One hundred and eight patients who fulfilled the 1990 American College of Rheumatology (ACR) classification criteria for TA were studied. Their clinical features, laboratory findings, angiographic findings, and clinical outcomes were evaluated retrospectively. The disease activities were assessed using the National Institutes of Health (NIH) criteria for active disease, and the angiographic types were classified using the International TA Conference in Tokyo 1994 angiographic classification. RESULTS Angiographic classification showed that type I was the most common, followed by types V and IV. Ninety-one patients had active disease at diagnosis, and remission was achieved in 81.3% of them. Among those who experienced remission and those who had stable disease at diagnosis, 28.6% experienced a relapse. A low erythrocyte sedimentation rate (ESR) at diagnosis and treatment with glucocorticoid were found to be independent predictors for remission, and the stable disease activity at diagnosis was an independent predictor for the quiescence of vascular lesions on follow-up angiography. Survival rates were 92.9% at the fifth year and 87.2% at the tenth year, and the presence of two or more complications was a risk factor for mortality. CONCLUSIONS These findings could provide useful information on the clinical features, angiographic findings, and outcomes in TA, particularly on the assessment of patients at risk of a poor outcome.
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Affiliation(s)
- M-C Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Samarkos M, Loizou S, Vaiopoulos G, Davies KA. The Clinical Spectrum of Primary Renal Vasculitis. Semin Arthritis Rheum 2005; 35:95-111. [PMID: 16194695 DOI: 10.1016/j.semarthrit.2005.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The vasculitides are potentially severe and often difficult to diagnose syndromes. Many forms of vasculitis may involve the kidneys. This review will focus on the clinical and histopathological aspects of renal involvement in the systemic vasculitides. METHODS We searched the MEDLINE database using as key terms the MeSH terms and textwords for different forms of vasculitis and for renal involvement, creating a database of more than 2200 relevant references. RESULTS The frequency of renal involvement in vasculitis varies among different syndromes. It is more frequent in Wegener's granulomatosis and microscopic polyarteritis, while it is uncommon to rare in other forms of vasculitis such as Behçet's disease and relapsing polychondritis. The vessels affected include the renal artery in Takayasu arteritis, medium-size renal parenchymal artery in classic polyarteritis nodosa, and glomerular involvement in Wegener's granulomatosis and microscopic polyarteritis. The clinical expression of renal vasculitis depends on the size of the affected vessels and includes renovascular hypertension, isolated nonnephrotic proteinuria, interstitial nephritis, and glomerulonephritis, which can be rapidly progressive. Diagnosis is established by a combination of history, clinical manifestations, laboratory findings (eg, urine sediment, urine protein, antineutrophil cytoplasmic antibodies), imaging techniques (renal angiography, especially when there is a suspicion of medium-to-large vessel disease, and chest radiograph), and finally, renal biopsy. Prognosis varies from unfavorable in the rapidly progressive glomerulonephritis of microscopic polyarteritis, which can lead to renal failure, chronic dialysis, and renal transplantation, to benign, as in the case of Henoch Schonlein purpura, in which the majority of patients recover. CONCLUSIONS The manifestations and prognosis of renal vasculitis range widely. Renal involvement greatly influences prognosis and dictates the need for early and prompt immunosuppressive therapy. Thus, the clinician should be alert for the timely diagnosis and treatment of renal vasculitis.
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Affiliation(s)
- Michael Samarkos
- 5th Department of Internal Medicine, Evangelismos Hospital, Athens, Greece.
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Doña Naranjo MA, Mata Martín AM, Riesco Díaz M. Fiebre de origen desconocido como presentación de arteritis de Takayasu de inicio tardío. Rev Clin Esp 2005; 205:407-8. [PMID: 16143092 DOI: 10.1157/13078261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kumar Chauhan S, Kumar Tripathy N, Sinha N, Singh M, Nityanand S. Cellular and humoral immune responses to mycobacterial heat shock protein-65 and its human homologue in Takayasu's arteritis. Clin Exp Immunol 2005; 138:547-53. [PMID: 15544635 PMCID: PMC1809240 DOI: 10.1111/j.1365-2249.2004.02644.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Expression of heat shock protein (HSP)-65 as well as infiltration of T-cells in arterial lesions and raised levels of circulating antibodies against mycobacterial HSP65 (mHSP65) led us to the concept that mHSP65 or its human homologue (hHSP60) might be involved in the etiopathogenesis of Takayasu's arteritis (TA). Therefore, we investigated mHSP65 and hHSP60 reactive peripheral blood T-cell subsets by BrdU incorporation assay and flow cytometry as well as investigating the different isotypes of anti-mHSP65 and hHSP60 antibodies by ELISA. Eighty-four percent (22/26) of the TA patients were observed to show T-cell proliferation to mHSP65 and hHSP60 whereas only 16% (3/18) healthy controls showed such proliferation (P <0.001). Both HSPs induced proliferation of exclusively CD4+ T-cells and not CD8+ T-cells. We also observed a significantly higher prevalence of only the IgG isotype reactive to mHSP65 and hHSP60 in TA as compared to HC (mHSP65: 92% TA versus 11% HC, P <0.0001 and hHSP60: 84% versus 22%, P <0.001). Our data show a significant correlation between mHSP65 and hHSP60 reactive T-cells (CD3+: r=0.901; CD4+: r=0.968) as well as anti-mHSP65 and anti-hHSP60 IgG antibodies (r=0.814) suggesting an infection induced autoimmunity in TA, possibly induced by molecular mimicry between mHSP65 and hHSP60 or other tissue specific antigens.
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Affiliation(s)
- S Kumar Chauhan
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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