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Suyamburajan S, Bhat R, Rao R, Srilatha Parampalli S. Simultaneous Presentation of Takayasu Arteritis and Crohn's Disease in a Middle-Aged Patient: Are they two sides of the same coin? BMJ Case Rep 2024; 17:e259110. [PMID: 38531553 PMCID: PMC10966719 DOI: 10.1136/bcr-2023-259110] [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: 03/28/2024] Open
Abstract
Autoimmune disorders have a wide spectrum of symptoms, often with multiorgan involvement. Multiple autoimmune disorders also often occur concurrently in the same patient. These two possibilities must be distinguished in patients with multiorgan involvement to ensure early diagnosis and treatment. Here, we report a case of a previously healthy man who presented with simultaneous Takayasu arteritis and Crohn's disease. He presented with heart failure with reduced ejection fraction and severe aortic regurgitation. An echocardiogram demonstrated a greatly dilated aorta, and a diagnosis of Takayasu arteritis was made, confirmed with CT aortogram. Inpatient treatment was begun, but the patient subsequently developed bloody diarrhoea a few days after admission. Colonoscopy done to locate the source of bleeding showed colonic ulcers; a biopsy confirmed a diagnosis of Crohn's disease. The patient was successfully managed with medical management of heart failure, steroids, mesalamine and azathioprine, and has been in remission for the last 2 years.
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Affiliation(s)
| | - Rama Bhat
- General Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | - Raghavendra Rao
- General Medicine, Kasturba Medical College, Manipal, Karnataka, India
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Raval SJ, Laxmidhar RM, Patel DR, Laxmidhar F, Solanki V. A Young Female Newly Diagnosed With Takayasu's Arteritis Masquerading As Cerebrovascular Stroke. Cureus 2023; 15:e49292. [PMID: 38143664 PMCID: PMC10748446 DOI: 10.7759/cureus.49292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
The condition known as Takayasu's disease or Takayasu's arteritis is a type of vascular inflammation that affects the large and medium arteries. It can lead to a reduction in blood flow to various parts of the body, and it can cause severe complications. Patients with this disease may not have specific symptoms, which can lead to their diagnosis not being confirmed. Takayasu's disease is believed to be a probable cause of stroke in young patients. Although stroke is a common cause of morbidity, it is usually not an initial presentation in Takayasu's disease. In this study, a young female with left-sided hemiparesis was diagnosed with Takayasu's disease after a clinical and angiographic examination.
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Affiliation(s)
- Shivam J Raval
- Internal Medicine, Byramjee Jeejeebhoy (BJ) Medical College and Civil Hospital, Ahmedabad, IND
| | - Rosy M Laxmidhar
- Internal Medicine, Byramjee Jeejeebhoy (BJ) Medical College and Civil Hospital, Ahmedabad, IND
| | - Divya R Patel
- Internal Medicine, Byramjee Jeejeebhoy (BJ) Medical College and Civil Hospital, Ahmedabad, IND
| | - Fehmida Laxmidhar
- Internal Medicine, Western Reserve Health Education/Northeast Ohio Medical University (NEOMED), Warren, USA
| | - Vraj Solanki
- Internal Medicine, American International Institute of Medical Sciences, Udaipur, IND
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3
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Augustine J, Harriss M, Satyanarayanan Y. An Interesting Case of Takayasu Arteritis With Acute Bilateral Pulmonary Thromboembolism. Cureus 2023; 15:e47944. [PMID: 38034186 PMCID: PMC10685052 DOI: 10.7759/cureus.47944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Takayasu arteritis (TA) is an autoimmune vasculitis with unknown etiology. It can have varied presentations ranging from nonspecific symptoms to florid vasculitic symptoms. Awareness of the complications of this disease is also vital in managing patients who are already diagnosed with TA. We present the interesting case of a middle-aged woman, diagnosed case of TA who presented with an acute pulmonary embolism masquerading as an acute lower respiratory infection. Delayed diagnosis or misdiagnosis of acute major thromboembolism can be fatal. There needs to be a high index of suspicion from the clinician's end to reach a diagnosis and prompt intervention.
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Harigai M, Miyamae T, Hashimoto H, Yoshida A, Yamashita K, Nakaoka Y. A multicentre, large-scale, observational study of tocilizumab in patients with Takayasu arteritis in Japan: The ACTEMRA® (ACT)-Bridge study. Mod Rheumatol 2023; 33:998-1006. [PMID: 36057089 DOI: 10.1093/mr/roac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/07/2022] [Accepted: 08/24/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES We evaluated the real-world tolerability and effectiveness of tocilizumab in Japanese patients with Takayasu arteritis (TAK). METHODS Patients with TAK who had not received tocilizumab in the previous 6 months were enrolled in ACTEMRA® (ACT)-Bridge, a phase 4, observational study, from 66 Japanese institutions (enrolment period, September 2017 to September 2020) and received weekly subcutaneous tocilizumab 162 mg (observation period, 52 weeks). RESULTS Among 120 patients included (mean age, 38.4 years; mean disease duration, 7.7 years; treated for relapse, 50.8%; previous immunosuppressant use, 57.5%; glucocorticoid use at baseline, 97.5%), 49 (40.8%) reported adverse events. The most common adverse event of special interest was serious infection (7.5%). Relapse was observed in 24 (20.0%) patients (0.8%, 2.5%, and 16.7% reporting ≥3, 2, and 1 relapses, respectively). The reasons for diagnosing relapse included chest and back pain (45.8%), neck pain (25.0%), fatigue (16.7%), fever and headache (12.5% each), abnormal imaging findings (50.0%), and elevated inflammatory markers (16.7%). At the last observation, 83.0% of relapse-free patients recorded a concomitant glucocorticoid dose (prednisolone equivalent) <10 mg/day. CONCLUSIONS This study demonstrated the effectiveness of tocilizumab in patients with TAK, with no new safety concerns. Tocilizumab plus glucocorticoids may be considered a treatment option for TAK.
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Affiliation(s)
- Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takako Miyamae
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | | | - Amika Yoshida
- Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | | | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
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Batool W, Khan S, Khan B, Khan M, Ali Z. Pyoderma Gangrenosum as a Presenting Feature of Takayasu Arteritis. Cureus 2023; 15:e36817. [PMID: 37123739 PMCID: PMC10138151 DOI: 10.7759/cureus.36817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/29/2023] Open
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis that involves the aorta and its major branches. The disease has a female preponderance, and it presents with a wide variety of symptoms including skin manifestations, mainly ulcerative nodules, pyoderma gangrenosum, and erythema nodosum-like lesions. We report a case of a 50-year-old female who presented to the outpatient department with multiple ulcerative lesions over both upper extremities and chest. On physical examination, the patient had pulseless upper limbs. Laboratory investigations revealed positive antinuclear antibodies (ANA) and raised inflammatory markers. CT angiography of the aorta showed thickened aortic arch with the obliterated lumen of the left common carotid and left subclavian arteries. A biopsy of the skin lesion revealed surface ulceration and densely inflamed granulation tissue with a fibroblastic proliferation of deeper tissues. The patient had three out of six features of the American College of Rheumatology 1990 (ACR-1990) criteria for the classification of TA and was diagnosed with TA associated with pyoderma gangrenosum. The patient was managed with steroids and immunosuppressants along with gentle wound debridement with grafting of skin wounds. Since TA has varying presentations, its diagnosis is often challenging and requires a combined approach including clinical signs and symptoms, as well as laboratory and radiological workup. The disease also requires long-term follow-up due to its remitting and relapsing course.
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Simeonova D, Georgiev T, Shivacheva T. Takayasu arteritis associated with autoimmune/inflammatory syndrome induced by adjuvants: a case-based review. Rheumatol Int 2023; 43:975-981. [PMID: 36920514 PMCID: PMC10015523 DOI: 10.1007/s00296-023-05309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Takayasu's arteritis (TA) is a chronic granulomatous vasculitis that predominantly affects the aorta and its major branches. Despite advancements in the understanding of the pathogenic pathways of vascular inflammation, the etiology and predisposing factors of TA remain to be fully understood. In susceptible individuals, exposure to adjuvants may trigger, unlock or unmask an autoimmune disorder, presenting as non-specific constitutional symptoms or a fully developed autoimmune syndrome such as vasculitis. Here, we hypothesize that TA could be triggered by siliconosis, a subtype of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). ASIA, also known as Shoenfeld syndrome, encompasses a wide range of autoimmune and immune-mediated diseases resulting from dysregulation of the immune response after exposure to agents with adjuvant activity. This case report describes the development of large artery vasculitis, TA, in an individual one year following the placement of silicone breast implants. The patient initially presented with non-specific symptoms, and multiple imaging methods were employed, including ultrasound diagnostics, CT angiography, and 18-fluorodeoxyglucose positron emission tomography/CT. These techniques revealed vasculitic alterations in the carotid arteries and thoracic aorta. Initial treatment with glucocorticosteroids proved ineffective, prompting the addition of steroid-sparing immunosuppressive agents. Due to the distinct clinical symptoms, disease progression, implant-associated fibrosis, and resistance to therapy, the potential involvement of implants in the development of large-vessel vasculitis was considered, and a potential association with ASIA was postulated. Although there is limited evidence to support a direct link between adjuvants and the pathogenesis of TA, similarities in cellular immunity between the two conditions exist. The diagnosis of this complex and potentially debilitating condition requires a comprehensive clinical examination, laboratory evaluation, and instrumental assessment. This will aid in identifying potential contributing factors and ensuring successful treatment.
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Affiliation(s)
| | - Tsvetoslav Georgiev
- Rheumatology Clinic, University Hospital St. Marina, Varna, 9010 Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria
| | - Tanya Shivacheva
- Rheumatology Clinic, University Hospital St. Marina, Varna, 9010 Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria
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Şentürk EF, Erden A, Sarı A, Armağan B, Kılıç L, Kalyoncu U, Karadağ Ö, Bilgen ŞŞA, Kiraz S, Ertenli Aİ, Akdoğan A. The impact of antiphospholipid antibodies in Takayasu arteritis. Turk J Med Sci 2023; 53:199-205. [PMID: 36945962 PMCID: PMC10388031 DOI: 10.55730/1300-0144.5573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/01/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The significance of antiphospholipid antibodies (aPL) is controversial in Takayasu arteritis (TA). This study was conducted to explore the frequency of aPL and their association with disease-related complications in TA. METHODS : This cross-sectional study was conducted to investigate the presence of anti-cardiolipin (aCL), anti-beta 2 glycoprotein- 1(aβ2G1) antibodies, and lupus anticoagulant (LA) in TA patients. TA patients admitted to the Department of Rheumatology of Hacettepe University Faculty of Medicine between December 2015 and September 2016 who fulfilled the American College of Rheumatology (ACR) classification criteria for TA were consecutively enrolled in the study. Patients were grouped according to aPL positivity and compared in terms of disease manifestations, type of vascular involvement at diagnosis, and vascular complications/interventions attributable to TA. RESULTS Fifty-three TA (49 female) patients were enrolled in the study. We detected 9 (16.9%) patients with IgM and/or IgG aβ2G1 and/or LA positivity. There were no patients with positive aCL. All aβ2G1 titers were low. There were no differences in terms of symptoms, signs, type of vascular involvement, the number of patients with disease-related complications or vascular interventions/surgery between aPL (+) and aPL(-) groups (p > 0.05 for all). The number of patients with thrombotic lesions was similar between the groups (p > 0.05). There were no patients with a history of venous thrombosis or on anticoagulant treatment in the aPL(+) group. Only 1 patient with IgM aβ2G1 (+) had a history of pregnancy loss. DISCUSSION Our results indicate that aPL positivity is not rare in TA. On the other hand, all aPL titers were low and no differences were found in the frequency of disease-related complications between aPL(+) and aPL(-) patient groups. Only TA patients with atypical manifestations with high suspicion of aPL-related complications should be considered to be investigated for aPL.
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Affiliation(s)
- Esra Fırat Şentürk
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Alper Sarı
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Berkan Armağan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Levent Kılıç
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ömer Karadağ
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sedat Kiraz
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ali İhsan Ertenli
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Akdoğan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
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Muacevic A, Adler JR, Govindasamy R, Rudrappa S, Vaithialingam B. Thoracic Compressive Myelopathy in a Patient With Takayasu Arteritis. Cureus 2023; 15:e33496. [PMID: 36756014 PMCID: PMC9902057 DOI: 10.7759/cureus.33496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
Takayasu arteritis (TA), also known as occlusive thromboaortopathy, is a type of chronic inflammatory arteritis that primarily affects large vessels. Compressive thoracic myelopathy is a rare and distinct manifestation of TA. We present the case of a 60-year-old woman who developed gradually progressive spastic paraplegia over one year. Magnetic resonance imaging revealed a well-defined extra-dual, intensely enhancing ventrodorsal lesion with severe spinal cord impingement. The aortogram revealed dilatation of the aortic arch (with narrowing of arch vessels) and descending aorta, as well as a right paravertebral soft tissue mass at the D4 level. Given the likelihood of TA, the patient underwent decompressive laminectomy and spinal fusion due to severe spinal cord compression. The biopsy of the dural-based lesion revealed an inflammatory granuloma, and the patient was treated postoperatively with oral prednisolone and mycophenolate mofetil. After six months of immunotherapy, there was excellent neurological recovery and near-total resolution of the lesion.
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As C, Danda D. Current Diagnosis and Management of Takayasu Arteritis. Int Heart J 2023; 64:519-534. [PMID: 37518335 DOI: 10.1536/ihj.23-195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Takayasu arteritis (TA or TAK) is a chronic large vessel vasculitis with predilection to affect the aorta and its branches. The new 2022 ACR/EULAR classification criteria for Takayasu arteritis incorporated imaging characteristics as an absolute requirement. ESR and CRP fails in accuracy as disease activity markers. Pentraxin 3 appears to be a relatively superior biomarker, which correlates with ITAS 2010 as per several studies. PET-CT is also increasingly being studied for assessing disease activity with variable results. The management of TAK involves use of steroids with upfront steroid sparing immunosuppressive agents. MMF is one such conventional DMARD/immunosuppressant with good efficacy and better safety profile, as reported in various cohort studies. Tocilizumab is proved to be a rapid remission inducing agent in refractory Takayasu arteritis in observational studies. TNF inhibitors in many uncontrolled studies showed good responses, and there is a need for good RCTs for confirmation. JAK inhibitors have also been used with success in a few reports.
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Affiliation(s)
- Chandhu As
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital
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de Oliveira JCS, dos Santos AM, de Aguiar MF, Gonçalves J, de Souza AWS, Pereira RMR, Shinjo SK. Characteristics of Older Patients with Takayasu's Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study. Arq Bras Cardiol 2022; 120:e20220463. [PMID: 36629607 PMCID: PMC9833251 DOI: 10.36660/abc.20220463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Few studies have assessed elderly patients with Takayasu's arteritis (TAK). OBJECTIVES To evaluate the progression of TAK in different age groups and its possible effects on drug treatment and disease activity. METHODS This cross-sectional and retrospective cohort study included 66 TAK patients. Patients were interviewed and data of the 12 preceding months were collected from electronic medical records. The patients were divided into four quartiles according to current age and compared for clinical and laboratory data, treatment, comorbidities, disease status, and functional status. Statistical significance was set at p<0.05. RESULTS The groups were Q1(22-36 years, n=16), Q2(37-42 years, n=18), Q3(43-49 years, n=17), and Q4(51-66 years, n=15). The frequency of patients with disease activity, fatigue, comorbidities and vascular impairments, and the TAK disease extent index were also comparable between the groups. With age, disease duration was longer (p=0.001), fewer patients used prednisone (Q1:43.8%, Q2:33.3%, Q3:11.8%, and Q4:6.7%; p=0.049) and immunosuppressive drugs [Q1:100.0%, Q2:66.7%, Q3:58.8%, and Q4:46.7%; Q1 versus Q3 (p=0.043), and Q1 versus Q4 (p=0.005) in post-hoc analyses], and patients had greater functional status impairment (Q2 versus Q3, p=0.003). In addition, the levels of disease damage, new TAK symptoms, and complications in the preceding 12 months were not different between the groups. CONCLUSIONS Older patients with TAK require minimal drug treatment, and have greater impairment of functional status, which may be attributed to aging-related factors.
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Affiliation(s)
- João Calvino Soares de Oliveira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
| | - Alexandre Moura dos Santos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
| | - Mariana Freitas de Aguiar
- Divisão de ReumatologiaUniversidade Federal de São PauloSão PauloSPBrasilDivisão de Reumatologia – Universidade Federal de São Paulo – UNIFESP, São Paulo, SP – Brasil
| | - Jucier Gonçalves
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
| | - Alexandre Wagner Silva de Souza
- Divisão de ReumatologiaUniversidade Federal de São PauloSão PauloSPBrasilDivisão de Reumatologia – Universidade Federal de São Paulo – UNIFESP, São Paulo, SP – Brasil
| | - Rosa Maria R. Pereira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil, In memorium
| | - Samuel Katsuyuki Shinjo
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
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Memon T, Shekha TAM, Acharya P, Nishu RI, Akhter N. A Case Report of Takayasu’s Arteritis With Cerebral Infarction As Initial Presentation. Cureus 2022; 14:e30472. [PMID: 36415359 PMCID: PMC9673871 DOI: 10.7759/cureus.30472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Takayasu’s arteritis is a chronic inflammation of the large arteries such as the aorta and its primary branches, causing progressive arterial occlusion. This leads to reduced blood flow in the limbs and organs, resulting in arm or leg claudication, diminished or absent peripheral pulses, and end-organ ischemia. Stroke is one of the common complications; however, it is rarely the initial presentation. We describe one such case of a 16-year-old female, who presented with right-sided hemiparesis and non-fluent aphasia, without any significant past history. On examination, her right arm was cold and pulseless. She was extensively investigated for the cause of her presentation. Only non-specific inflammatory markers such as erythrocyte sedimentation rate (ESR) were elevated. Imaging studies revealed left middle cerebral artery territory infarct with occlusion of common carotid arteries, bilateral bifurcation, most parts of the left internal carotid artery, and the proximal part of the right internal carotid artery. She was diagnosed with Takayasu's arteritis and was prescribed steroids, on which she gradually recovered and was discharged. In conclusion, young patients, who present with stroke, should be investigated for Takayasu’s arteritis, which leads to earlier treatment and prevention of further life-threatening end-organ damage.
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Giant Cell Arteritis: A Case-Based Narrative Review of the Literature. Curr Pain Headache Rep 2022; 26:725-740. [PMID: 36057073 PMCID: PMC9440460 DOI: 10.1007/s11916-022-01075-1] [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] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Giant cell arteritis (GCA) is a chronic, inflammatory condition, primarily affecting the medium and larger arteries. The purpose of this narrative review is to describe GCA in the context of headache and facial pain, based on a case and the available current literature. Understanding the etiology, pathophysiology, the associated conditions, and the differential diagnoses is important in managing GCA. Recent Findings In a patient presenting with unilateral facial/head pain with disturbances of vision, GCA should be considered in the differential diagnosis. There is an association of GCA with several comorbid conditions, and infections including coronavirus-19 (COVID-19) infection. Management of GCA primarily depends upon the identification of the affected artery and prompt treatment. Permanent visual loss and other serious complications are associated with GCA. Summary GCA is characterized by robust inflammation of large- and medium-sized arteries and marked elevation of systemic mediators of inflammation. An interdisciplinary approach of management involving the pertinent specialties is strongly recommended.
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Kwon OC, Park MC. Derivation and Validation of a New Disease Activity Assessment Tool With Higher Accuracy for Takayasu Arteritis. Front Immunol 2022; 13:925341. [PMID: 35784279 PMCID: PMC9248800 DOI: 10.3389/fimmu.2022.925341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To develop a new disease activity assessment tool with high accuracy for Takayasu arteritis. Methods Individual items from National Institute of Health (NIH) criteria and the Indian Takayasu Clinical Activity Score (ITAS2010) were tested as candidate variables to develop a new disease activity assessment tool in a derivation cohort (N = 100). Physician global assessment on disease activity was used as the gold standard. Multivariable logistic regression models were constructed and the model with the highest accuracy was identified. A formula assessing disease activity was generated using simplified β coefficients (rounded to decimal place). Diagnostic performance was evaluated through estimating the area under the curve (AUC). The new assessment tool was subsequently validated in a validation cohort (N = 46). Results The multivariable model yielding the highest accuracy consisted of a high erythrocyte sedimentation rate (ESR), NIH criteria 1 and 4, and carotidynia. Using simplified β coefficients, the following disease activity assessment tool was developed: high ESR (3 points), NIH criterion 1 (2 points), NIH criterion 4 (4 points), and carotidynia (3 points) (total score ≥5, active; total score <5, inactive). The new disease activity assessment tool had a higher AUC (89.37) for discriminating active and inactive diseases than NIH criteria (AUC 77.96), ITAS2010 (AUC 66.12), ITAS-ESR (AUC 75.58), and ITAS-C-reactive protein (AUC 71.34). The AUC (85.23) of the new assessment tool was similar in the validation cohort. Conclusion A new disease activity assessment tool that consists of high ESR, NIH criteria 1 and 4, and carotidynia had higher accuracy in discriminating active and inactive disease than currently used clinical assessment tools.
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Law N, Quencer K, Kaufman C, Iravani A, Hardman R, Smith T. Embolization of pulmonary artery aneurysms in a patient with Behçet’s disease complicated by coil erosion into the airway. J Vasc Surg Cases Innov Tech 2022; 8:193-195. [PMID: 35402753 PMCID: PMC8989708 DOI: 10.1016/j.jvscit.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicole Law
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT
| | - Keith Quencer
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT
| | - Claire Kaufman
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT
| | - Aidin Iravani
- Department of Pulmonology, University of Utah, Salt Lake City, UT
| | | | - Tyler Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT
- Correspondence: Tyler Smith, MD, Department of Interventional Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
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Suda T, Zoshima T, Ito K, Mizushima I, Kawano M. Successful Early Immunosuppressive Therapy for Pulmonary Arterial Hypertension Due to Takayasu arteritis: Two Case Reports and a Review of Similar Case Reports in the English Literature. Intern Med 2022; 61:1767-1774. [PMID: 34776481 PMCID: PMC9259310 DOI: 10.2169/internalmedicine.8095-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The efficacy of early immunosuppressive therapy without invasive therapy, such as endovascular or surgical revascularization, for pulmonary hypertension due to Takayasu arteritis (TAK-PH) remains to be elucidated. We herein report two cases of TAK-PH due to pulmonary arteritis successfully treated with early immunosuppressive therapy. A literature review of 42 cases of TAK-PH with pulmonary artery involvement showed that the cases treated with immunosuppressive therapy early after the onset (within 12 months) had a higher erythrocyte sedimentation rate and better outcome without invasive therapy than those treated later. TAK-PH may be successfully treated with immunosuppressive therapy without invasive therapy when diagnosed early with high disease activity.
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Affiliation(s)
- Takuya Suda
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
| | - Takeshi Zoshima
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
| | - Kiyoaki Ito
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
| | - Ichiro Mizushima
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
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16
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Zeng Y, Duan J, Ge G, Zhang M. Therapeutic Management of Ocular Ischemia in Takayasu's Arteritis: A Case-Based Systematic Review. Front Immunol 2022; 12:791278. [PMID: 35095866 PMCID: PMC8795594 DOI: 10.3389/fimmu.2021.791278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023] Open
Abstract
Background Takayasu’s arteritis (TA) is a rare, chronic granulomatous large-vessel vasculitis that can lead to ocular ischemia. Ocular outcomes after therapeutic management in TA remain largely unknown. We herein conduct a case-based systematic review to address the current treatment options in this particular cohort. Methods PubMed, Medline, and EMBASE databases were searched pertaining to ocular outcomes after systemic treatment in TA. Studies reporting ocular examinations before and after treatment in TA patients with ocular ischemia were included. Clinical characteristics, therapies, ocular outcomes, and complications were recorded. Results A 29-year-old woman with newly diagnosed TA showed dramatic regression of Takayasu’s retinopathy (TR) following balloon angioplasty. Optical coherence tomography angiography (OCTA) was used as a novel strategy for subsequent follow-up. A total of 117 eyes of 66 patients with a median age of 27 years were included for systematic review. TR was the most common ocular manifestation. Oral steroids were prescribed in nearly all patients (n = 65), followed by the use of methotrexate and antiplatelet therapy. Of the patients, 65.8% and 34.2% underwent open surgery and endovascular procedure, respectively. The median follow-up period was 12 weeks (interquartile range 8–33.5). Surgical therapy showed better ocular improvement (including visual and imaging responses) in both acute and chronic vision loss, along with fewer complications than medical therapy alone. In the surgical group, the visual prognosis was significantly better in patients with initial visual acuity better than 20/200 (p = 0.03) and those who underwent surgery before stage III TR (p = 0.01). Ocular outcomes were equivalent in the two surgical approaches. Conclusion Clinicians should be familiar with ophthalmic manifestations of this potentially treatable complication in TA. Compared with medical therapy alone, surgical intervention might be a better choice for both acute and chronic vision loss. Surgery is best recommended before the onset of irreversible ischemia to the globe. A combined regimen (oral steroids, immunosuppressants, and antiplatelet drugs) might be effective for those with surgical contradictions or reluctance to an invasive procedure. Physicians should be aware of the importance of ocular examinations, including OCTA, during the diagnosis and follow-up in TA.
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Affiliation(s)
- Yue Zeng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jianan Duan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Ge
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
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17
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Variations in Takayasu arteritis characteristics in a cohort of patients with different racial backgrounds. Semin Arthritis Rheum 2022; 53:151971. [DOI: 10.1016/j.semarthrit.2022.151971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 11/19/2022]
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18
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Valenzuela-Rodríguez G, Lescano-Alva M, Bryce-Alberti M, Portmann-Baracco A, Prudencio-León W. [Acute cardiovascular complications in a Peruvian population of oncology patients]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:1-7. [PMID: 37583980 PMCID: PMC10424505 DOI: 10.47487/apcyccv.v3i1.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/09/2022] [Indexed: 07/07/2023]
Abstract
Objective To know the most frequent acute cardiovascular complications in a Peruvian population of oncologic patients. Materials and methods Retrospective, descriptive study of oncologic patients treated at Clinica Delgado between January 2014 and December 2019, from which the subgroup with the seven most prevalent cancers at the national level was selected according to information from Globocan 2018. Additionally, we evaluated the epidemiology of patients with cardiovascular complications that conditioned their hospitalization or were detected during this, calculating their cardiovascular risk according to Hermann and SCORE risk scales. Results Forty-four patients had complications; 27 (61.4%) were hospitalized due to acute cardiovascular causes. The mean age of this subgroup was 69.88 years (SD 12.77), and 22 (81.5%) were older than 60 years. Fourteen (51.9%) were male. According to the Hermann scale, 33.3% had intermediate-risk and 14.9% had a high or very high risk. According to the SCORE scale, 62.97% had an intermediate-risk and 7.40% high risk. The most common acute cardiovascular complications were deep vein thrombosis and ischemic stroke (66.65%). One patient (3.7%) reported previous cardiovascular disease. Four patients (14.8%) had a fatal outcome during hospitalization. The median length of hospitalization was five days. Conclusions We present the cases of acute cardiovascular complications in a population of oncologic patients and their vascular risk according to Hermann and SCORE scales. The most common complications were deep vein thrombosis (48.14%), stroke (18.51%), and myocardial infarction (14.81%).
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Affiliation(s)
- Germán Valenzuela-Rodríguez
- Servicio de Medicina Interna, Clínica Delgado. Lima, Perú.Servicio de Medicina InternaClínica DelgadoLimaPerú
- Universidad San Ignacio de Loyola, Unidad de Revisiones Sistemáticas y Metaanálisis, Guías de Práctica Clínica y Evaluaciones Tecnológicas Sanitarias. Lima, Perú.Universidad San Ignacio de LoyolaUniversidad San Ignacio de LoyolaUnidad de Revisiones Sistemáticas y MetaanálisisGuías de Práctica Clínica y Evaluaciones Tecnológicas SanitariasLimaPeru
| | - Miguel Lescano-Alva
- Servicio de Cardiología Posoperatoria, Instituto Nacional Cardiovascular, Lima, Perú.Servicio de Cardiología PosoperatoriaInstituto Nacional CardiovascularLimaPerú
| | - Mayte Bryce-Alberti
- Universidad Peruana Cayetano Heredia. Lima, Perú.Universidad Peruana Cayetano HerediaUniversidad Peruana Cayetano HerediaLimaPeru
| | - Arianna Portmann-Baracco
- Universidad Peruana Cayetano Heredia. Lima, Perú.Universidad Peruana Cayetano HerediaUniversidad Peruana Cayetano HerediaLimaPeru
| | - Walter Prudencio-León
- Servicio de Epidemiología, Hospital Nacional Edgardo Rebagliati. Lima, Perú.Servicio de EpidemiologíaHospital Nacional Edgardo RebagliatiLimaPerú
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19
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Wu S, Guo J, Zhang F, Tong Z, Guo J, Gao X, Gu Y, Guo L. Covered Cheatham-Platinum Stent for Treatment of Descending Thoracic Aortic Stenosis Caused by Takayasu Arteritis in Two Children. Ann Vasc Surg 2021; 80:393.e1-393.e4. [PMID: 34775027 DOI: 10.1016/j.avsg.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/02/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022]
Abstract
Takayasu arteritis (TA) is a chronic type of systemic large vessel vasculitis, mainly involving the aorta and its main branches. Both surgical and endovascular revascularization are effective methods for treating TA-related stenosis of the aorta and its branches. By December 2020, there have been very limited reports on the use of coated Cheatham-Platinum (CP) stents in the treatment of TA associated descending thoracic aortic stenosis. Two children with thoracic aortic stenosis caused by TA who received the covered CP stent in Xuanwu Hospital of Capital Medical University were reported. The follow-up time was 1.5 years and 4 years, respectively. The covered cheatham-platinum (CP) stent may be an alternative treatment for TA associated children with descending aortic stenosis.
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Affiliation(s)
- Sensen Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xixiang Gao
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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20
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Murugan C, Kavishwar RA, Ramachandran K, Shetty AP, B T P, Rajasekaran S. Spinal Hypertrophic Pachymeningitis Causing Thoracic Myelopathy in a Patient of Takayasu Arteritis: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00053. [PMID: 34762610 DOI: 10.2106/jbjs.cc.21.00520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE A 52-year-old man presented with thoracic myelopathy, and his magnetic resonance imaging (MRI) was suggestive of T1-T4 hypertrophic-pachymeningitis. Incidentally, circumferential thickening of the infra-renal abdominal aorta and right common iliac artery was seen, which along with the findings in a contrast computed tomography was consistent with Takayasu arteritis (TA). The patient underwent T1-T4 laminectomy, thinning of dura, biopsy, and steroid therapy. At the 1-year follow-up, he was asymptomatic and MRI revealed resolution of the lesion. CONCLUSION This is the first report describing an association between TA and hypertrophic spinal pachymeningitis, emphasizing the unusual neurological manifestation of myelopathy and complete resolution of symptoms with timely and appropriate intervention.
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Affiliation(s)
- Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Rohit Akshay Kavishwar
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Pushpa B T
- Department of Radiology, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - S Rajasekaran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
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21
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Wu S, Kong X, Sun Y, Dai X, Yu W, Chen R, Ma L, Jiang L. FABP3 overexpression promotes vascular fibrosis in Takayasu's arteritis via enhancing fatty acid oxidation in aorta adventitial fibroblasts. Rheumatology (Oxford) 2021; 61:3071-3081. [PMID: 34718429 DOI: 10.1093/rheumatology/keab788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify the role of fatty acid-binding protein-3 (FABP3) in vascular fibrosis in Takayasu's arteritis (TAK) and to explore the underlying molecular mechanism. METHODS The expression of FABP3 and extracellular matrix proteins (ECMs) were detected in aorta tissues from TAK patients (n = 12) and healthy controls (n = 8) by immunohistochemistry. The concentration of serum proteins was determined by ELISA. CCK8 and Ki67 staining were used to measure aorta adventitial fibroblasts (AAFs) proliferation. Widely-targeted lipidomic profiling was used to screen for associated metabolic pathways. Changes in ECMs and fatty acid oxidation (FAO) related enzymes were determined by RT-qPCR and Western blot. The interactions between FABP3 and these enzymes were explored with Co-immunoprecipitation (Co-IP) assay. RESULTS The expression of FABP3 was increased in the thickened adventitia of TAK patients, and was positively correlated with the serum expression of ECMs. FABP3 knockdown inhibited AAF proliferation and ECMs production, whereas FABP3 overexpression enhanced these processes. Further analysis revealed that FABP3 upregulation promoted carnitine palmitoyltransferase 1A (CPT1A) and carnitine/acylcarnitine carrier protein (CACT) expressions, two key enzymes in FAO, as well as ATP levels. FABP3 and CACT were co-localized in the adventitia and bound to each other in AAFs. Etomoxir reversed the enhanced FAO, ATP production, AAF proliferation, and ECM production mediated by FABP3 upregulation. Treatment with 60 g/day curcumin granules for three months reduced the level of serum FABP3. Curcumin also inhibited vascular fibrosis by reducing FABP3-enhanced FAO in AAFs. CONCLUSION Elevated FABP3 expression accelerated vascular fibrosis in TAK, which was likely mediated by promoting FAO in AAFs.
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Affiliation(s)
- Sifan Wu
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiufang Kong
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ying Sun
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaojuan Dai
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wensu Yu
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Rongyi Chen
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Lili Ma
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Evidence-base Medicine Center, Fudan University, Shanghai, 200032, China
| | - Lindi Jiang
- Department of Rheumatology, ZhongShan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Evidence-base Medicine Center, Fudan University, Shanghai, 200032, China
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22
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Alibaz-Oner F, Kaymaz-Tahra S, Bayındır Ö, Yazici A, Ince B, Kalkan K, Kanıtez NA, Kocaer SB, Yasar Bilge NS, Omma A, Durak E, Ilgın C, Akar S, Kaşifoğlu T, Önen F, Emmungil H, İnanç M, Cefle A, Aksu K, Keser G, Direskeneli H. Biologic treatments in Takayasu's Arteritis: A comparative study of tumor necrosis factor inhibitors and tocilizumab. Semin Arthritis Rheum 2021; 51:1224-1229. [PMID: 34706312 DOI: 10.1016/j.semarthrit.2021.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the treatment outcomes of TNF inhibitors and tocilizumab (TCZ) in patients with Takayasu arteritis. METHODS Takayasu arteritis patients who were refractory to conventional immunosuppressive (IS) drugs and received biologic treatment were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data during follow-up were recorded. Remission, glucocorticoid (GC) sparing effect, drug survival was compared between TNF inhibitor and TCZ treatments. Also, a subgroup matched comparison was performed between groups. RESULTS One hundred and eleven (F/M: 98/13) patients were enrolled. A total of 173 biologic treatment courses (77 infliximab, 49 TCZ, 33 adalimumab, 9 certolizumab, 3 rituximab, 1 ustekinumab and 1 anakinra) were given. Tocilizumab was chosen in 23 patients and TNF inhibitors were chosen in 88 patients as first-line biologic agent. Complete/partial remission rates between TCZ and TNF inhibitors were similar at 3rd month and at the end of the follow-up. GC dose decrease (≤4 mg) or discontinuation of GCs was achieved in a similar rate in both groups (TNF inhibitors vs TCZ: 78% vs 59%, p = 0.125). Drug survival rate was 56% in TNF inhibitors and 57% in TCZ group (p = 0.22). The use of concomitant conventional ISs did not affect the drug survival (HR =0.78, 95% CI =0.42-1.43, p = 0.42). The match analysis showed similar results between groups in terms of relapse, decrease in GC dose, surgery need and mortality. CONCLUSION The efficacy and safety outcomes and drug survival rates seem to be similar for TNF inhibitors and tocilizumab in patients with Takayasu arteritis.
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Affiliation(s)
- Fatma Alibaz-Oner
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
| | - Sema Kaymaz-Tahra
- Sancaktepe Prof.Dr. Ilhan Varank Training and Research Hospital, Rheumatology, Istanbul, Turkey
| | - Özün Bayındır
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Ayten Yazici
- Kocaeli University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Kocaeli, Istanbul, Turkey
| | - Burak Ince
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine Rheumatology, Istanbul, Turkey
| | - Kübra Kalkan
- Trakya University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Edirne, Turkey
| | - Nilüfer Alpay Kanıtez
- Koc University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Sinem Burcu Kocaer
- Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Nazife Sule Yasar Bilge
- Osmangazi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Eskisehir, Turkey
| | - Ahmet Omma
- Ministry of Health Ankara City Hospital, Rheumatology, Ankara, Turkey
| | - Elif Durak
- Katip Celebi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Can Ilgın
- Marmara University Faculty of Medicine, Department of Public Health, Istanbul, Turkey
| | - Servet Akar
- Katip Celebi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Timuçin Kaşifoğlu
- Osmangazi University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Eskisehir, Turkey
| | - Fatoş Önen
- Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Hakan Emmungil
- Trakya University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Edirne, Turkey
| | - Murat İnanç
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine Rheumatology, Istanbul, Turkey
| | - Ayşe Cefle
- Kocaeli University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Kocaeli, Istanbul, Turkey
| | - Kenan Aksu
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Gökhan Keser
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - Haner Direskeneli
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
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23
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Takayasu's Arteritis Diagnosed in an Adolescent Patient with Crohn's Disease: Management of Biologicals. Life (Basel) 2021; 11:life11101019. [PMID: 34685390 PMCID: PMC8537758 DOI: 10.3390/life11101019] [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: 08/24/2021] [Revised: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
We report a 14-year-old man with Crohn’s disease (CD) who developed right upper arm pain while being treated with the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab. There were no symptoms suggestive of active CD, but the inflammatory response was high, and a contrast-enhanced CT showed the occlusion of the right brachial artery. We diagnosed the patient as having Takayasu’s arteritis (TA) and started treatment with corticosteroids, then tapered off the steroids as the symptoms of TA resolved. Later, TA flared up, and his treatment was changed from infliximab to an anti-IL-6 receptor antibody, tocilizumab. The change to TCZ stabilized TA, but exacerbated CD. It is difficult to control both diseases at the same time, and the choice of biologics for treatment must be carefully considered.
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24
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Yamamoto T, Endo D, Shimada A, Yamaoka H, Ooishi A, Dohi S, Matsushita S, Asai T, Amano A. Surgical 5-year Outcomes of Extra-Anatomical Bypass for Middle Aortic Syndrome: A Case Series. Vasc Endovascular Surg 2021; 56:85-94. [PMID: 34407713 DOI: 10.1177/15385744211038892] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Middle aortic syndrome is a rare disease. Several surgical treatments are available; however, the optimal treatment strategy and long-term outcomes remain unelucidated. We herein report the 5-year outcomes of six patients treated with extra-anatomical bypass surgery for middle aortic syndrome. CASE PRESENTATIONS Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu's arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle-brachial pressure index was .61. The three patients with Takayasu's arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle-brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up. CONCLUSION Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.
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Affiliation(s)
- Taira Yamamoto
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
| | - Daisuke Endo
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
| | - Hironobu Yamaoka
- Department of Cardiovascular Surgery, 158026Edogawa Hospital, Tokyo, Japan
| | - Atsumi Ooishi
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
| | - Shizuyuki Dohi
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, 12847Juntendo University, Tokyo, Japan
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25
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Misra DP, Rathore U, Patro P, Agarwal V, Sharma A. Corticosteroid monotherapy for the management of Takayasu arteritis-a systematic review and meta-analysis. Rheumatol Int 2021; 41:1729-1742. [PMID: 34302232 DOI: 10.1007/s00296-021-04958-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
We evaluated clinical response, normalization of inflammatory markers, angiographic stabilization (primary outcomes), relapses and adverse events (secondary outcomes) in Takayasu arteritis (TAK) patients following corticosteroid monotherapy. MEDLINE, EMBASE, Web of Science, Scopus, Pubmed Central, Cochrane library, clinical trial databases and major international Rheumatology conferences were searched for studies reporting outcomes in TAK following corticosteroid monotherapy (without language/date restrictions). Risk ratios were calculated for controlled studies. Proportions were pooled for uncontrolled studies. Heterogeneity was assessed using I2 statistic. Quality assessment of individual studies utilized the Newcastle-Ottawa scale. GRADE methodology ascertained certainty of individual outcomes across studies. Twenty-eight observational studies (1098 TAK) were identified. Twenty-three uncontrolled studies (580 TAK) were synthesized in meta-analysis. Clinical response was observed in 60% (95% CI 45-74%, 19 studies), normalization of inflammatory markers in 84% (95% CI 54-100%, 4 studies) and angiographic stabilization in 28% (95% CI 6-57%, 4 studies). Relapses occurred in 66% (95% CI 18-99%, 4 studies). Adverse events were reported in 51% (95% CI 2-99%, 4 studies). All pooled estimates had considerable heterogeneity, unexplained by subgroup analyses (time period, geographic location or number of patients). Two studies reported lesser restenosis following vascular surgery and fewer relapses when corticosteroids were combined with immunosuppressants compared with corticosteroid monotherapy. All outcomes had very low certainty. While corticosteroid monotherapy induces clinical response in most TAK patients, angiographic stabilization is observed in fewer than one-third. Most patients relapse following corticosteroid withdrawal. Preliminary evidence supports up-front addition of immunosuppressants to retard angiographic progression and reduce relapses (PROSPERO identifier CRD42021242910).
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.
| | - Upendra Rathore
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India
| | - Pallavi Patro
- School of Telemedicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Sener S, Basaran O, Ozen S. Wind of Change in the Treatment of Childhood-Onset Takayasu Arteritis: a Systematic Review. Curr Rheumatol Rep 2021; 23:68. [PMID: 34218346 DOI: 10.1007/s11926-021-01032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW We lack evidence-based data for the treatment of childhood-onset Takayasu arteritis (c-TA) since it is a rare disease in children. In this systematic literature review, we aimed to evaluate the treatment choices in c-TA patients and integrate our experience for the treatment of our patients in the recent years/in the biologic era. RECENT FINDINGS We reviewed 24 articles addressing treatments of 413 c-TA patients. Steroids were given to 352 patients (85.2%) as the main immunosuppressive therapy. Other immunosuppressive agents included methotrexate (37.3%), cyclophosphamide (24.5%), azathioprine (16.9%), and mycophenolate mofetil (7.9%). Besides, various biological agents were used, including tumor necrosis factor-alpha inhibitors in 70 of 107 c-TA patients (65.4%) and interleukin-6 inhibitors in 33 of them (30.8%). Biologics are increasingly used in our center as well. Even in severe patients, CYC is switched to either anti-TNF or antiIL6 once disease control is achieved. Recently, in addition to conventional immunosuppressants, biologics are increasingly used in c-TA. We have revised our treatment protocol to start with 1-3 doses of high-dose steroids and CYC, in a child with TA with types III-V involvement and high acute phase reactants; once clinical features subside and CRP normalizes, biologics should be started to replace CYC while decreasing the steroid dose.
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Affiliation(s)
- Seher Sener
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Ozge Basaran
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
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Holton-Burke R, Laurenzano S, Phillips S, Stover LB, Radhakrishna S, Khare M. Takayasu's Arteritis in a Patient With Preexisting Autoimmune Disease. Clin Pediatr (Phila) 2021; 60:210-213. [PMID: 33736502 DOI: 10.1177/0009922821999471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Susan Phillips
- Rady Children's Hospital, University of California, San Diego, CA, USA
| | | | | | - Manaswitha Khare
- Rady Children's Hospital, University of California, San Diego, CA, USA
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Shirai T, Sato H, Fujii H, Ishii T, Harigae H. The feasible maintenance dose of corticosteroid in Takayasu arteritis in the era of biologic therapy. Scand J Rheumatol 2021; 50:462-468. [PMID: 33729078 DOI: 10.1080/03009742.2021.1881155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Although biologic agents are used in Takayasu arteritis (TAK), corticosteroids are still the mainstay of treatment. This study aimed to investigate the feasible maintenance dose of prednisolone (PSL) in the biologic therapy era.Method: We enrolled 93 patients with TAK who satisfied the criteria of the American College of Rheumatology and visited our department from 2008 to 2018. The clinical characteristics and PSL dose of the patients were retrospectively evaluated.Results: The mean ± sd maintenance dose of PSL was 5.0 ± 3.0 mg/day. In patients having TAK for > 20 years, PSL discontinuation and drug-free status were achieved in 27.2% and 18%, respectively. Although tapering the PSL dose to 10 mg/day was achieved within 12 months, tapering to 5 mg/day required 10 years. Relapse significantly interfered with the PSL dose reduction. The clinical characteristics of patients with relapse included a lower rate of combination therapy using immunosuppressants. Moreover, biologics were used in > 60% of patients with relapse. Tapering of PSL was significantly possible in patients receiving biologics and additional relapse was observed in 6.3% and 50% of patients with and without biologics, respectively. Such PSL-sparing effect enabled the reduction of the median PSL dose from 10 to 5 mg/day. Steroid discontinuation was achieved in some patients.Conclusions: The use of biologics significantly reduced the PSL dose in relapsed patients. A PSL dose of ≤ 5 mg/day is a feasible target for TAK, especially when biologic agents are used. Nevertheless, corticosteroid discontinuation may also be the target in some patients.
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Affiliation(s)
- T Shirai
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Miyag, Japan
| | - H Sato
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Miyag, Japan
| | - H Fujii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Miyag, Japan
| | - T Ishii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Miyag, Japan
| | - H Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Miyag, Japan
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Chen ST, Luo CB, Guo WY, Chang FC. Endovascular management of symptomatic stenosis of supra-aortic arteries in patients with Takayasu arteritis. J Chin Med Assoc 2021; 84:303-308. [PMID: 33350653 DOI: 10.1097/jcma.0000000000000479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endovascular management is used to treat Takayasu arteritis (TA) involving the supra-aortic branches. However, the long-term outcome of this treatment remains unclear. Here, technical safety, outcomes, and restenosis management of supra-aortic arteries in TA patients receiving endovascular treatment were evaluated. METHODS TA patients with symptomatic supra-aortic stenosis who underwent percutaneous angioplasty and stenting between 2008 and 2018 at our institute were enrolled in this study. Pre- and post-procedural magnetic resonance imaging (MRI) evaluations, including high-resolution vessel wall imaging (HR-VWI), were performed. Technical efficacy, peri-procedural complications, early post-procedural MRI results, and stent patency were examined. RESULTS All six patients successfully received stent placement or percutaneous transluminal angioplasty in a total of 22 treated arteries without neurologic complications. During follow-up (mean, 56.3 ± 41.1 months), no recurrent stroke occurred, yet significant restenosis developed in 12 of 22 (54.5%) of the treated arteries. Three of the patients underwent HR-VWI before surgery. Concentric wall thickening and enhancement of the left common carotid artery was detected in one patient, indicating acute inflammation. Angioplasty with drug-eluting balloon (DEB) successfully treated a case of refractory restenosis. Among 10 early post-procedure MRI performed, only two asymptomatic new lesions were detected with diffusion-weighted imaging. CONCLUSION Endovascular treatment of supra-aortic arteries of TA patients was safe and effective, yet was associated with a high restenosis rate. Thus, close follow-up is needed. HR-VWI is helpful for pre-procedural selection of patients for percutaneous angioplasty and stenting and drug-eluting balloon angioplasty appears to be a promising treatment for refractory in-stent restenosis.
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Affiliation(s)
- Shu-Ting Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Keleşoğlu Dinçer AB, Kılıç L, Erden A, Kalyoncu U, Hazirolan T, Kiraz S, KaradaĞ Ö. Imaging modalities used in diagnosis and follow-up of patients with Takayasu’s arteritis. Turk J Med Sci 2021; 51:224-230. [PMID: 33155792 PMCID: PMC7991884 DOI: 10.3906/sag-2005-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim Takayasu’s arteritis (TA) is a rare, large-vessel vasculitis of unknown etiology, affecting aortic arch, and its main branches. Noninvasive imaging methods are frequently used in diagnosis and follow-up in Takayasu’s arteritis. Studies investigating optimal timing of follow up imaging are rare. This study is aimed to investigate the radiologic changes in vascular involvements of Takayasu’s arteritis patients one year after diagnosis. Materials and methods Database of our Vasculitis Center was analyzed retrospectively and 97 patients were included into the study. Demographic, clinical, radiological, and therapeutic findings of patients were recorded. Patients with follow-up imaging after approximately one year of diagnosis were recruited into further analysis. Radiological changes and the effect of different immunosuppressive agents on vascular involvements were investigated. Results Mean age and disease duration of patients were 43.0 and 9.0 years. The most commonly used imaging methods/modalities for the diagnosis of TA were computer tomography-angiography (CT-Ang) (58.8%), magnetic resonance-angiography (MR-Ang) (29.9%), and doppler ultrasonography (11.3%). Subclavian and common carotid arteries were the most frequently involved vessels. Fifty-three patients underwent follow-up imaging after one year of diagnosis and, in 64% of patients, same imaging method had been used. MR-Ang (62.3%) and CT-Ang (35.9%) were the most preferred follow-up imaging studies. Sixty-eight percent of patients had stable vascular involvement, 28% had progression, and 4% had regression. No difference was found in radiological changes regarding patients with usage of different immunosuppressive agents (P = 0.634). There was no association between the change in serum acute phase reactants and radiological disease activity. Conclusion The most commonly used imaging modality for the diagnosis of TA was CT-Ang, whereas MR-Ang was the most preferred for follow-up. Almost 30% of TA patients in our Vasculitis Center had progression at around one year concordant with previous literature. A follow-up imaging at around one year of treatment seems feasible in management of TA.
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Affiliation(s)
| | - Levent Kılıç
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Abdulsamet Erden
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sedat Kiraz
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ömer KaradaĞ
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Isobe M, Maejima Y, Saji M, Tateishi U. Evaluation of tocilizumab for intractable Takayasu arteritis and 18F-fluorodeoxyglucose-positron emission tomography for detecting inflammation under tocilizumab treatment. J Cardiol 2021; 77:539-544. [PMID: 33451862 DOI: 10.1016/j.jjcc.2020.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although high-dose glucocorticoids are effective in suppressing active inflammation of Takayasu arteritis (TAK), many patients experience relapse during tapering of glucocorticoids. Recently, the interleukin-6 receptor antibody, tocilizumab (TCZ), was reported to be effective for steroid-resistant TAK. However, there are no objective ways of diagnosing TAK recurrence because TCZ suppresses inflammatory biomarkers. OBJECTIVES To investigate the efficacy of TCZ at 1-year follow-up and of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography for detection of recurrence of inflammation during TCZ treatment. METHODS AND RESULTS We treated 19 patients with refractory TAK with TCZ. TCZ was discontinued in 2 cases because of side effects. Abatement of arteritis symptoms along with reduction of glucocorticoid dosage was achieved in 12 patients, resulting in a remission induction rate of 70.6%. The dosage of glucocorticoid was reduced from 16.1 ± 10.2 mg to 3.8 ± 1.7 mg at 1 year (p<0.001) in these patients. In the remaining 5 patients, glucocorticoid tapering led to exacerbation of symptoms and glucocorticoid dose had to be increased. FDG-PET scan results closely matched clinical course in all 5 patients with recurrence even during TCZ treatment, while the scan was negative for the remaining 12 patients. CONCLUSIONS TCZ injection provides robust steroid-sparing effect and improvement of inflammation without significant adverse effects. Recurrence of inflammation can be detected by FDG-PET even during TCZ treatment.
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Affiliation(s)
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
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Shumy F, Anam A, Choudhury M, Shahin M, Haq S, Amin M, Minhaj S. Rate and predictors of response to glucocorticoid therapy in patients of takayasu arteritis at a tertiary level hospital of Bangladesh: A longitudinal study. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_40_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Javadi Parvaneh V, Jari M, Rahmani K, Azma R, Shiari R. Five-day fever: The main presentation of childhood-onset Takayasu arteritis. Clin Case Rep 2020; 8:2361-2365. [PMID: 33363741 PMCID: PMC7752334 DOI: 10.1002/ccr3.3148] [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: 02/14/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 11/11/2022] Open
Abstract
In children with a nonspecific constitutional presentation such as prolonged fever, the physician should pay attention to primary vasculitides after ruling out the more common diseases such as infectious diseases, malignancies, and the other rheumatic disorders. The past history of autoimmunity may be a clue for this.
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Affiliation(s)
- Vadood Javadi Parvaneh
- Department of Pediatric RheumatologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mohsen Jari
- Department of PediatricsImam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
| | - Khosro Rahmani
- Department of Pediatric RheumatologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Roxana Azma
- Department of RadiologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Reza Shiari
- Department of Pediatric RheumatologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
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34
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Cherednichenko Y, Dzyak L, Tsurkalenko O. The experience of comprehensive conservative and endovascular management of Takayasu arteritis, manifested with repeated ischemic strokes. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Das SK, Dahal A, Shrestha N, Tnawanasu S, Sharma S. Takayasu's Arteritis with Subcutaneous Nodules in a 4-year -old Child: A Case Report. JNMA J Nepal Med Assoc 2020; 58:930-933. [PMID: 34506410 PMCID: PMC7775015 DOI: 10.31729/jnma.5387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
A 4-year-old girl who presented with pain in the abdomen, subcutaneous nodule, fever and was later diagnosed with Takayasu arteritis . Oral corticosteroid and methotrexate were started. Childhood TA should be kept in differential diagnosis when presented with subcutaneous nodules and increased acute phase reactants.
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Affiliation(s)
| | - Aakrit Dahal
- Oxford University Clinical Research Unit-Nepal, Lalitpur, Nepal
| | - Nikhil Shrestha
- Oxford University Clinical Research Unit-Nepal, Lalitpur, Nepal
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Stroke Treatment in the Setting of Systemic Disease. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Parab A, Sivakumar P. A Rare Case of Pulseless Retinopathy. JAMA Ophthalmol 2020; 138:e201404. [PMID: 33180133 DOI: 10.1001/jamaophthalmol.2020.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Aditi Parab
- Department of Ophthalmology, Aravind Eye Hospital, Puducherry, India
| | - Priya Sivakumar
- Department of Neuro-ophthalmology and Low Vision Services, Aravind Eye Care, Puducherry, India
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38
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Martinez-Garri M, Haver K, Boyer D, Nimkin K, Son MB, Nelson BA. Chronic chest pain: Where is the pathology? Pediatr Pulmonol 2020; 55:3145-3151. [PMID: 32735388 DOI: 10.1002/ppul.24999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Marina Martinez-Garri
- Division of Pulmonary Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Kenan Haver
- Division of Pulmonary Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Debra Boyer
- Division of Pulmonary Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Katherine Nimkin
- Department of Pediatric Radiology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth Son
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin A Nelson
- Department of Pediatric Pulmonology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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Nakamura H, Sato K, Yoshimura S, Hayashi Y, Izumo T, Tokunaga Y. Moyamoya Disease Associated with Graves' Disease and Down Syndrome: A Case Report and Literature Review. J Stroke Cerebrovasc Dis 2020; 30:105414. [PMID: 33130479 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/26/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Moyamoya vessels are cerebral vasculopathies characterized by net-like collateral vessel formation at the cerebral basal area and stenosis of the terminal internal carotid artery, proximal middle cerebral artery, and anterior cerebral artery. A diagnosis of Moyamoya disease depends on the bilateral presence of Moyamoya vessels. Moyamoya disease associated with Graves' disease has rarely been reported to be a cause of ischemic events due to hyperthyroidism. However, there are extremely rare cases of Moyamoya disease with concurrent Graves' disease and Down syndrome. We aimed to report such a case, and to compare these cases' clinical features, pathogenesis, and treatment effects to those of the cases of concurrent Moyamoya disease and Graves' disease alone. METHODS We performed an English literature search using the PubMed database and the keywords Moyamoya, quasi-Moyamoya, Graves' disease, thyrotoxicosis, Down syndrome, and trisomy 21. RESULTS Only five cases of Moyamoya disease with Graves' disease and Down syndrome have been reported, including our own. Four patients were female (80%), and all underwent antithyroid therapy and experienced ischemic episodes, including transient ischemic attacks. At the time of their vascular accident, two patients were in a thyrotoxic state; only our patient was in a euthyroid state. The mean age was 15.6 years (standard deviation: 6.1), which was younger than the mean age of 31.4 years (standard deviation: 13) in patients with Moyamoya disease and Graves' disease alone. Down syndrome is commonly associated with abnormal vascular networks due to increased endostatin concentrations or immunological abnormalities such as those that occur in Graves' disease. Graves' disease accelerates the progression of Moyamoya disease and ischemic attacks due to atherosclerosis, enhances sympathetic nervous system activity and immunological changes. As compared to Moyamoya disease patients, patients with concurrent Graves' disease only and Moyamoya disease patients with concurrent Graves' disease and Down syndrome may experience accelerated disease progression or more frequent ischemic attacks. CONCLUSION Early imaging follow-ups and strict control of thyroid function are necessary in such cases; if ischemic attacks have already occurred, revascularization surgery may be effective.
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Affiliation(s)
- Hikaru Nakamura
- Department of Neurosurgery, Nagasaki Prefecture Shimabara Hospital, 7895 Shimokawasiri, Shimabara, Nagasaki 855-0816, Japan.
| | - Kei Sato
- Department of Neurosurgery, Nagasaki Prefecture Shimabara Hospital, 7895 Shimokawasiri, Shimabara, Nagasaki 855-0816, Japan
| | - Shota Yoshimura
- Department of Neurosurgery, Nagasaki Prefecture Shimabara Hospital, 7895 Shimokawasiri, Shimabara, Nagasaki 855-0816, Japan
| | - Yukishige Hayashi
- Department of Neurosurgery, Nagasaki Prefecture Shimabara Hospital, 7895 Shimokawasiri, Shimabara, Nagasaki 855-0816, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan
| | - Yoshiharu Tokunaga
- Department of Neurosurgery, Nagasaki Prefecture Shimabara Hospital, 7895 Shimokawasiri, Shimabara, Nagasaki 855-0816, Japan
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40
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Gamboa P. Arteritis de Takayasu. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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41
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KiŞla Ekİncİ RM, Balci S, PİŞkİn FC, Varan C, Erdem S, Yilmaz M. Pre-Pulseless Takayasu Arteritis in a Child Represented With Prolonged Fever of Unknown Origin and Successful Management With Concomitant Mycophenolate Mofetil and Infliximab. Arch Rheumatol 2020; 35:278-282. [PMID: 32851379 DOI: 10.46497/archrheumatol.2020.7599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/21/2019] [Indexed: 11/03/2022] Open
Abstract
Takayasu arteritis (TA) is classified as a large vessel vasculitis of predominantly aorta and its main branches, resulting in fibrosis and stenosis. Only a minority of TA patients are diagnosed in pre-stenosis phase when constitutional symptoms including fever, arthralgia, weight loss, headache, abdominal pain, and elevated acute phase reactants are dominant insidious characteristics. In this article, we present a 12-year-old female patient, who was referred to our department with a one-year history of low-grade fever, fatigue, and myalgia. Physical examination did not reveal pulse and blood pressure discrepancies between any extremities. Acute phase reactants were markedly elevated, and autoantibodies were negative. Magnetic resonance angiography (MRA) findings have confirmed TA diagnosis with prominent vessel wall thickening in the ascendant and abdominal aorta, focal ectasias and a thoracoabdominal fusiform aneurysm. As methotrexate and methylprednisolone treatment during three months was unsuccessful, infliximab was induced. During the next 12 months, patient had clinical improvement, but worsening of MRA findings and new onset of carotidynia forced us to switch methotrexate to mycophenolate mofetil. Six months later, laboratory and radiological remission were achieved. In conclusion, we report a challenge to diagnose pre-pulseless childhood-TA (c-TA) in the state of prolonged fever with no signs of vascular stenosis, systemic hypertension, pulses and blood pressure discrepancies, bruits and claudication. Therefore, we wish to discourse the importance of early diagnosis of TA since, to our knowledge, there are no studies investigating treatment success only in the early phases of c-TA.
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Affiliation(s)
| | - Sibel Balci
- Department of Pediatric Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ferhat Can PİŞkİn
- Department of Radiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Celal Varan
- Department of Pediatric Cardiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mustafa Yilmaz
- Department of Pediatric Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
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Goel R, Gribbons KB, Carette S, Cuthbertson D, Hoffman GS, Joseph G, Khalidi NA, Koening CL, Kumar S, Langford C, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Nair A, Pagnoux C, Quinn KA, Ravindran R, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Merkel PA, Danda D, Grayson PC. Derivation of an angiographically based classification system in Takayasu's arteritis: an observational study from India and North America. Rheumatology (Oxford) 2020; 59:1118-1127. [PMID: 31580452 DOI: 10.1093/rheumatology/kez421] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/08/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To develop and replicate, using data-driven methods, a novel classification system in Takayasu's arteritis based on distribution of arterial lesions. METHODS Patients were included from four international cohorts at major academic centres: India (Christian Medical College Vellore); North America (National Institutes of Health, Vasculitis Clinical Research Consortium and Cleveland Clinic Foundation). All patients underwent whole-body angiography of the aorta and branch vessels, with categorization of arterial damage (stenosis, occlusion or aneurysm) in 13 territories. K-means cluster analysis was performed to identify subgroups of patients based on pattern of angiographic involvement. Cluster groups were identified in the Indian cohort and independently replicated in the North American cohorts. RESULTS A total of 806 patients with Takayasu's arteritis from India (n = 581) and North America (n = 225) were included. Three distinct clusters defined by arterial damage were identified in the Indian cohort and replicated in each of the North American cohorts. Patients in cluster one had significantly more disease in the abdominal aorta, renal and mesenteric arteries (P < 0.01). Patients in cluster two had significantly more bilateral disease in the carotid and subclavian arteries (P < 0.01). Compared with clusters one and two, patients in cluster three had asymmetric disease with fewer involved territories (P < 0.01). Demographics, clinical symptoms and clinical outcomes differed by cluster. CONCLUSION This large study in Takayasu's arteritis identified and replicated three novel subsets of patients based on patterns of arterial damage. Angiographic-based disease classification requires validation by demonstrating potential aetiological or prognostic implications.
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Affiliation(s)
- Ruchika Goel
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - K Bates Gribbons
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Gary S Hoffman
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Sathish Kumar
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Carol Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Carol A McAlear
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Division of Rheumatology, VA Boston Healthcare System, Boston, MA
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Aswin Nair
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | | | - Kaitlin A Quinn
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA.,Division of Rheumatology, Georgetown University, Washington DC, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Antoine G Sreih
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | | | | | - Peter A Merkel
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Peter C Grayson
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
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Nitzberg M, Parikh R, Govender P, Farber HW. Pulmonary hypertension secondary to takayasu's arteritis: management using a combined medical and interventional approach. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:239-241. [PMID: 33093790 PMCID: PMC7569558 DOI: 10.36141/svdld.v37i2.8987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew Nitzberg
- Pulmonary Critical Care Medicine, Newton-Wellesley Hospital, Newton, MA
| | - Raj Parikh
- The Pulmonary Center, Boston University School of Medicine, Boston, MA
| | - Praveen Govender
- The Pulmonary Center, Boston University School of Medicine, Boston, MA
| | - Harrison W Farber
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
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Singh A, Danda D, Hussain S, Najmi AK, Mathew A, Goel R, Lakhan SE, Tajudheen B, Antony B. Efficacy and safety of tocilizumab in treatment of Takayasu arteritis: A systematic review of randomized controlled trials. Mod Rheumatol 2020; 31:197-204. [PMID: 32000551 DOI: 10.1080/14397595.2020.1724671] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Takayasu arteritis (TAK) is a chronic immune vasculitis in which Interleukin-6 (IL-6) receptors play a key role in pathogenesis. Tocilizumab (TCZ), an IL-6 receptor antagonist with a favorable safety and efficacy profile, has been tried as an option for patients with TAK. This systematic review analyzed the evidence from randomized control trials (RCT) assessing the safety and efficacy of TCZ in patients with TAK. METHODS MEDLINE, Embase, the Cochrane Library, and clinical trial registries were searched from inception to July 2018. We included RCT assessing the efficacy and safety of TCZ versus placebo/other comparators for the treatment of patients with TAK. The risk of bias (RoB) was assessed using Cochrane RoB tool. RESULTS 2799 identified articles were screened as per abstract and title; 42 selected full-texts articles were assessed for the potential inclusion. One trial, reported in two publications, comparing subcutaneous TCZ (162 mg/week) versus matching placebo in 36 patients with TAK was included. The relapse-free rate at 24 weeks was 50.6% and 22.9% in TCZ and placebo arm, respectively. The hazard ratio (HR) for time to first relapse was statistically significant in the per-protocol population (HR 0.34 [95.41% CI, 0.11-1.00]; p = .0345), while non-significant in the intention-to-treat population (HR 0.41 [95.41% CI, 0.15-1.10]; p = .0596). The serious adverse events were higher in the placebo arm. CONCLUSIONS This systematic review finds the existing evidence from RCT on efficacy and safety profile of TCZ in TAK to be promising but limited. Additional evidence is required to draw a stronger conclusion.
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Affiliation(s)
- Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Salman Hussain
- Department of Pharmaceutical Medicine (Division of Pharmacology), School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Abul Kalam Najmi
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Ashish Mathew
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Ruchika Goel
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | | | | | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
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de Graeff N, Groot N, Brogan P, Ozen S, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Pilkington C, Ravelli A, van Royen A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides - the SHARE initiative. Rheumatology (Oxford) 2020; 58:656-671. [PMID: 30535249 DOI: 10.1093/rheumatology/key322] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The European initiative Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) aimed to optimize care for children with rheumatic diseases. Systemic vasculitides are very rare in children. Consequently, despite recent advances, paediatric-specific information is sparse. The lack of evidence-based recommendations is an important, unmet need. This study aimed to provide recommendations for diagnosing and treating children with rare forms of childhood systemic vasculitis. METHODS Recommendations were developed by a consensus process in accordance with the European League Against Rheumatism standard operating procedures. A systematic literature review informed the recommendations, which were devised and evaluated by a panel of experts via an online survey, and two consensus meetings using nominal group technique. Recommendations were accepted when ⩾ 80% of experts agreed. RESULTS Ninety-three relevant articles were found, and 78 recommendations were accepted in the two consensus meetings. General, cross-cutting recommendations and disease-specific statements regarding the diagnosis and treatment of childhood-onset PAN, granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, and Takayasu arteritis are provided. CONCLUSION These Single Hub and Access point for paediatric Rheumatology in Europe recommendations were formulated through an evidence-based consensus process to support uniform, high-quality standard of care for children with rare forms of paediatric systemic vasculitis.
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Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht.,Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | - Paul Brogan
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Brigitte Bader-Meunier
- Department of Paediatric Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Brian M Feldman
- Department of Paediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre University Hospital, APHP, University of Paris Sud, Paris, France
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Stephen D Marks
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Gaslini Children's Hospital, Genoa, Italy
| | - Annet van Royen
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Yosef Uziel
- Meir Medical Center, Kfar Saba, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Abstract
Takayasu arteritis (TA) is a rare chronic granulomatous inflammation of the aorta or its branches and is prevalent all around the world. It causes stenosis of large arteries and ischaemic damage to target organs. There is usually a delay in recognising TA because of the rarity and unfamiliarity with the disease, unspecific early symptoms and lack of diagnostic equipment for early diagnosis. In this report, we present a case of an 18-year-old woman from Pasuruan, East Java, Indonesia, with recurrent fever, headache, claudication of extremities and postprandial abdominal pain. She was diagnosed clinically with suspicion of TA and was sent to a tertiary hospital to confirm the diagnosis. Arteriography revealed that the patient had narrowing of the thoracic and abdominal aorta until the level of the aortic bifurcation. The patient was started on high-dose corticosteroid, cyclosporine A and diltiazem. The patient then showed improvement in her symptoms.
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Affiliation(s)
- Michael Lusida
- General Practice and Primary Care, RSUD Dr R Soedarsono, Pasuruan, Indonesia
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47
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Pham V, Hemptinne QD, Grinda JM, Duboc D, Varenne O, Picard F. Giant coronary aneurysms, from diagnosis to treatment: A literature review. Arch Cardiovasc Dis 2020; 113:59-69. [DOI: 10.1016/j.acvd.2019.10.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
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Chaolun LMD, Lingying MMD, Linjin HMD, Hong HMD, Lingdi JMD, Wenping WMD. Use of Contrast-Enhanced Ultrasound for Detecting the Disease Activity of the Carotid Artery in Takayasu Arteritis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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49
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Dalkilic E, Coskun BN, Yağız B, Pehlivan Y. A successful pregnancy in a patient with Takayasu's arteritis under tocilizumab treatment: A longitudinal case study. Int J Rheum Dis 2019; 22:1941-1944. [DOI: 10.1111/1756-185x.13687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Ediz Dalkilic
- Rheumatology Department, Faculty of Medicine Uludağ University Bursa Turkey
| | | | - Burcu Yağız
- Rheumatology Department, Faculty of Medicine Uludağ University Bursa Turkey
| | - Yavuz Pehlivan
- Rheumatology Department, Faculty of Medicine Uludağ University Bursa Turkey
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50
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Acosta-Herrera M, González-Gay MA, Martín J, Márquez A. Leveraging Genetic Findings for Precision Medicine in Vasculitis. Front Immunol 2019; 10:1796. [PMID: 31428096 PMCID: PMC6687877 DOI: 10.3389/fimmu.2019.01796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
Vasculitides are a heterogeneous group of low frequent disorders, mainly characterized by the inflammation of blood vessels that narrows or occlude the lumen and limits the blood flow, leading eventually to significant tissue and organ damage. These disorders are classified depending on the size of the affected blood vessels in large, medium, and small vessel vasculitis. Currently, it is known that these syndromes show a complex etiology in which both environmental and genetic factors play a major role in their development. So far, these conditions are not curable and the therapeutic approaches are mainly symptomatic. Moreover, a percentage of the patients do not adequately respond to standard treatments. Over the last years, numerous genetic studies have been carried out to identify susceptibility loci and biological pathways involved in vasculitis pathogenesis as well as potential genetic predictors of treatment response. The ultimate goal of these studies is to identify new therapeutic targets and to improve the use of existing drugs to achieve more effective treatments. This review will focus on the main advances made in the field of genetics and pharmacogenetics of vasculitis and their potential application for ameliorating long-term outcomes in patient management and in the development of precision medicine.
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Affiliation(s)
| | - Miguel A González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina "López-Neyra," CSIC, Granada, Spain
| | - Ana Márquez
- Instituto de Parasitología y Biomedicina "López-Neyra," CSIC, Granada, Spain.,Systemic Autoimmune Disease Unit, Hospital Clínico San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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