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Lefebvre F, Ross C, Soowamber M, Pagnoux C. Aneurysmal Disease in Patients With Takayasu Arteritis. J Rheumatol 2024; 51:277-284. [PMID: 38101913 DOI: 10.3899/jrheum.2023-0629] [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] [Accepted: 11/23/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Takayasu arteritis (TA) leads to stenotic disease. Aneurysmal lesions are rarer. This study assessed the main characteristics of aneurysmal disease in a Canadian cohort of patients with TA. METHODS This monocentric retrospective study included patients with TA followed at the Mount Sinai Hospital Vasculitis Clinic in Toronto. Diagnosis of TA was based on clinical findings and/or satisfied the 1990 American College of Rheumatology classification criteria. RESULTS Seventy-four patients were included. At any time, aneurysmal disease was found in 23 (31%) patients. Median disease duration was 9.0 (IQR 7.0-19.0) years. Prior hypertension (P = 0.02), fever (P = 0.04), and seizure disorders (P = 0.03) were more common. Limb claudication was less frequent (P = 0.01). Persistent and/or new aneurysms were demonstrated in 22/23 patients at follow-up. Thoracic aorta aneurysm (13/22) was most common, followed by abdominal aorta (8/22), subclavian (7/22), and carotid (6/22) artery disease. Aortic valve regurgitation was more frequent (9/23 vs 3/48; P = 0.001). Twenty-one patients had been treated with glucocorticoids (median 6.1 years [IQR 3.7-8.1]). Methotrexate, azathioprine, and leflunomide were repeatedly used. Infliximab (7/23) was used more often (P = 0.04), whereas tocilizumab was received by only 4 patients with aneurysmal disease (P = 0.01). Patients with aneurysms suffered more frequent relapses (2.0 [IQR 0.0-4.0] vs 1.0 [IQR 0.0-2.0], P = 0.04). CONCLUSION Aneurysmal disease was found in a significant proportion of patients with TA. Given that aneurysms may carry a risk of rupture, and are associated with a higher rate of relapse, this finding should be reported systematically in TA studies.
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Affiliation(s)
- Frédéric Lefebvre
- F. Lefebvre, MD, MSc, Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, and Vasculitis Clinic, Mount Sinai Hospital, Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario;
| | - Carolyn Ross
- C. Ross, PharmD, MD, Vasculitis Clinic, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, and Vasculitis Clinic, Mount Sinai Hospital, Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario
| | - Medha Soowamber
- M. Soowamber, MD, MSc, C. Pagnoux, MD, MSc, MPH, Vasculitis Clinic, Mount Sinai Hospital, Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Ergi DG, Schaff HV, Pochettino A, Hurst PD, Greason KL, Daly RC, Crestanello JA, Dearani JA, Todd A, Saran N. Outcomes of aortic surgery in patients with Takayasu arteritis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00099-0. [PMID: 38325517 DOI: 10.1016/j.jtcvs.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To investigate the presentation, aortic involvement, and surgical outcomes in patients with Takayasu arteritis undergoing aortic surgery. METHODS We queried our surgical database for patients with Takayasu arteritis who underwent aortic surgery from 1994 to 2022. RESULTS There were a total of 31 patients with Takayasu arteritis who underwent aortic surgery. Patients' median age at the time of diagnosis was 35.0 years (interquartile range, 25.0-42.0). The majority were female (n = 27, 87.0%). Most patients (n = 28, 90.3%) were diagnosed before surgery, and 3 patients (9.6%) were diagnosed perioperatively. The median time interval from diagnosis to surgery was 2.8 years (interquartile range, 0.5-13.9). The most common presentation was ascending aorta aneurysm (n = 22, 70.9%), and severe aortic regurgitation was the most common valve insufficiency (n = 17, 54.8%). The most common operation was ascending aorta replacement (n = 20, 64.5%), and aortic valve replacement was the most common valve intervention (n = 17, 54.8%). Active vasculitis was identified in 2 (11.7%) aortic valve specimens. Early mortality was 6.5% (n = 2). A total of 6 deaths occurred over a median follow-up of 13.1 years (interquartile range, 6.1-25.2). Survival at 10 years was 86.7% (95% CI, 75.4-99.7). A total of 5 patients (16.1%) required a subsequent operation in a median of 1.9 years (interquartile range, 0.2-7.4). Freedom from reoperation was 96.9% (95% CI, 90.1-100) at 1 year, 89.4% (95% CI, 78.7-100.0) at 5 years, and 77.5% (95% CI, 61.2-98.1) at 10 and 15 years. CONCLUSIONS Ascending aorta aneurysm and aortic valve regurgitation are the most frequent presentations in patients with Takayasu arteritis requiring aortic surgery. Surgery in these individuals is safe, with acceptable short- and long-term results.
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Affiliation(s)
- Defne Gunes Ergi
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | | | - Philip D Hurst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Austin Todd
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minn
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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Konda N, Sakai R, Saeki K, Matsubara Y, Nakamura Y, Miyamae T, Nakaoka Y, Harigai M. Nationwide clinical and epidemiological study of large-vessel vasculitis in Japan in 2017. Mod Rheumatol 2023; 34:167-174. [PMID: 36737863 DOI: 10.1093/mr/road019] [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: 10/31/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We conducted a nationwide epidemiological study to estimate the number of patients with Takayasu arteritis (TAK) and giant cell arteritis (GCA) in Japan and to describe the clinical characteristics of these patients. METHODS The first survey was designed to estimate the number of patients with TAK and GCA who were treated at medical institutions in Japan in 2017. The second survey was designed to collect data on the clinical characteristics of the patients who were reported in the first survey. RESULTS Of the 3495 institutions selected for the first survey, 1960 (56.1%) responded. The number of patients with clinically diagnosed TAK and GCA was estimated to be 5320 (95% confidence interval, 4810-5820) and 3200 (95% confidence interval, 2830-3570), respectively. Aortic regurgitation was reported in 35% of patients with TAK, and eye-related comorbidities were observed in 30.4% of patients with GCA. The common carotid and internal carotid arteries were the most frequently involved in patients with TAK (62.7%). Subclavian artery lesions and thoracic or abdominal aorta lesions were reported in 31% and 42.6% of patients with GCA, respectively. CONCLUSIONS The number of patients with TAK and GCA was estimated simultaneously, and significant differences in clinical characteristics were observed between the two diseases.
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Affiliation(s)
- Naoko Konda
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Ryoko Sakai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo 162-8666, Japan
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Kiyose, Tokyo 204-8588, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Kashihara, Nara 634-8521, Japan
| | - Yuri Matsubara
- Department of Public Health, Jichi Medical University, Shimotsuke-shi, Tochigi 329-0498, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke-shi, Tochigi 329-0498, Japan
| | - Takako Miyamae
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka 564-8565, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo 162-8666, Japan
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Wawak M, Tekieli Ł, Badacz R, Pieniążek P, Maciejewski D, Trystuła M, Przewłocki T, Kabłak-Ziembicka A. Clinical Characteristics and Outcomes of Aortic Arch Emergencies: Takayasu Disease, Fibromuscular Dysplasia, and Aortic Arch Pathologies: A Retrospective Study and Review of the Literature. Biomedicines 2023; 11:2207. [PMID: 37626704 PMCID: PMC10452526 DOI: 10.3390/biomedicines11082207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Non-atherosclerotic aortic arch pathologies (NA-AAPs) and anatomical variants are characterized as rare cardiovascular diseases with a low incidence rate, below 1 case per 2000 population, but enormous heterogeneity in terms of anatomical variants, i.e., Takayasu disease (TAK) and fibromuscular dysplasia (FMD). In specific clinical scenarios, NA-AAPs constitute life-threatening disorders. METHODS In this study, 82 (1.07%) consecutive patients with NA-AAPs (including 38 TAKs, 26 FMDs, and 18 other AAPs) out of 7645 patients who underwent endovascular treatment (EVT) for the aortic arch and its side-branch diseases at a single institution between 2002 and 2022 were retrospectively reviewed. The recorded demographic, biochemical, diagnostic, operative, and postoperative factors were reviewed, and the functional outcomes were determined during follow-up. A systematic review of the literature was also performed. RESULTS The study group comprised 65 (79.3%) female and 17 (21.7%) male subjects with a mean age of 46.1 ± 14.9 years. Overall, 62 (75.6%) patients were diagnosed with either cerebral ischemia symptoms or aortic arch dissection on admission. The EVT was feasible in 59 (72%) patients, whereas 23 (28%) patients were referred for medical treatment. In EVT patients, severe periprocedural complications occurred in two (3.39%) patients, including one periprocedural death and one cerebral hyperperfusion syndrome. During a median follow-up period of 64 months, cardiovascular events occurred in 24 (29.6%) patients (5 deaths, 13 ISs, and 6 myocardial infarctions). Repeated EVT for the index lesion was performed in 21/59 (35.6%) patients, including 19/33 (57.6%) in TAK and 2/13 (15.4%) in FMD. In the AAP group, one patient required additional stent-graft implantation for progressing dissection to the iliac arteries at 12 months. A baseline white blood count (odds ratio [HR]: 1.25, 95% confidence interval [CI]: 1.11-1.39; p < 0.001) was the only independent prognostic factor for recurrent stenosis, while a baseline hemoglobin level (HR: 0.73, 95%CI: 0.59-0.89; p = 0.002) and coronary involvement (HR: 4.11, 95%CI: 1.74-9.71; p = 0.001) were independently associated with a risk of major cardiac and cerebral events according to the multivariate Cox proportional hazards regression analysis. CONCLUSIONS This study showed that AAPs should not be neglected in clinical settings, as it can be a life-threatening condition requiring a multidisciplinary approach. The knowledge of prognostic risk factors for adverse outcomes may improve surveillance in this group of patients.
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Affiliation(s)
- Magdalena Wawak
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Łukasz Tekieli
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Rafał Badacz
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
| | - Piotr Pieniążek
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
| | - Damian Maciejewski
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Mariusz Trystuła
- Department of Vascular and Endovascular Surgery, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland;
| | - Tadeusz Przewłocki
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
- Noninvasive Cardiovascular Laboratory, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
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Perugino CA, Isselbacher EM, Baliyan V, Unizony SH, Smith RN. Case 18-2023: A 19-Year-Old Woman with Dyspnea and Tachypnea. N Engl J Med 2023; 388:2275-2286. [PMID: 37314709 DOI: 10.1056/nejmcpc2300894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Cory A Perugino
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Eric M Isselbacher
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Vinit Baliyan
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Sebastian H Unizony
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Rex N Smith
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
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Owino C, Sirera B, Tarus F, Ganda B, Oduor C, Siika A. Ischemic stroke at first presentation of Takayasu arteritis in a young African male from Kenya, East Africa: Case report and brief literature review. Clin Case Rep 2023; 11:e7412. [PMID: 37255613 PMCID: PMC10225614 DOI: 10.1002/ccr3.7412] [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: 11/29/2022] [Revised: 03/03/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
Key Clinical Message This case highlights the need for thorough clinical examination to rule out Takayasu arteritis (TA) as a cause of stroke in a young asymptomatic East-African male. Available clinical management guidelines should guide management of TA patients. Abstract We present a case of a young, previously asymptomatic East-African Black male presenting with large territory ischemic infarct at first diagnosis of TA. To our knowledge, this is the first published report of a male patient in East Africa with a stroke as the first presentation of TA.
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Affiliation(s)
- Christopher Owino
- Department of Internal MedicineMoi University School of MedicineEldoretKenya
| | | | - Felix Tarus
- Moi Teaching and Referral HospitalEldoretKenya
| | - Beryl Ganda
- Moi Teaching and Referral HospitalEldoretKenya
| | - Chrispine Oduor
- Department of Internal MedicineMoi University School of MedicineEldoretKenya
| | - Abraham Siika
- Department of Internal MedicineMoi University School of MedicineEldoretKenya
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Ben Jomaa S, El Aini I, Chebbi E, Ben Hammouda S, Bouzid O, Haj Salem N. Sudden death due to Takayasu arteritis complication associated with situs inversus totalis: A case discovered at autopsy. J Forensic Leg Med 2023; 96:102527. [PMID: 37094461 DOI: 10.1016/j.jflm.2023.102527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
Takayasu arteritis is a rare pathology that usually has general and atypical signs that make its diagnosis difficult. These characteristics can delay diagnosis, thus leading to complications and death. We, herein, report an autopsy case of a 25-year-old female patient with a history of multiple consultations for dyspnea. During these consultations, no diagnosis was made. She was found unconscious near her home and shortly after, she was declared dead. Forensic autopsy revealed superficial traumatic lesions. Internal examination revealed complete situs inversus. Multiple bilateral pleural adhesions and bilateral moderate effusion were found. The heart was heavy with thickening of the aortic wall (1.1cm), carotid arteries, and pulmonary trunk, associated with a large aortic valve and evidence of leakage. Histological examination of the aorta and its major branches showed features of panarteritis with segmental involvement. The vascular wall was thick with lymphoplasmacytic infiltrate and giant cells involving mainly the medio-adventitial junction. Disruption of the elastic lamina and reactive fibrosis in the intima were also noted. Diagnosis of large vessel vasculitis and particularly Takayasu arteritis was made. Death was therefore attributed to heart failure due to aortic insufficiency as a complication of Takayasu arteritis.
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Affiliation(s)
- Sami Ben Jomaa
- Department of Forensic Medicine, University Hospital of Fattouma Bourguiba of Monastir, 5000, Tunisia.
| | - Imen El Aini
- Department of Forensic Medicine, University Hospital of Fattouma Bourguiba of Monastir, 5000, Tunisia
| | - Elaa Chebbi
- Department of Forensic Medicine, University Hospital of Fattouma Bourguiba of Monastir, 5000, Tunisia
| | - Seifeddine Ben Hammouda
- Department of Pathology, University Hospital of Fattouma Bourguiba of Monastir, 5000, Tunisia
| | - Oumeima Bouzid
- Department of Forensic Medicine, University Hospital of Fattouma Bourguiba of Monastir, 5000, Tunisia
| | - Nidhal Haj Salem
- Department of Forensic Medicine, University Hospital of Fattouma Bourguiba of Monastir, 5000, Tunisia
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Zhou J, Li J, Wang Y, Yang Y, Zhao J, Li M, Pang H, Wang T, Chen Y, Tian X, Zeng X, Zheng Y. Age, sex and angiographic type-related phenotypic differences in inpatients with Takayasu arteritis: A 13-year retrospective study at a national referral center in China. Front Cardiovasc Med 2023; 10:1099144. [PMID: 37008316 PMCID: PMC10062600 DOI: 10.3389/fcvm.2023.1099144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Backgrounds We aimed to investigate the demographic characteristics, vascular involvement, angiographic patterns, complications, and associations of these variables in a large sample of TAK patients at a national referral center in China. Methods The medical records of TAK patients discharged from 2008 to 2020 were retrieved from the hospital discharge database using ICD-10 codes. Demographic data, vascular lesions, Numano classifications and complications were collected and analyzed. Results The median age at onset was 25 years in 852 TAK patients (670 female, 182 male). Compared with the females, the male patients were more likely to have type IV and were more likely to have iliac (24.7% vs. 10.0%) and renal artery (62.7% vs. 53.9%) involvement. They also had a higher prevalence of systemic hypertension (62.1% vs. 42.4%), renal dysfunction (12.6% vs. 7.8%) and aortic aneurysm (AA) (8.2% vs. 3.6%). The childhood-onset group was more likely to have involvement of the abdominal aorta (68.4% vs. 52.1%), renal artery (69.0% vs. 51.8%) and superior mesenteric artery (41.5% vs. 28.5%), and they were more likely to have type IV, V and hypertension than the adult-onset group. After adjusting for sex and age at onset, the patients with type II were associated with an increased risk of cardiac dysfunction (II vs. I: OR = 5.42; II vs. IV: OR = 2.63) and pulmonary hypertension (II vs. I: OR = 4.78; II vs. IV: OR = 3.95) compared with those with types I and IV. Valvular abnormalities (61.0%) were observed to be most prevalent in patients with type IIa. The patients with Type III were associated with a higher risk of aortic aneurysm (23.3%) than the patients with types IV (OR = 11.00) and V (OR = 5.98). The patients with types III and IV were more commonly complicated with systemic hypertension than the patients with types I, II and V. P < 0.05 in all of the above comparisons. Conclusion Sex, adult/childhood presentation and Numano angiographic type were significantly associated with differences in phenotypic manifestations, especially cardiopulmonary abnormalities, systemic hypertension, renal dysfunction and aortic aneurysm.
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Affiliation(s)
- Jingya Zhou
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- WHO Family of International Classifications Collaborating Center of China, Beijing, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yi Wang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- WHO Family of International Classifications Collaborating Center of China, Beijing, China
| | - Yunjiao Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Haiyu Pang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingyu Wang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- WHO Family of International Classifications Collaborating Center of China, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhang G, Ni J, Yang Y, Li J, Tian X, Zeng X. Clinical and vascular features of stroke in Takayasu's arteritis: A 24-year retrospective study. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2023; 4:22-29. [PMID: 37138651 PMCID: PMC10150874 DOI: 10.2478/rir-2023-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/23/2021] [Indexed: 05/05/2023]
Abstract
Objective To investigate the clinical characteristics, vascular imaging features, and prognosis of Takayasu's arteritis (TA) patients with stroke in China. Methods Medical charts of 411 in-patients who fulfilled the classification criteria of modified 1990 American College of Rheumatology (ACR) criteria for TA and with complete data from 1990 to 2014 were reviewed retrospectively. The demographic data, symptoms and signs, laboratory test results, radiological features, treatment, and interventional or surgical procedures were collected and analyzed. Patients with radiological confirmed stroke were identified. Chi-square test or Fisher exact test was used to compare the differences between patients with and without stroke. Results Twenty-two patients with ischemic stroke (IS) and 4 patients with hemorrhagic stroke were identified. The incidence of stroke in TA patients was 6.3% (26/411), of which 11 patients were considered to be the initial manifestation. Stroke patients had more visual acuity loss (15.4% vs. 4.7%, P = 0.042). Systemic inflammatory symptoms and inflammatory markers were less common in patients with stroke than in those without stroke [fever P = 0.007; erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), P < 0.001]. Cranial angiography showed that common carotid artery (CCA) (73.0%, 19/26) and subclavian artery (SCA) (73.0%, 19/26) were the most involved, followed by internal carotid artery (ICA) (57.7%, 15/26) in stroke patients. The intracranial vascular involvement rate of stroke patients was 38.5% (10/26); the middle cerebral artery (MCA) was the most common artery involved. The most common site of stroke was the basal ganglia region. The occurrence of intracranial vascular involvement was much higher in patients with stroke when compared to patients without stroke (38.5% vs. 5.5%, P < 0.001). Among all patients with intracranial vascular involvement, patients without stroke received more aggressive treatment than patients with stroke (90.4% vs. 20.0%, P < 0.001). There was no significant increase in in-hospital mortality in patients with stroke compared with patients without stroke (3.8% vs. 2.3%, P = 0.629). Conclusion Stroke is the initial presentation in 50% of TA patients with stroke. The intracranial vascular involvement rate is significantly increased in stroke patients than in patients without stroke. The artery invloved in patients with stroke are cervical artery and intracranial involvement. Systemic inflammation is less in patients with stroke. Aggressive treatment for TA with glucosteroid (GC) and immunosuppressive agents combined with anti-stroke therapy is needed to improve the prognosis of TA complicated stroke.
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Affiliation(s)
- Guizhi Zhang
- Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Rheumatism Data Center (CRDC), Beijing100730, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing100032, China
| | - Yunjiao Yang
- Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Rheumatism Data Center (CRDC), Beijing100730, China
| | - Jing Li
- Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Rheumatism Data Center (CRDC), Beijing100730, China
| | - Xinping Tian
- Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Rheumatism Data Center (CRDC), Beijing100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Rheumatism Data Center (CRDC), Beijing100730, China
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10
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Liao H, Zhang N, Pan L, Du J, Liu J, Zheng Y. Predictors for pulmonary artery involvement in Takayasu arteritis and its cluster analysis. Arthritis Res Ther 2023; 25:9. [PMID: 36639641 PMCID: PMC9840297 DOI: 10.1186/s13075-022-02987-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the clinical characteristics and the site of pulmonary involvement in Takayasu arteritis (TAK) patients with pulmonary artery involvement (PAI). METHODS We retrospectively investigated data of 141 TAK patients. The clinical and image data of the patients with and without PAI were analyzed and compared. The patients were followed up. The major outcome was all-cause mortality. The minor outcome was exacerbation or new occurrence of PAI, which leads to disease progression events. RESULTS For the 141 TAK patients considered, PAI was detected in 65 (46.1%) patients. TAK patients with PAI had a significantly higher cumulative incidence of events than those without PAI (P < 0.001). The frequencies of the following were significantly higher in TAK with PAI than those in TAK without PAI: disease duration [median 96 months (IQR: 24-174) vs. median 42 months (IQR: 6-120); P = 0.012], hemoptysis (10.8% vs. 1.32%; P = 0.040), oppression in the chest (40.0% vs. 21.1%; P = 0.014), fever (23.1% vs. 9.21%; P = 0.024), Mycobacterium tuberculosis infection (21.5% vs. 6.57%; P = 0.010), pulmonary hypertension (PAH) (21.5% vs. 2.6%; P < 0.001), pulmonary infarction (41.5% vs. 0%; P < 0.001), and hypoxemia (18.5% vs. 1.3%; P < 0.001). Multivariate logistic regression analysis of data of TAK patients with symptom presentation showed that oppression in the chest (OR: 2.304; 95% CI: 1.024-5.183; P = 0.044) and thoracic aorta involvement (OR: 2.819; 95% CI: 1.165-6.833; P = 0.022) were associated with PAI. The cluster analysis performed for data of TAK patients with PAI revealed that the cluster characterized as the upper lobe of the right lung (Cluster1) had the worst prognosis. CONCLUSION In TAK, PAI is associated with thoracic aorta involvement. In TAK patients with PAI, the involvement of the upper lobe of the right lung is characterized with the worst prognosis.
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Affiliation(s)
- Hua Liao
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lili Pan
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiayi Liu
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Zheng
- Departments of Rheumatology, Beijing Chaoyang Hospital, Capital Medical University, #8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, China.
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11
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Tamartash Z, Javinani A, Pehlivan Y, Coskun BN, Yekta RA, Dalkilic E, Yağız B, Khavandgar N, Pournazari M, Hajiabbasi A, Sakar O, Zayeni H, Masoleh IS, Shakibi MR, Yazdi F, Mahmoudi M, Masoumi M, Mohammadzadegan AM, Sima F, Salehi S, Faezi ST, Jamshidi AR, Kavosi H. Comparison of clinicodemographic characteristics and pattern of vascular involvement in 126 patients with Takayasu arteritis: a report from Iran and Turkey. Reumatismo 2022; 74. [PMID: 36580066 DOI: 10.4081/reumatismo.2022.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/11/2022] [Indexed: 12/30/2022] Open
Abstract
Takayasu arteritis (TA) is an extremely uncommon vasculitis that primarily affects the aorta and its branches. Due to the genetic and ethnicity effect, a diverse array of TA clinical manifestations has been reported worldwide. The purpose of the present study was to compare the clinicodemographic characteristics and pattern of vascular involvement of Iranian and Turkish TA patients. This study was a retrospective, cross-sectional investigation of 126 TA patients in Iran and Turkey. All of the variables analyzed were extracted from historical medical records. In 126 TA patients, the ratio of females to males was 8.6:1, and the average age at onset of disease was 30.5±11.1 years. Fatigue (49.2%) and a weak or absent pulse (79.4%) were the most prevalent symptoms and signs, respectively. The most prevalent angiographic classifications were types V and I in Iranian patients (41.09%) and type I in the Turkish population (47.7%) The left subclavian artery was the vessel most frequently affected by TA (66.6%). Our findings indicated that there were no significant differences between the two countries in terms of clinicodemographic characteristics or vascular involvement. Some clinical manifestations, such as claudication, were more prevalent in the Turkish population due to a higher incidence of occlusive lesions in the right subclavian artery.
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Affiliation(s)
- Z Tamartash
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - A Javinani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - Y Pehlivan
- Department of Rheumatology, Uludag University, Bursa.
| | - B N Coskun
- Department of Rheumatology, Uludag University, Bursa.
| | - R A Yekta
- Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran.
| | - E Dalkilic
- Department of Rheumatology, Uludag University, Bursa.
| | - B Yağız
- Department of Rheumatology, Uludag University, Bursa.
| | - N Khavandgar
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - M Pournazari
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah.
| | - A Hajiabbasi
- Department of Rheumatology, Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht.
| | - O Sakar
- Department of Internal Medicine, Uludag University, Bursa.
| | - H Zayeni
- Department of Rheumatology, Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht.
| | - I S Masoleh
- Department of Rheumatology, Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht.
| | - M R Shakibi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman.
| | - F Yazdi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman.
| | - M Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - M Masoumi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom.
| | - A M Mohammadzadegan
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - F Sima
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - S Salehi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - S T Faezi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - A R Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
| | - H Kavosi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran.
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12
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Misra DP, Tomelleri A, Rathore U, Benanti G, Singh K, Behera MR, Jain N, Ora M, Bhadauria DS, Gambhir S, Kumar S, Baldissera E, Agarwal V, Campochiaro C, Dagna L. Impact of Geographic Location on Diagnosis and Initial Management of Takayasu Arteritis: A Tale of Two Cohorts from Italy and India. Diagnostics (Basel) 2022; 12:diagnostics12123102. [PMID: 36553110 PMCID: PMC9777621 DOI: 10.3390/diagnostics12123102] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/08/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
The present study compares disease characteristics, imaging modalities used, and patterns of treatment in two large cohorts of Takayasu arteritis (TAK) from Italy and India. Clinic files were retrospectively reviewed to retrieve information about initial choices of vascular imaging and immunosuppressive therapies. Unpaired t-tests compared means, and proportions were compared using Fisher’s exact test or Chi square test [Odds ratios (OR) with 95% confidence intervals (95%CI) calculated where appropriate]. The cohorts comprised 318 patients [Italy (n = 127), India (n = 191)] with similar delays to diagnosis. Ultrasound (OR Italy vs. India 9.25, 95%CI 5.02−17.07) was more frequently used in Italy and CT angiography in India (OR 0.32, 95%CI 0.20−0.51). Corticosteroid use was more prevalent and for longer duration in Italy. TAK from Italy had been more often treated with methotrexate, leflunomide or azathioprine, as opposed to tacrolimus in TAK from India (p < 0.05). Biologic or targeted synthetic disease-modifying agents were almost exclusively used in Italy. Survival on first immunosuppressive agent was longer from Italy than from India (log rank test p value 0.041). Considerable differences in the choice of initial vascular imaging modality and therapies for TAK from Italy and India could relate to prevalent socio-economic disparities. These should be considered while developing treatment recommendations for TAK.
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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
- Correspondence: (D.P.M.); (C.C.)
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Upendra Rathore
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Giovanni Benanti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Kritika Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Manas Ranjan Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Neeraj Jain
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Manish Ora
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Dharmendra Singh Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence: (D.P.M.); (C.C.)
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
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13
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Comparison of Presentation and Prognosis of Takayasu Arteritis with or without Stroke or Transient Ischemic Attack-A Retrospective Cohort Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111904. [PMID: 36431038 PMCID: PMC9697956 DOI: 10.3390/life12111904] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. We compared the clinical presentation, angiographic features, longitudinal patterns of disease activity, medical treatments, and survival in 34 TAK patients with stroke/TIA and 157 without stroke/TIA from a single-center retrospective cohort. TAK patients with stroke/TIA were older (p = 0.044) with a greater proportion of males (p = 0.022), more frequent vision loss (odds ratio (OR) for stroke/TIA vs. without stroke TIA 5.21, 95% CI 1.42-19.14), and less frequent pulse or blood pressure inequality (OR 0.43, 95% CI 0.19-0.96) than TAK patients without stroke/TIA. Hata's angiographic type IIa was more common in TAK patients with stroke/TIA (OR 11.00, 95%CI 2.60-46.58) and type V in TAK patients without stroke/TIA (OR 0.27, 95% CI 0.12-0.58). Cyclophosphamide was used more often in TAK patients with stroke/TIA (p = 0.018). Disease activity at baseline, 6, 12, and 24 months of follow-up was mostly similar for both groups. Risk of mortality was similar in TAK patients with or without stroke/TIA (hazard ratio unadjusted 0.76, 95% CI 0.15-3.99; adjusted for gender, age of disease onset, delay to diagnosis, baseline disease activity, and the number of conventional or biologic/targeted synthetic immunosuppressants used 1.38, 95% CI 0.19-10.20) even after propensity score-matched analyses. Stroke or TIA does not appear to affect survival in TAK patients adversely.
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14
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Direct aortic access for endovascular thoracoabdominal aneurysm repair using a bifurcated endograft as a branched device. J Vasc Surg Cases Innov Tech 2022; 9:101056. [PMID: 36747604 PMCID: PMC9898790 DOI: 10.1016/j.jvscit.2022.10.014] [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: 07/24/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Aortic aneurysms (AA) are a common complication in patients with large-vessel vasculitis, such as chronic phase Takayasu arteritis, that often require surgical management to prevent a lethal rupture. Historically, mainstay of treatment for AA in the setting of arteritis was traditional open repair. However, in this case study an alternative surgical approach was devised to successfully treat an extent III thoracoabdominal AA in a patient with a diagnosis of Takayasu arteritis and a complex surgical history that made her high risk for an open surgical intervention. This case study summarizes a hybrid surgical approach that successfully excluded a thoracoabdominal AA and revascularized the superior mesenteric artery and left renal artery, by directly accessing the infrarenal aorta and using a bifurcated abdominal aortic endograft as a two-vessel branched device.
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15
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Mirouse A, Deltour S, Leclercq D, Squara PA, Pouchelon C, Comarmond C, Kahn JE, Benhamou Y, Mirault T, Mekinian A, Lambert M, Chiche L, Koskas F, Cluzel P, Redheuil A, Cacoub P, Biard L, Saadoun D. Cerebrovascular Ischemic Events in Patients With Takayasu Arteritis. Stroke 2022; 53:1550-1557. [PMID: 35354303 DOI: 10.1161/strokeaha.121.034445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Takayasu arteritis (TA) is a large vessel vasculitis that may complicate with cerebrovascular ischemic events. The objective was to describe clinical and vascular features of TA patients with cerebrovascular ischemic events and to identify risk factors for these events. METHODS We analyzed the prevalence and type of stroke/transient ischemic attack (TIA), factors associated with cerebrovascular ischemic events, and stroke-free survival in a large cohort fulfilling the American College of Rheumatology or Ishikawa criteria of TA. RESULTS Among 320 patients with TA (median age at diagnosis, 36 [25-47] years; 261 [86%] women), 63 (20%) had a stroke (n=41; 65%) or TIA (n=22; 35%). Ischemic event localized in the carotid territory for 55 (87%) patients and the vertebral artery territory in 8 (13%) patients. Multiple stenosis were observed in 33 (52%) patients with a median number of stenosis of 2 (minimum, 0 to maximum, 11), and aneurysms were observed in 10 (16%) patients. A history of stroke or TIA before TA diagnosis (hazard ratio [HR], 4.50 [2.45-8.17]; P<0.0001), smoking (HR, 1.75 [1.01-3.02]; P=0.05), myocardial infarction history (HR, 0.21 [0.05-0.89]; P=0.039), thoracic aorta involvement (HR, 2.05 [1.30-3.75]; P=0.023), time from first symptoms to diagnosis >1 year (HR, 2.22 [1.30-3.80]; P=0.005), and aspirin treatment (HR, 1.82 [1.04-3.19]; P=0.035) were associated with cerebrovascular ischemic event. In multivariate analysis, time from first symptoms to TA diagnosis >1 year (HR, 2.16 [1.27-3.70]; P=0.007) was independently associated with cerebrovascular ischemic events in patients with TA. The HR for cerebrovascular ischemic event in patients who already experienced a stroke/TIA was 5.11 (2.91-8.99; P<0.0001), compared with those who had not. CONCLUSIONS Carotid stroke/TIA is frequent in TA. We identified factors associated with cerebrovascular ischemic events.
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Affiliation(s)
- Adrien Mirouse
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Sandrine Deltour
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Service de Neurologie, Hôpital Raymond Poincaré, APHP, Université Versailles Saint Quentin en Yvelines, Garches, France (S.D.)
| | - Delphine Leclercq
- Service de Neuro-Radiologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (D.L.)
| | - Pierre-Alexandre Squara
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - Clara Pouchelon
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.)
| | - Cloé Comarmond
- Département de Médecine Interne et Immunologie Clinique, Hôpital Lariboisière APHP, Paris, France. (C.C.)
| | - Jean-Emmanuel Kahn
- Service de Médecine Interne, Hôpital Ambroise Paré, APHP, Boulogne, France (J.-E.K.)
| | - Ygal Benhamou
- Service de Médecine Interne, Vasculaire et Thrombose, CHU de Rouen, France (Y.B.)
| | - Tristan Mirault
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, APHP, Paris, France. (T.M.)
| | - Arsène Mekinian
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France. (A. Mekinian).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Marc Lambert
- Service de Médecine Interne, CHRU de Lille, France (M.L.)
| | - Laurent Chiche
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.)
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Philippe Cluzel
- Service de Radiologie Interventionnelle, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (P. Cluzel).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Alban Redheuil
- Service de Radiologie et Imagerie Cardio-Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (A.R.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Lucie Biard
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - David Saadoun
- Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
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Abstract
Large-vessel vasculitis (LVV) manifests as inflammation of the aorta and its major branches and is the most common primary vasculitis in adults. LVV comprises two distinct conditions, giant cell arteritis and Takayasu arteritis, although the phenotypic spectrum of primary LVV is complex. Non-specific symptoms often predominate and so patients with LVV present to a range of health-care providers and settings. Rapid diagnosis, specialist referral and early treatment are key to good patient outcomes. Unfortunately, disease relapse remains common and chronic vascular complications are a source of considerable morbidity. Although accurate monitoring of disease activity is challenging, progress in vascular imaging techniques and the measurement of laboratory biomarkers may facilitate better matching of treatment intensity with disease activity. Further, advances in our understanding of disease pathophysiology have paved the way for novel biologic treatments that target important mediators of disease in both giant cell arteritis and Takayasu arteritis. This work has highlighted the substantial heterogeneity present within LVV and the importance of an individualized therapeutic approach. Future work will focus on understanding the mechanisms of persisting vascular inflammation, which will inform the development of increasingly sophisticated imaging technologies. Together, these will enable better disease prognostication, limit treatment-associated adverse effects, and facilitate targeted development and use of novel therapies.
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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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de Boysson H, Pagnoux C. Vasculiti del sistema nervoso centrale. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Intracranial Involvement in Takayasu's Arteritis. Diagnostics (Basel) 2021; 11:diagnostics11111997. [PMID: 34829344 PMCID: PMC8624213 DOI: 10.3390/diagnostics11111997] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Takayasu’s arteritis (TAK) is a large-vessel vasculitis that targets the aorta and its major branches. Although extracranial vascular involvement is uniformly present in this disease, the frequency of intracranial involvement in TAK has not been well studied. We retrospectively reviewed the clinical and imaging records of patients diagnosed with TAK at a single Canadian university medical centre to determine the prevalence of intracranial vascular involvement. Intracranial vascular and non-vascular findings were described, and a review of the literature was performed. Of 20 patients with TAK, 12 had vascular neuroimaging completed. Intracranial vascular lesions were identified in 4 patients (33.3% of those with imaging available, 20% of all patients). The frequency of intracranial vessel involvement in TAK may be more common than appreciated. Imaging of both the intra- and extra-cranial vessels should be considered in these young patients.
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20
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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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21
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Ying S, Sifan W, Yujiao W, Rongyi C, Qingrong H, Lili M, Huiyong C, Lindi J. Clinical characteristics, imaging phenotypes and events free survival in Takayasu arteritis patients with hypertension. Arthritis Res Ther 2021; 23:196. [PMID: 34289874 PMCID: PMC8293580 DOI: 10.1186/s13075-021-02579-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension occurred in 30-80% of Takayasu arteritis (TAK) patients around the world and the occurrence of hypertension might worsen the disease prognosis. This study aimed to investigate the clinical characteristics and imaging phenotypes, as well as their associations with events free survival (EFS) in Chinese TAK patients with hypertension. METHODS This current research was based on a prospectively ongoing observational cohort-the East China Takayasu Arteritis (ECTA) cohort, centered in Zhongshan Hospital, Fudan University. Totally, 204 TAK patients with hypertension were enrolled between January 2013 and December 2019. Clinical characteristics and imaging phenotypes of each case were evaluated and their associations with the EFS by the end of August 30, 2020, were analyzed. RESULTS Severe hypertension accounted for 46.1% of the entire population. Three specific imaging phenotypes were identified: Cluster 1: involvement of the abdominal aorta and/or renal artery (27.5%); Cluster 2: involvement of the ascending aorta, thoracic aorta, the aortic arch, and/or its branches (18.6%); and Cluster 3: combined involvement of Cluster 1 and 2 (53.9%). Clinical characteristics, especially hypertensive severity, differed greatly among the three imaging clusters. In all, 187 patients were followed up for a median of 46 (9-102) months; 72 events were observed in 60 patients (1-3 per person). The overall blood pressure control rate was 50.8%, and the EFS was 67.9% by the end of the follow-up. Multivariate Cox regression indicated that controlled blood pressure (HR = 2.13, 95% CI 1.32-3.74), Cluster 1 (HR = 0.69, 95% CI 0.48-0.92) and Cluster 3 (HR = 0.72, 95% CI 0.43-0.94) imaging phenotype was associated with the EFS. Kaplan-Meier curves showed that patients with controlled blood pressure showed better EFS (p = 0.043). Furthermore, using cases with Cluster 1 imaging phenotype and controlled blood pressure as reference, better EFS was observed in patients with Cluster 2 phenotype and controlled blood pressure (HR = 2.21, 95%CI 1.47-4.32), while the case with Cluster 1 phenotype plus uncontrolled blood pressure (HR = 0.64, 95%CI 0.52-0.89) and those with Cluster 3 phenotype and uncontrolled blood pressure (HR = 0.83, 95%CI 0.76-0.92) suffered worse EFS. CONCLUSION Blood pressure control status and imaging phenotypes showed significant effects on the EFS for TAK patients with hypertension.
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Affiliation(s)
- Sun Ying
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wu Sifan
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wang Yujiao
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chen Rongyi
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Huang Qingrong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ma Lili
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Centre of Evidence-based Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chen Huiyong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jiang Lindi
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China. .,Centre of Evidence-based Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
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22
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Danda D, Goel R, Joseph G, Kumar ST, Nair A, Ravindran R, Jeyaseelan L, Merkel PA, Grayson PC. Clinical course of 602 patients with Takayasu's arteritis: comparison between Childhood-onset versus adult onset disease. Rheumatology (Oxford) 2021; 60:2246-2255. [PMID: 33179052 DOI: 10.1093/rheumatology/keaa569] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/18/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe the clinical profile of Asian Indian patients with Takayasu's arteritis (TAK) and to compare clinical features and outcome of childhood-onset Takayasu's arteritis (cTAK) with adult-onset TAK (aTAK). METHODS Data related to clinical features and response to treatment of patients with cTAK (age of onset <16 years) and aTAK from a large observational cohort in our tertiary care teaching hospital were noted and compared. RESULTS Altogether, 602 patients (cTAK = 119; aTAK = 483) were studied. Patients with cTAK had a blunted female: male ratio; but fever, elevated acute phase reactants, involvement of abdominal aorta or its branches, hypertension, abdominal pain, elevated serum creatinine and cardiomyopathy were more common in cTAK as compared with aTAK. Patients with aTAK were more likely to have aortic-arch disease and claudication than cTAK. During follow-up, complete remission was more common in cTAK (87% vs 66%; P < 0.01), but subsequent relapses were equally common (30% vs 27%; P = 0.63). Independent associations of disease duration at presentation with disease extent [Disease Extent Index in TAK (DEI.Tak)] and damage [TAK Damage Score (TADS)] were observed (P ≤ 0.01). Moreover, 54% of patients with symptom duration of >5 years at presentation still continued to have elevated CRP suggesting continued and active inflammation warranting escalation or inititation of immunosuppression. CONCLUSION Patients with cTAK are more likely to have arterial disease below the diaphragm, systemic inflammation and achieve remission. Disease of the aortic arch is more common in patients with aTAK. Longer duration of symptoms prior to initiation of immunosuppression, thereby leading to extensive disease and damage, reflects ongoing disease activity as the rule rather than exception in untreated TAK.
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Affiliation(s)
| | - Ruchika Goel
- Department of Clinical Immunology and Rheumatology
| | | | - Sathish T Kumar
- Department of Child Health, Christian Medical College, Vellore, India
| | - Aswin Nair
- Department of Clinical Immunology and Rheumatology
| | | | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch/NIAMS, National Institutes of Health, Bethesda, MD, USA
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23
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Liu HH, Tsai HH, Wei JCC. Cardiovascular and Renal Morbidity in Takayasu Arteritis: Comment on the Article by Goel et al. Arthritis Rheumatol 2021; 73:2145. [PMID: 34042289 DOI: 10.1002/art.41804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Affiliation(s)
| | - Hao-Hung Tsai
- Department of Medical Imaging, Chung Shan Medical University Hospital and Institute of Medicine, College of Medicine, Chung Shan Medical University
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Institute of Medicine, College of Medicine, Chung Shan Medical University and Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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24
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Kong F, Huang X, Su L, Liao Q, Wang C, Zhao Y. Risk factors for cerebral infarction in Takayasu arteritis: a single-centre case-controlled study. Rheumatology (Oxford) 2021; 61:281-290. [PMID: 33774663 DOI: 10.1093/rheumatology/keab308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We aimed to investigate the clinical features of Takayasu arteritis (TA) with cerebral infarction (CI) and the risk factors for CI. METHODS The study analysed 122 consecutive patients with TA retrospectively. The clinical characteristics of TA patients with and without CI were compared. Binary logistic regression analysis was performed to determine risk factors for CI in TA patients. RESULTS CI was present in 42 (34.4%) of 122 patients with TA. There were 33 patients with ischemic stroke and 11 with asymptomatic lacunar infarction, including two patients with both types of infarction. The CI group had a significantly higher proportion of males, higher prevalence of blurred vision, and higher Indian Takayasu Clinical Activity Score (ITAS) 2010 than the non-CI group. Binary logistic regression analysis indicated that hyperlipidaemia (OR 5.549, p = 0.021), ITAS 2010 (OR 1.123, p = 0.023), number of involved arteries (OR 1.307, p = 0.018), and middle cerebral artery (MCA) involvement (OR 4.013, p = 0.029) were significantly associated with CI in patients with TA. Receiver operating characteristic curves indicated fair performance of the ITAS 2010 (> 6) and number of involved arteries (> 7) for distinguishing TA patients at risk of CI from those without such risk. CONCLUSION Hyperlipidaemia, higher ITAS 2010, larger number of involved arteries, and MCA involvement are independent risk factors for CI in TA patients.
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Affiliation(s)
- Fang Kong
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Xu Huang
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Li Su
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Qiuju Liao
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Chunxiu Wang
- Evidence-Based Medical Centre, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, 100053, China
| | - Yi Zhao
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
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25
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Goel R, Chandan JS, Thayakaran R, Adderley NJ, Nirantharakumar K, Harper L. Cardiovascular and Renal Morbidity in Takayasu Arteritis: A Population‐Based Retrospective Cohort Study From the United Kingdom. Arthritis Rheumatol 2021; 73:504-511. [DOI: 10.1002/art.41529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ruchika Goel
- University of Birmingham and Queen Elizabeth Hospital Birmingham Birmingham UK
| | | | | | | | | | - Lorraine Harper
- University of Birmingham and Queen Elizabeth Hospital Birmingham Birmingham UK
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26
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Jang SY, Park TK, Kim DK. Survival and causes of death for Takayasu's arteritis in Korea: A retrospective population-based study. Int J Rheum Dis 2020; 24:69-73. [PMID: 33089946 DOI: 10.1111/1756-185x.14005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few studies have evaluated survival of Takayasu's arteritis (TAK; M31.4) in Korea. The purpose of this study was to assess the survival rate (SR) and causes of death for TAK. METHODS Newly diagnosed TAK data (N = 2731) were collected from the National Health Insurance Service in Korea from 2006 through 2017. The Kaplan-Meier method was used. Korean death data was used from 2006 through 2018. RESULTS The mean age was 48.1 (±16.9) years. The proportion of female patients was 74.4%. The most common cause of death in TAK was diseases of the circulatory system. The 1-, 3-, 5-, and 10-year SRs were 97.5%, 94.7%, 91.7%, and 84.7%, respectively. The 1-, 3-, 5-, and 10-year SRs by gender were 97.8%, 95.6%, 92.9%, and 86.3%, respectively, among females and 96.8%, 92.2%, 88.4%s and 79.7%, respectively, among males (P < .001). CONCLUSIONS The overall 10-year SR was about 85%. The 10-year SR in males was lower than that in females. The most common cause of death in TAK was diseases of the circulatory system.
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Affiliation(s)
- Shin Yi Jang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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27
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Koster MJ, Warrington KJ, Matteson EL. Morbidity and Mortality of Large-Vessel Vasculitides. Curr Rheumatol Rep 2020; 22:86. [DOI: 10.1007/s11926-020-00963-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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Aydin F, Acar B, Uncu N, BaŞaran Ö, Adalet Yildiz E, GÜven A, Çakar N. Takayasu Arteritis: A Case Presenting With Neurological Symptoms and Proteinuria. Arch Rheumatol 2020; 35:287-291. [PMID: 32851381 DOI: 10.46497/archrheumatol.2020.7402] [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: 01/12/2019] [Accepted: 07/01/2019] [Indexed: 11/03/2022] Open
Abstract
In this article, we present an 18-year-old female patient who was initially diagnosed as central nervous system vasculitis and focal segmental glomerulosclerosis but later diagnosed as Takayasu arteritis.
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Affiliation(s)
- Fatma Aydin
- Department of Pediatric Rheumatology, Ankara Child Health, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Rheumatology, Ankara Child Health, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Nermin Uncu
- Department of Pediatric Rheumatology, Ankara Child Health, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Özge BaŞaran
- Department of Pediatric Rheumatology, Ankara Child Health, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Elçin Adalet Yildiz
- Department of Pediatric Radiology, Ankara Child Health, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Alev GÜven
- Department of Pediatric Neurology, Ankara Child Health, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Nilgün Çakar
- Department of Pediatric Rheumatology and Nephrology, Ankara University School of Medicine, Ankara, Turkey
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29
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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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30
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Mangouka GL, Iroungou BA, Bivigou-Mboumba B, Ngabou D, Badidi Moulay EM, Darbi A, Nzenze JR. Takayasu Arteritis Associated with Latent Tuberculosis Infection: A 39-Year-Old Woman Is the First Case in Gabon. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920195. [PMID: 32740649 PMCID: PMC7423173 DOI: 10.12659/ajcr.920195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 39-year-old Final Diagnosis: Takayasu arteritis Symptoms: Fever • arthralgia • asthenia Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
| | | | - Berthold Bivigou-Mboumba
- Franceville International Center for Medical Research, Mixed Unit on HIV and Related Infectious Diseases, Franceville, Gabon
| | - Davy Ngabou
- Department of Surgery, HIAOBO (Omar Bongo Ondimba Army Training Hospital), Libreville, Gabon
| | - El Medhi Badidi Moulay
- Department of Cardiology, HIAOBO (Omar Bongo Ondimba Army Training Hospital), Libreville, Gabon
| | - Abdelatif Darbi
- Department of Radiology, HIAOBO (Omar Bongo Ondimba Army Training Hospital), Libreville, Gabon
| | - Jean Raymond Nzenze
- Department of Internal Medicine, HIAOBO (Omar Bongo Ondimba Army Training Hospital), Libreville, Gabon
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31
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Yu RY, AlSolimani R, Khalidi N, Pagnoux C, Barra L. Characteristics of Takayasu Arteritis Patients with Severe Ischemic Events. J Rheumatol 2020; 47:1224-1228. [PMID: 31615911 DOI: 10.3899/jrheum.190407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Takayasu arteritis (TA) is a rare large-vessel vasculitis that puts patients at high risk of developing severe ischemic events (SIE). Outcomes for TA patients with SIE are poorly understood. We aim to describe the characteristics of TA patients experiencing SIE. METHODS All TA patients with at least 1 followup visit seen between 1988 and 2015 were included from 3 academic centers in Ontario, Canada. Diagnosis was based on American College of Rheumatology criteria, physician opinion, and vascular imaging. SIE were defined as cerebrovascular accident (CVA), acute coronary syndrome (ACS), ischemic cardiomyopathy, ischemic blindness, and/or ischemic bowel or limb requiring surgery. RESULTS Of the 52 patients with TA included in the study, 51 (98%) were female and 22 (42%) were of European descent. The mean age was 31 (SD 12) at the time of diagnosis and the followup time was 6 years (SD 5). Fifteen (29%) experienced an SIE: 5 CVA, 5 ACS, 1 ischemic cardiomyopathy, and 4 limb ischemia. Thirteen out of 15 SIE (87%) occurred at or before diagnosis. Patients with SIE were more likely than those without SIE to be started on corticosteroids combined with immunosuppressants (p = 0.04) and antiplatelet agents (p = 0.004). Outcomes including disease activity and damage scores were similar between patients with and without SIE. CONCLUSION SIE are common in patients with TA and occur early in the disease. With aggressive treatment, patients with SIE had a favorable prognosis.
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Affiliation(s)
- Richard Ying Yu
- From the Schulich School of Medicine and Dentistry, Western University, London, Ontario; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, Ontario; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,R.Y. Yu, BSc, Schulich School of Medicine and Dentistry, Western University; R. AlSolimani, MD, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, and Consultant of Internal Medicine, Rheumatologist, King Abdulaziz University, Jeddah, Saudi Arabia; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C. Pagnoux, MD, MPH, Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; L. Barra, MD, MPH, Schulich School of Medicine and Dentistry, Western University, and Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario
| | - Roaa AlSolimani
- From the Schulich School of Medicine and Dentistry, Western University, London, Ontario; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, Ontario; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,R.Y. Yu, BSc, Schulich School of Medicine and Dentistry, Western University; R. AlSolimani, MD, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, and Consultant of Internal Medicine, Rheumatologist, King Abdulaziz University, Jeddah, Saudi Arabia; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C. Pagnoux, MD, MPH, Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; L. Barra, MD, MPH, Schulich School of Medicine and Dentistry, Western University, and Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario
| | - Nader Khalidi
- From the Schulich School of Medicine and Dentistry, Western University, London, Ontario; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, Ontario; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,R.Y. Yu, BSc, Schulich School of Medicine and Dentistry, Western University; R. AlSolimani, MD, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, and Consultant of Internal Medicine, Rheumatologist, King Abdulaziz University, Jeddah, Saudi Arabia; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C. Pagnoux, MD, MPH, Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; L. Barra, MD, MPH, Schulich School of Medicine and Dentistry, Western University, and Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario
| | - Christian Pagnoux
- From the Schulich School of Medicine and Dentistry, Western University, London, Ontario; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, Ontario; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,R.Y. Yu, BSc, Schulich School of Medicine and Dentistry, Western University; R. AlSolimani, MD, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, and Consultant of Internal Medicine, Rheumatologist, King Abdulaziz University, Jeddah, Saudi Arabia; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C. Pagnoux, MD, MPH, Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; L. Barra, MD, MPH, Schulich School of Medicine and Dentistry, Western University, and Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario
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Pulmonary artery involvement in Takayasu arteritis: a retrospective study in Chinese population. Clin Rheumatol 2020; 40:635-644. [PMID: 32643055 DOI: 10.1007/s10067-020-05271-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 06/14/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Takayasu's arteritis (TA) may involve the pulmonary artery, which signifies a poor prognosis. This study investigated the features of TA patients with pulmonary artery involvement. METHODS One hundred and twenty-six inpatients diagnosed with TA were retrospectively studied. The clinical data of TA patients with and without pulmonary artery involvement were compared. The imaging features of pulmonary artery lesions in TA patients were evaluated. The treatment responses of pulmonary artery lesions were described, and the drug regimens in different treatment response groups were compared. RESULTS Among the patients with TA, 15.9% showed associated pulmonary artery involvement. The disease durations were significantly longer in patients with pulmonary artery involvement than in those without (108.0 months (53.5, 222.0) vs. 36.0 months (12.0, 120.0); p = 0.038). Hemoptysis was more common in TA patients with pulmonary artery involvement than in those without (15.0%, 3 cases vs. 0.0%; p < 0.001). TA patients with disease duration longer than 5 years showed a 3.42-fold higher odds of pulmonary artery involvement than those with a disease duration of less than 5 years (adjusted odds ratio, 3.42 (95% confidence interval, 1.20-9.76); p = 0.02). The most common imaging manifestations of pulmonary artery involvement were stenosis and occlusion. Among the six patients who had good response to treatment of pulmonary artery lesions, five were treated with the interleukin-6 receptor antagonist tocilizumab. CONCLUSIONS TA patients with pulmonary artery involvement have a longer course of disease and more symptoms of hemoptysis. TA-related pulmonary artery lesions more commonly manifested as stenosis and occlusion. Tocilizumab may be effective for TA-related pulmonary vascular disease. Key Points • Disease duration longer than 5 years is associated with pulmonary artery involvement in TA. • Hemoptysis is a characteristic clinical symptom of TA with pulmonary artery involvement. • Tocilizumab may be more effective for pulmonary artery lesions of TA.
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Malek Mahdavi A, Rashtchizadeh N, Kavandi H, Hajialilo M, Kolahi S, Nakhjavani MR, Ebrahimi AA, Seyedmardani S, Salesi M, Soroush M, Khabbazi A. Clinical characteristics and long-term outcome of Takayasu arteritis in Iran: a multicentre study. Turk J Med Sci 2020; 50:713-723. [PMID: 32093440 PMCID: PMC7379441 DOI: 10.3906/sag-1910-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/19/2020] [Indexed: 01/09/2023] Open
Abstract
Background/aim This study aimed to evaluate the demographic, clinical, angiographic and prognostic characteristics of Takayasu
arteritis (TA) in Iran. Materials and methods A total of 75 patients with TA based on the American College of Rheumatology 1990 criteria for TA classification referred to the Rheumatology Centres, were followed-up from 1989 to 2019. Demographic, clinical, angiographic and prognostic characteristics were collected at baseline and last visit. Results The mean age was 31.9 ± 9.8 years at the disease onset. Female to male ratio was 14. The median latency in diagnosis was 24 months. Pulse discrepancy in the arms, blood pressure discrepancy in the arms, limb claudication, hypertension and constitutional symptoms were the most common clinical features. The most common angiographic type at the time of diagnosis was Type I (42.7%). The most frequent arterial lesion was stenosis (89.4%). Subclavian, carotid and aortic arteries were the most commonly involved arteries. New lesions developed in 28.6% of patients during the 5.25-year follow-up. Vasculitis-induced chronic damage was observed in all patients. Disease activity decreased and vascular damage remained stable throughout the follow-up period. Conclusions The clinical features and angiographic type of TA in Iran are different from most Asian countries. Differences in angiographic and clinical features may lead to delayed diagnosis. The issue of delay in diagnosis should create awareness among health care providers that TA is not a very rare disease in Iranians and failure to pay attention to warning symptoms may delay the diagnosis.
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Affiliation(s)
- Aida Malek Mahdavi
- Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nadereh Rashtchizadeh
- Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadiseh Kavandi
- Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrzad Hajialilo
- Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sousan Kolahi
- Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Ali-Asghar Ebrahimi
- Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyedmostafa Seyedmardani
- Rheumatology Section, Department of Internal Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mansour Salesi
- Rheumatology Section, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Soroush
- Rheumatology Section, Department of Internal Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Alireza Khabbazi
- Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
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Multiple occlusions in extracranial arteries in patients with aortic arch syndrome: is minimally invasive treatment still possible? Technical aspects of the treatment based on our own experience and a review of the literature. Wideochir Inne Tech Maloinwazyjne 2020; 16:183-190. [PMID: 33786133 PMCID: PMC7991926 DOI: 10.5114/wiitm.2020.94517] [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: 02/24/2020] [Accepted: 03/08/2020] [Indexed: 11/21/2022] Open
Abstract
Takayasu arteritis is a large vessel vasculitis of granulomatous nature and unknown aetiology affecting predominantly the aorta and its major branches, which may lead to ischaemic symptoms of many organs including the central nervous system. To decrease the risk of neurological complications and improve the quality of life, an arterial revascularisation may be necessary. The treatment options include pharmacotherapy as well as both open surgical and endovascular procedures, which has to be carefully chosen to obtain clinical success. There is an ongoing debate on the advantages, possibilities, and indications for implementing endovascular and open surgical methods, especially in high-risk patients. In this article we present our own experience in the treatment of an unusually complex and high-risk patient with multiple occlusion of supra-aortic branches, focusing on the technical aspects of the procedures and the decision-making process, as well as to confront with contemporary medical knowledge.
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Zaldivar Villon MLF, de la Rocha JAL, Espinoza LR. Takayasu Arteritis: Recent Developments. Curr Rheumatol Rep 2019; 21:45. [DOI: 10.1007/s11926-019-0848-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Tomelleri A, Campochiaro C, Sartorelli S, Cavalli G, De Luca G, Baldissera E, Dagna L. Gender differences in clinical presentation and vascular pattern in patients with Takayasu arteritis. Scand J Rheumatol 2019; 48:482-490. [PMID: 31064248 DOI: 10.1080/03009742.2019.1581838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To compare clinical characteristics and pattern of vascular involvement at disease onset according to gender specificity in patients with Takayasu arteritis (TA).Methods: Data from 117 TA patients (11 male, 106 female), diagnosed according to the American College of Rheumatology criteria, from our centre were retrospectively collected. Differences between men and women regarding demographic features, diagnostic delay, signs and symptoms attributed to TA, and arteries involved at diagnosis were compared. Data were obtained from three published articles describing gender differences in TA. A global analysis of these three cohorts plus ours (a total of 578 patients; 108 men, 470 women) was performed.Results: In our TA cohort, age at disease onset and age at diagnosis were not significantly different between genders. Diagnostic delay was higher in men. Male patients showed higher involvement of iliac arteries (right, p = 0.016; left, p = 0.021); females suffered more frequently from upper limb claudication (p = 0.026). In the overall analysis, men had higher prevalence of arterial hypertension (p = 0.007) and more frequent involvement of abdominal aorta (p = 0.026), renal arteries (right, p < 0.001; left, p < 0.001), and iliac arteries (right, p = 0.009; left, p = 0.002). Women more frequently exhibited upper limb claudication (p = 0.042) and involvement of left subclavian artery (p = 0.005), carotid arteries (right, p < 0.001; left, p < 0.001), and supradiaphragmatic aorta (ascending, p = 0.050; arch, p < 0.001; descending, p = 0.003). Inflammatory markers were more frequently raised in women (p = 0.005).Conclusions: In TA patients, gender has a strong influence on pattern of vascular involvement and consequently on clinical presentation. Specifically, women have a higher involvement of the supradiaphragmatic vessels, whereas in men the abdominal vessels are more frequently affected.
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Affiliation(s)
- A Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - C Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - S Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - G Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Radboud University Medical Center, Nijmegen, The Netherlands
| | - G De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - E Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - L Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Delaval L, Daumas A, Samson M, Ebbo M, De Boysson H, Liozon E, Dupuy H, Puyade M, Blockmans D, Benhamou Y, Sacré K, Berezne A, Devilliers H, Pugnet G, Maurier F, Zénone T, de Moreuil C, Lifermann F, Arnaud L, Espitia O, Deroux A, Grobost V, Lazaro E, Agard C, Balageas A, Bouiller K, Durel CA, Humbert S, Rieu V, Roriz M, Souchaud-Debouverie O, Vinzio S, Nguyen Y, Régent A, Guillevin L, Terrier B. Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years. Autoimmun Rev 2019; 18:714-720. [PMID: 31059846 DOI: 10.1016/j.autrev.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Age at onset of large-vessel vasculitis (LVV) is commonly used to distinguish giant cell arteritis (GCA) and Takayasu arteritis (TA). However, LVV between age 50 and 60 years may be difficult to classify. METHODS We conducted a retrospective study including LVV aged between 50 and 60 years at onset (LVV50-60, cases) and compared them to LVV aged over 60 years (LVV>60, controls). LVV was defined histologically and/or morphologically. Controls fulfilled ACR 1990 criteria for GCA or presented isolated aortitis. RESULTS We included 183 LVV50-60 and 183 gender-matched LVV>60. LVV50-60 had more frequent peripheral limb manifestations (23 vs. 5%), and less frequent cephalic (73 vs. 90%) and ocular signs (17 vs. 27%) than LVV>60. Compared to LVV>60, CT angiography and PET/CT scan were more frequently abnormal in LVV50-60 (74 vs. 38%, and 90 vs. 72%, respectively), with aorta being more frequently involved (78 vs. 47%). By multivariate analysis, absence of cephalic symptoms, presence of peripheral limb ischemia and aorta involvement, and increased CRP level were significantly associated with LVV50-60 presentation compared to LVV>60. At last follow-up, compared to LVV>60, LVV50-60 received significantly more lines of treatment (2 vs. 1), more frequent biologics (12 vs. 3%), had more surgery (10 vs. 0%), and had higher prednisone dose (8.8 vs. 6.5 mg/d) at last follow-up, CONCLUSION: LVV onset between 50 and 60 years identifies a subset of patients with more frequent aorta and peripheral vascular involvement and more refractory disease compared to patients with LVV onset after 60.
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Affiliation(s)
- Laure Delaval
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Aurélie Daumas
- Department of Internal Medecine, La Timone University Hospital, Marseille, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Mikael Ebbo
- Department of Internal Medecine, La Timone University Hospital, Marseille, France
| | - Hubert De Boysson
- Department of Internal Medecine, Caen University Hospital, University of Caen-Basse Normandie, France
| | - Eric Liozon
- Department of Internal Medecine, Limoges University Hospital, France
| | - Henry Dupuy
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Mathieu Puyade
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | - Daniel Blockmans
- Clinical department of general internal medicine department, University Hospitals Leuven, Belgium
| | - Ygal Benhamou
- Department of Internal Medecine, 1 rue de Germont, Rouen, France
| | - Karim Sacré
- Department of Internal Medecine, Bichat Hospital, Paris, France
| | - Alice Berezne
- Department of Internal Medecine, CHR Annecy-Genevois, Annecy, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, CHU Dijon Bourgogne, Inserm CIC 1432, Clinical Epidemiology Unit, Dijon, France
| | - Grégory Pugnet
- Department of Internal Medecine, CHU de Toulouse, UMR 1027 Inserm-Université de Toulouse, France
| | - François Maurier
- Department of Internal Medicine, Hôpital Belle Isle, Metz, France
| | - Thierry Zénone
- Internal Medicine Department, Valence Hospital, Valence, France
| | - Claire de Moreuil
- Department of Internal Medecine and pneumology, CHU Brest, La Cavale Blanche Hospital, Brest Cedex, France
| | | | - Laurent Arnaud
- Department of Rheumatology, CHU Strasbourg, INSERM UMR-S1109, RESO, Strasbourg University, F-67000 Strasbourg, France
| | - Olivier Espitia
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Alban Deroux
- Grenoble University Hospital, Division of Internal Medicine, Grenoble F-38043, France
| | - Vincent Grobost
- Internal Medicine Department, University Hospital, Clermont-Ferrand, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Kevin Bouiller
- Department of internal medicine, CHU Jean Minjoz, Besancon, France
| | | | | | - Virginie Rieu
- Internal Medicine Department, University Hospital, Clermont-Ferrand, France
| | - Mélanie Roriz
- Department of Internal Medicine, Hôpital Lariboisière, Paris, France
| | | | - Stéphane Vinzio
- Department of Internal Medicine Groupe Hospitalier Mutualiste of Grenoble, Grenoble, France
| | - Yann Nguyen
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Alexis Régent
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France.
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Reply. Arthritis Rheumatol 2019; 71:836-838. [DOI: 10.1002/art.40824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Childhood-onset Takayasu arteritis (c-TA) is the third most common systemic vasculitic disorder in children. Vascular stenosis is the main complication, and aneurysms are reported in 19-65% of cases, often in combination with stenotic lesions. Management of patients with c-TA is largely based on studies involving predominantly patients with adult-onset TA (a-TA). More widely used criteria for patients with c-TA have been devised by the joint European League Against Rheumatism, Pediatric Rheumatology International Trials Organization, and Pediatric Rheumatology European Society. Of the available imaging modalities, those that do not use radiation (color Doppler ultrasound and magnetic resonance angiogram) are preferred over 18F-labeled fluoro-2-deoxyglucose (18F-FDG) positron-emission tomography, computed tomography (CT), and CT angiogram in children. Remission rates have been reported to be lower in c-TA than in a-TA, and published mortality rates in c-TA range from 16 to 40%, which is much higher than reported in patients with a-TA. The usual drug therapy options include steroids plus steroid-sparing second-line immunosuppressants, such as mycophenolate, azathioprine, methotrexate, cyclophosphamide, and cyclosporine, along with antiplatelet agents. Interleukin-6 inhibitors such as tocilizumab, as well as the tumor necrosis factor inhibitors, are other aggressive therapeutic options. As yet, no randomized controlled trials have been conducted in c-TA.
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Affiliation(s)
- Ruchika Goel
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - T Sathish Kumar
- Department of Child Health, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.
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Certolizumab Pegol Treatment in Three Patients With Takayasu Arteritis. Arch Rheumatol 2019; 34:357-362. [PMID: 31598605 DOI: 10.5606/archrheumatol.2019.7177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/19/2019] [Indexed: 11/21/2022] Open
Abstract
Although glucocorticoids are the mainstay of treatment in Takayasu arteritis (TA), anti-tumor necrosis factor agents are other treatment options in refractory disease. The onset of TA is generally observed in females of reproductive age. Certolizumab pegol (CZP) lacks a fragment crystallizable region and this gives advantage of minimal transfer through the placenta, which makes CZP a safer option in pregnancy. Although there are case reports and trials about use of infliximab, etanercept, and adalimumab in TA, there are scarce data about use of CZP. In this article, we present three TA cases treated with CZP. While two patients benefited from CZP, one patient was refractory to CZP.
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Podgorska D, Podgorski R, Aebisher D, Dabrowski P. Takayasu arteritis - epidemiology, pathogenesis, diagnosis and treatment. J Appl Biomed 2019; 17:20. [PMID: 34907753 DOI: 10.32725/jab.2018.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/05/2022] Open
Abstract
Takayasu disease belongs to the group of autoimmune vasculitis which most often affects the aorta and its branches. It is rare, and it mainly affects young women. Recent epidemiologic studies suggest that Takayasu arteritis is being increasingly recognized in Europe. The first symptoms are non-specific and an early diagnosis is difficult and requires clinical awareness and suspicion. Patients with Takayasu arteritis often present increased inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, but systemic inflammatory response does not always show a positive correlation with inflammatory activity in the vessel wall. Therefore, imaging studies play a principal role in diagnosis and control of the disease. Glucocorticoids remain the most effective and serve as a cornerstone first line treatment. Immunosuppressive drugs play an important role as well, and biological therapy is increasingly being included in the treatment. This article describes the epidemiology, pathophysiology, diagnostics and treatment of this rare disease, so as to alert clinicians because disease left untreated can lead to narrowing and even closure of vital blood vessels. The most common Takayasu arteritis complications include pulmonary thrombosis, aortic regurgitation, congestive heart failure, cerebrovascular events, vision degeneration or blindness, and hearing problems.
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Affiliation(s)
- Dominika Podgorska
- Clinical Provincial Hospital No. 2, Department of Rheumatology, Rzeszow, Poland
| | - Rafal Podgorski
- University of Rzeszow, Centre for Medical and Natural Sciences Research and Innovation, Rzeszow, Poland.,University of Rzeszow, Faculty of Medicine, Department of Biochemistry, Rzeszow, Poland
| | - David Aebisher
- University of Rzeszow, Faculty of Medicine, Department of Human Immunology, Rzeszow, Poland
| | - Piotr Dabrowski
- Clinical Provincial Hospital No. 2, Department of Rheumatology, Rzeszow, Poland
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Kurata A, Saito A, Hashimoto H, Fujita K, Ohno SI, Kamma H, Nagao T, Kobayashi S, Yamashina A, Kuroda M. Difference in immunohistochemical characteristics between Takayasu arteritis and giant cell arteritis: It may be better to distinguish them in the same age. Mod Rheumatol 2019; 29:992-1001. [DOI: 10.1080/14397595.2019.1570999] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Akira Saito
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | | | - Koji Fujita
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Shin-ichiro Ohno
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Kamma
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Shigeto Kobayashi
- Department of Rheumatology, Juntendo Koshigaya Hospital, Saitama, Japan
| | - Akira Yamashina
- Department of Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
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43
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El-Shareif H. Takayasu's arteritis in a Libyan female. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2019. [DOI: 10.4103/ijmbs.ijmbs_40_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aeschlimann FA, Barra L, Alsolaimani R, Benseler SM, Hebert D, Khalidi N, Laxer RM, Noone D, Pagnoux C, Twilt M, Yeung RSM. Presentation and Disease Course of Childhood‐Onset Versus Adult‐Onset Takayasu Arteritis. Arthritis Rheumatol 2018; 71:315-323. [DOI: 10.1002/art.40690] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 08/07/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lillian Barra
- St. Joseph’s Health Care London and University of Western Ontario London Ontario Canada
| | - Roaa Alsolaimani
- St. Joseph’s Health Care London and University of Western Ontario London Ontario Canada
| | - Susanne M. Benseler
- Alberta Children’s Hospital and University of Calgary Calgary Alberta Canada
| | - Diane Hebert
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Nader Khalidi
- St. Joseph’s Healthcare and McMaster University Hamilton Ontario Canada
| | - Ronald M. Laxer
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Damien Noone
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Christian Pagnoux
- Mount Sinai Hospital and University of Toronto Toronto Ontario Canada
| | - Marinka Twilt
- Alberta Children’s Hospital and University of Calgary Calgary Alberta Canada
| | - Rae S. M. Yeung
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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45
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Cheng X, Dang A, Lv N, Zhao T. Microparticles from Endothelial Cells and Immune Cells in Patients with Takayasu Arteritis. J Atheroscler Thromb 2018; 26:547-558. [PMID: 30555130 PMCID: PMC6545457 DOI: 10.5551/jat.45351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM This study was designed to analyze microparticles (MPs) from endothelial cells (EMPs) and immune cells from healthy individuals and paitents with Takayasu arteritis (TA), and any possible relationships between MPs and TA acitivity. METHODS MPs derived from the plasma of 51 subjects were analyzed, including 32 patients with TA and 19 healthy individuals. Flow cytometry was performed with Annexin (Anx)-V and antibodies against surface markers of endothelial cells (CD144), T cells (CD3), B cells (CD19), and monocytes (CD14). RESULTS The concentrations of total EMPs, AnxV+ EMPs and AnxV- EMPs were significantly increased when comparing patients with TA and healthy controls (54×103 vs. 32×103 MPs /ml, P=0.0004; 22×103 vs. 12×103 MPs /ml, P=0.0006; and 31×103 vs. 19×103 MPs /ml, P=0.0005), and comparing active TA patients with remission ones (85×103 vs. 45×103 MPs /ml, P=0.016; 39×103 vs. 14×103 MPs /ml, P=0.0092; and 47×103 vs.29×103 MPs /ml, P=0.0371). In addition, the concentrations of total EMPs (odds ratio [OR]=1.024, 95% confidence interval [CI]: 1.001 to 1.048, P=0.037), AnxV+(OR=1.089, 95%CI: 1.011 to 1.172, P=0.024), and AnxV- EMPs (OR=1.029, 95% CI: 1.002 to 1.056, P=0.034) were positively related to TA activity. With multiple linear regression analysis, platelet was associated with both total and AnxV- EMP concentrations independently, while erythrocyte sedimentation rate was independently correlated with AnxV+EMPs. CONCLUSION Concentrations of endothelial microparticles are correlated with inflammation in Takayasu arteritis and may be useful markers to assess disease activity.
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Affiliation(s)
- Xuesen Cheng
- Department of Special Care Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Aimin Dang
- Department of Special Care Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Naqiang Lv
- Department of Special Care Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Tong Zhao
- Institute of Microbiology, Chinese Academy of Sciences
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46
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Harky A, Fok M, Balmforth D, Bashir M. Pathogenesis of large vessel vasculitis: Implications for disease classification and future therapies. Vasc Med 2018; 24:79-88. [PMID: 30355272 DOI: 10.1177/1358863x18802989] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite being recognised over a century ago, the aetiology and pathogenesis of large vessel vasculitis (LVV) still remains elusive. Takayasu’s arteritis (TA) and giant cell arteritis (GCA) represent the two major categories of LVV, each with distinctive clinical features. Over the last 10 years an increased understanding of the immunopathogenesis of the inflammatory cascade within the aortic wall has revived the view that LVVs may represent subtypes of the same pathological process, with implications in the treatment of this disease. In this review, the histological, genetic and immunopathological features of TA and GCA will be discussed and the evidence for a common underlying disease mechanism examined. Novel markers of disease activity and therapies based on advances in our understanding of the immunopathogenesis of these conditions will also be discussed.
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Affiliation(s)
- Amer Harky
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, UK
| | - Matthew Fok
- Department of General Surgery, Peterborough City Hospital, Peterborough, UK
| | - Damian Balmforth
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, UK
| | - Mohamad Bashir
- Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, UK
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47
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Wong SPY, Mok CC, Lau CS, Yip ML, Tam LS, Ying KY, Ng WL, Ng KH, Leung MH, Lee TY, To CH, Lee KL, Wan MC, Yu KL, Wong PCH, Sung CK, Lee KF, Kun EWL. Clinical presentation, treatment and outcome of Takayasu's arteritis in southern Chinese: a multicenter retrospective study. Rheumatol Int 2018; 38:2263-2270. [PMID: 30182290 DOI: 10.1007/s00296-018-4150-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/27/2018] [Indexed: 01/25/2023]
Abstract
To study the clinical presentation, treatment and outcome of southern Chinese patients with Takayasu's arteritis (TA). This is a retrospective chart review study of 78 patients managed in 14 public hospitals in Hong Kong between the years 2000 and 2010. Patients were identified from the hospital registry using the ICD-10 diagnostic code of the disease. The classification of TA was based on the American College of Rheumatology (ACR) or modified Ichikawa's criteria. Demographic data, clinical presentation, angiographic findings, pattern of vascular involvement (Numano's classification), treatment and outcome of these patients were presented. 78 patients were studied (82% women, age at presentation 34.2 ± 14 years). The estimated point prevalence of TA was 11/million population. The commonest initial manifestations were hypertension (62%) and vascular ischemic symptoms (38%). Systemic symptoms occurred in nine (12%) patients only. The proportion of patients fulfilling the angiographic subtypes of the Numano's classification was: types I (13%), IIa (4%), IIb (12%), III (12%), IV (20%) and V (39%), respectively. Thirty-two patients (41%) were treated with high-dose glucocorticoids (GCs) and 22 patients (28%) received additional non-GC immunosuppressive drugs. Vascular complications occurred in 26 (33%) patients and revascularization surgery was performed in 23(29%) patients. Three (4%) patients died of vascular complication at a median of 8 years after disease onset. TA is rare in southern Chinese patients of Hong Kong. Most patients present with ischemic symptoms during the stenotic phase of the disease. Although mortality is low, a significant proportion of patients developed vascular stenosis that required surgical interventions. More awareness of TA as a differential diagnosis of non-specific systemic symptoms with elevated inflammatory markers in younger patients is needed for earlier diagnosis.
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Affiliation(s)
- Stella Pui Yan Wong
- Department of Medicine, Tseung Kwan O Hospital, 2, Po Ning Lane, Hang Hau, Kowloon, Hong Kong SAR, China.
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man Lung Yip
- Tung Wah Groups of Hospital Integrated Diagnostic and Medical Centre, Kowloon, Hong Kong SAR, China
| | - Lai Shan Tam
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - King Yee Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Woon Leung Ng
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Kam Hung Ng
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China
| | - Moon Ho Leung
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Tsz Yan Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Chi Hung To
- Department of Medicine, Pok Oi Hospital, Hong Kong SAR, China
| | - Ka Lai Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Man Choi Wan
- Department of Medicine, Ruttonjee Hospital, Hong Kong SAR, China
| | - Ka Lung Yu
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Priscilla Ching Han Wong
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Chi Keung Sung
- Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China
| | - Kwok Fai Lee
- Department of Medicine, Yan Chai Hospital, Hong Kong SAR, China
| | - Emily Wai Lin Kun
- Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China
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48
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Li Cavoli G, Mulè G, Vallone MG, Caputo F. Takayasu's disease effects on the kidneys: current perspectives. Int J Nephrol Renovasc Dis 2018; 11:225-233. [PMID: 30147353 PMCID: PMC6101009 DOI: 10.2147/ijnrd.s146355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Takayasu arteritis (TA) is a chronic vasculitis disease of unknown etiology. Clinically significant renal disease is relatively common, and renovascular hypertension is the major renal problem. The assessment of TA activity is usually challenging because vascular inflammation may progress to fixed vascular injury without findings of active disease. Until now, the best therapeutic options have not been identified. This review highlights the current perspectives of renal involvement in TA.
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Affiliation(s)
- Gioacchino Li Cavoli
- Nephrology, Dialysis and Renal Transplant Department, Civico and Di Cristina Hospital, Palermo, Italy,
| | - Giuseppe Mulè
- Internal Medicine, Cardiovascular and Renal Diseases Department, University of Palermo, Palermo, Italy
| | | | - Flavia Caputo
- Nephrology, Dialysis and Renal Transplant Department, Civico and Di Cristina Hospital, Palermo, Italy,
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49
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Baldwin C, Mohammad AJ, Cousins C, Carette S, Pagnoux C, Jayne D. Long-term outcomes of patients with Takayasu arteritis and renal artery involvement: a cohort study. Rheumatol Adv Pract 2018; 2:rky026. [PMID: 31431972 PMCID: PMC6649896 DOI: 10.1093/rap/rky026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/05/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To describe the long-term outcomes of patients with Takayasu arteritis (TAK) and renal artery involvement (RAI). Methods A retrospective review of 122 patients with TAK at three tertiary centres in Canada, Sweden and the UK. Data on demographics, laboratory and clinical parameters, medications and angiography findings were collected. Non-renal and renal parameters were compared at baseline and follow-up. Results A total of 37 patients (30%) with RAI were identified: 18 (49%) with unilateral and 19 (51%) with bilateral RAI. Patients were predominantly female (89%). The median age at diagnosis was 27 years [interquartile range (IQR) 16–38]. The median follow-up time was 7 years (IQR 2–12). Hypertension was seen in 27 patients (73%) at presentation and 25 (68%) at follow-up. The median estimated glomerular filtration (eGFR) at presentation was 94 and 98 ml/min/1.73 m2 in those with unilateral and bilateral RAI, respectively. The corresponding median eGFR at follow-up was 101.5 and 104 ml/min/1.73 m2, respectively. Three patients at presentation and two at follow-up had an eGFR of <60 ml/min/1.73 m2. Five underwent endovascular intervention and three required surgical interventions. Among the 33 patients with radiologic follow-up, 23 (69%) had persistent RAI and 10 (30%) had resolution of RAI. One (6%) patient with unilateral RAI developed bilateral RAI and three (19%) with bilateral RAI regressed to unilateral RAI. Over time, 23 (62%) patients had stable renal function, 7 (19%) had improvement and 4 had a decline in renal function; no patient developed end-stage renal disease (ESRD). Conclusion In this series of TAK patients with RAI, long-term non-renal and renal outcomes were favourable. No patient experienced ESRD or died.
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Affiliation(s)
- Corisande Baldwin
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Claire Cousins
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Simon Carette
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christian Pagnoux
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
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50
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Kim H, Barra L. Ischemic complications in Takayasu’s arteritis: A meta-analysis. Semin Arthritis Rheum 2018; 47:900-906. [DOI: 10.1016/j.semarthrit.2017.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/15/2017] [Accepted: 11/03/2017] [Indexed: 02/03/2023]
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