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Miller-Barmak A, Sztajnbok F, Balik Z, Borzutzky A, Fogel LA, Goldzweig O, Ozen S, Butbul Aviel Y. Infantile Takayasu: clinical features and long-term outcome. Rheumatology (Oxford) 2023; 62:3126-3132. [PMID: 36495199 DOI: 10.1093/rheumatology/keac691] [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: 06/16/2022] [Accepted: 12/01/2022] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Takayasu arteritis (TAK) is a large-vessel vasculitis rarely reported in children and infants. Most articles on paediatric TAK have not focused on infants. We present the largest case series of infantile TAK, aiming to identify its demographic and clinical characteristics and compare them with existing data on older children. METHODS We conducted an international multicentre retrospective cohort study. Epidemiological and clinical data were collected from patients' charts from six rheumatology centres. All patients met both the EULAR/PReS 2008 criteria and the 1990 ACR/EULAR criteria and were diagnosed with TAK at age <5 years. RESULTS Twelve patients were included (50% female). Median age of symptom onset was 11 months, with a diagnostic delay of 4 months. The most common symptoms at presentation were hypertension, blood pressure differences between limbs, and fever. The most commonly involved arteries were the abdominal aorta and renal artery. Medications included steroids, conventional and biologic DMARDs, and other immunosuppressive therapies. Half of the patients received biologic agents, of which infliximab had the highest complete remission rate (40%). Other medications resulting in complete remission were CYC (40%) and MTX (38%). Invasive procedures were required for 58% of patients. The most common complications were cardiac (50%), stroke (42%), and serious infections (33%). No patients died. CONCLUSION This study presents the largest series of infantile TAK. Compared with other reported series on older children, infants with TAK have more severe disease and were more likely to receive biologic agents, develop complications, and require invasive interventions.
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Affiliation(s)
- Adi Miller-Barmak
- Department of Pediatrics B, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Flavio Sztajnbok
- Pediatric Rheumatology Division, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Zeynep Balik
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arturo Borzutzky
- Department of Infectious Diseases and Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leslie A Fogel
- Department of Pediatrics, Washington University in St. Louis, St. Louis, USA
| | - Ofra Goldzweig
- Pediatric Rheumatology Service, Kaplan Medical Center, Rehovot, Israel
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yonatan Butbul Aviel
- Department of Pediatrics B, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Shi X, Du J, Li T, Gao N, Fang W, Chen S, Qiao Z, Li C, Zhu J, Pan L. Risk factors and surgical prognosis in patients with aortic valve involvement caused by Takayasu arteritis. Arthritis Res Ther 2022; 24:102. [PMID: 35526024 PMCID: PMC9077813 DOI: 10.1186/s13075-022-02788-9] [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: 03/19/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Aortic valve involvement is not uncommon in patients with Takayasu arteritis (TAK) and leading to poor prognosis. The aim of our study was to explore the risk factors of aortic valve involvement and to evaluate the prognosis in TAK patients with aortic valve involvement. Method In this retrospective study, 172 TAK patients were divided into groups with or without aortic valve involvement to identify the risk factors. Patients who underwent aortic valve surgical treatment were followed up to assess cumulative incidence of postoperative adverse events. Results A total of 92 TAK patients (53.49%) had aortic valvular lesion. The infiltration of inflammatory cells was found in surgical specimens of aortic valve. Numano type IIb, elevated high-sensitivity C-reactive protein (hs-CRP) level, and dilation of ascending aorta and aortic root were statistically associated with aortic valvular lesion in TAK patients (OR [95%CI] 6.853 [1.685–27.875], p=0.007; 4.896 [1.646–14.561], p=0.004; 4.509 [1.517–13.403], p=0.007; 9.340 [2.188–39.875], p=0.003). The 1-, 5-, and 7-year cumulative incidence of postoperative adverse events were 14.7%, 14.7%, and 31.8%, respectively. Surgical methods (p=0.024, hazard ratio (HR) 0.082) and postoperatively anti-inflammatory therapy (p=0.036, HR 0.144) were identified as potential predictors of postoperative adverse events. Conclusions Regularly echocardiogram screening is suggested in patients with Numano type IIb and aggressive treatment should be performed early in TAK patients. As for TAK patients with aortic valve surgery, aortic root replacement seems to be the preferred option and regular anti-inflammatory therapy may reduce the occurrence of adverse events of them. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02788-9.
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Affiliation(s)
- Xuemei Shi
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Juan Du
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Taotao Li
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Na Gao
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wei Fang
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Suwei Chen
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zhiyu Qiao
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chengnan Li
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Lili Pan
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Birlutiu V, Birlutiu RM, Sandu M, Mihali-Oniga E. Is prolonged febrile syndrome associated with reactive thrombocytosis a possible association in the diagnosis of Takayasu's arteritis? A case report. J Int Med Res 2021; 49:3000605211055388. [PMID: 34749567 PMCID: PMC8581799 DOI: 10.1177/03000605211055388] [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] [Indexed: 12/03/2022] Open
Abstract
Takayasu’s arteritis is a rare, systemic, inflammatory vasculitis of large blood vessels with an unknown aetiology that more frequently affects women of childbearing age with progression to stenosis, fibrosis or thrombogenesis. Clinical manifestations are associated either with inflammation of the vascular wall (including fever, myalgia, arthralgia, weight loss) or the development of aneurysms and extensive vascular lesions, which creates challenges for a differential diagnosis. This current report presents the case of a female Caucasian patient, aged 23 years, that presented herself repetitively at the hospital reporting symptoms including fever, productive cough, myalgia associated with physical effort, arthralgia, inconstant headache, weight loss and altered general condition. The patient was diagnosed with Takayasu’s arteritis in the context of a prolonged febrile syndrome associated with reactive thrombocytosis. This association results in the need to exclude multiple differential diagnoses. Nonspecific management was initiated, which included antibiotic treatment, antifungal medication, anticoagulants, steroidal anti-inflammatory drugs and correction of anaemia. The patient slowly improved. Takayasu’s arteritis in the inflammatory phase associated with a prolonged febrile syndrome and reactive thrombocytosis is a rare diagnosis of exclusion of a multitude of inflammatory diseases of large blood vessels, infectious diseases and neurofibromatosis, which requires multiple investigations for an accurate diagnosis and management.
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Affiliation(s)
- Victoria Birlutiu
- Faculty of Medicine, 61786Lucian Blaga University of Sibiu, Lucian Blaga University of Sibiu, Sibiu, Romania.,Infectious Diseases Clinic, Academic Emergency Hospital, Sibiu, Romania
| | - Rares-Mircea Birlutiu
- Faculty of Medicine, 61786Lucian Blaga University of Sibiu, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Mariana Sandu
- Department of Radiology and Medical Imaging, Academic Emergency Hospital, Sibiu, Romania
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Zhou Y, Feng Y, Zhang W, Li H, Zhang K, Wu Z. Physical Exercise in Managing Takayasu Arteritis Patients Complicated With Cardiovascular Diseases. Front Cardiovasc Med 2021; 8:603354. [PMID: 34055922 PMCID: PMC8149735 DOI: 10.3389/fcvm.2021.603354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Takayasu arteritis (TA) is a kind of large-vessel vasculitis that mainly affects the aorta and its branches, and the patients are usually women at a relatively young age. The chronic inflammation of arteries in TA patients leads to stenosis, occlusion, dilatation, or aneurysm formation. Patients with TA thereby have a high risk of cardiovascular disease (CVD) complications, which are the most common cause of mortality. This review summarizes the main cardiovascular complications and the risk factors of cardiovascular complications in patients with TA. Here, we discuss the benefits and potential risks of physical exercise in patients with TA and give recommendations about exercise prescription for TA patients to decrease the risks of CVD and facilitate rehabilitation of cardiovascular complications, which might maximally improve the outcomes.
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Affiliation(s)
- Yaxin Zhou
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Yuan Feng
- Department of Rheumatology and Immunology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Wei Zhang
- Department of Rheumatology and Immunology, Xi'an No.5 Hospital, Xi'an, China
| | - Hongxia Li
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China.,Department of Rheumatology and Immunology, Air Force Medical Center, Air Force Medical University (Fourth Military Medical University), Beijing, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Zhenbiao Wu
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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Abstract
Takayasu arteritis is an idiopathic granulomatous vasculitis of the aorta and its main branches and it constitutes one of the more common vasculitides in children. Inflammation and intimal proliferation lead to wall thickening, stenotic or occlusive lesions, and thrombosis, while destruction of the elastica and muscularis layers originates aneurysms and dissection. Carotid artery tenderness, claudication, ocular disturbances, central nervous system abnormalities, and weakening of pulses are the most frequent clinical features. The diagnosis is usually confirmed by the observation of large vessel wall abnormalities: stenosis, aneurysms, occlusion, and evidence of increased collateral circulation in angiography, MRA or CTA imaging. The purpose of this revision is to address the current knowledge on pathogenesis, investigations, classification, outcome measures and management, and to emphasize the need for timely diagnosis, effective therapeutic intervention, and close monitoring of this severe condition.
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Affiliation(s)
- Ricardo A G Russo
- Service of Immunology & Rheumatology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María M Katsicas
- Service of Immunology & Rheumatology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
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Linnemeier L, Sharma R, Srivastava N, Turrentine M. Annuloplasty for Aortic Regurgitation in Infantile Takayasu Arteritis: A Case Report. World J Pediatr Congenit Heart Surg 2017; 11:NP31-NP33. [DOI: 10.1177/2150135117692979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aortic regurgitation (AR) is a life-threatening complication of Takayasu arteritis (TA). Takayasu arteritis is a large-vessel vasculitis with a predominance in young adolescent and adult females. Inflammation involves the aorta and its major branches resulting in arterial dilatation, stenosis, aneurysm, occlusion, and thrombosis formation. Pediatric TA cases have been reported to also cause severe complications such as coronary aneurysms, retinopathy, and hypertension due to renovascular stenosis. In this report, we present a rare occurrence of infantile TA with severe AR requiring surgical intervention after failing medical therapy. Due to the patient’s age and clinical status, a valve-sparing aortic annuloplasty with aortoplasty was performed.
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Affiliation(s)
- Laura Linnemeier
- Deparment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richa Sharma
- Deparment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nayan Srivastava
- Deparment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Turrentine
- Deparment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Cardiovascular and Thoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Sandeep S, Unni VN, Sreekumar KP, Mathew A, Nair RR, Kurian G. Takayasu arteritis in an infant. Indian J Nephrol 2014; 24:257-9. [PMID: 25097343 PMCID: PMC4119343 DOI: 10.4103/0971-4065.133036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Takayasu arteritis (TA), a chronic inflammatory arteritis affecting the aorta and its main branches, is a rare condition mainly affecting young women in the second and third decades of life. Occurrence of TA in infants is extremely rare, with only less than 10 cases reported all over the world until date. We report a case of a 2-year-old girl who presented with hypertension and was diagnosed to have TA with bilateral renal artery stenosis and this is probably the youngest case reported from India.
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Affiliation(s)
- S Sandeep
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham University, Kochi, Kerala, India
| | - V N Unni
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham University, Kochi, Kerala, India
| | - K P Sreekumar
- Department of Radiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham University, Kochi, Kerala, India
| | - A Mathew
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham University, Kochi, Kerala, India
| | - R R Nair
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham University, Kochi, Kerala, India
| | - G Kurian
- Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham University, Kochi, Kerala, India
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