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Peremans L, Twilt M, Benseler SM, Grisaru S, Kirton A, Myers KA, Hamiwka L. Real-World Biomarkers for Pediatric Takayasu Arteritis. Int J Mol Sci 2024; 25:7345. [PMID: 39000452 PMCID: PMC11242898 DOI: 10.3390/ijms25137345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
Childhood-onset Takayasu arteritis (TA) is a rare, heterogeneous disease with limited diagnostic markers. Our objective was to identify and classify all candidates for biomarkers of TA diagnosis in children reported in the literature. A systematic literature review (PRISMA) of MEDLINE, EMBASE, Wiley Cochrane Library, ClinicalTrias.gov, and WHO ICTRP for articles related to TA in the pediatric age group between January 2000 and August 2023 was performed. Data on demographics, clinical features, laboratory measurements, diagnostic imaging, and genetic analysis were extracted. We identified 2026 potential articles, of which 52 studies (81% case series) met inclusion criteria. A total of 1067 TA patients were included with a peak onset between 10 and 15 years. Childhood-onset TA predominantly presented with cardiovascular, constitutional, and neurological symptoms. Laboratory parameters exhibited a low sensitivity and specificity. Imaging predominantly revealed involvement of the abdominal aorta and renal arteries, with magnetic resonance angiography (MRA) being the preferred imaging modality. Our review confirms the heterogeneous presentation of childhood-onset TA, posing significant challenges to recognition and timely diagnosis. Collaborative, multinational efforts are essential to better understand the natural course of childhood-onset TA and to identify accurate biomarkers to enhance diagnosis and disease management, ultimately improving patient outcomes.
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Affiliation(s)
- Lieselot Peremans
- Section of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marinka Twilt
- Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Susanne M Benseler
- Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Children's Health Ireland, D01 R5P3 Dublin, Ireland
| | - Silviu Grisaru
- Section of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Adam Kirton
- Section of Neurology, Departments of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kimberly A Myers
- Section of Cardiology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Lorraine Hamiwka
- Section of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Vaideeswar P, Sabnis G. Acute rheumatic fever and Takayasu arteritis - A synchronous co-occurrence. J Postgrad Med 2024; 70:173-177. [PMID: 38629271 DOI: 10.4103/jpgm.jpgm_693_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 08/31/2024] Open
Abstract
ABSTRACT Acute rheumatic fever and Takayasu arteritis are examples of autoimmune diseases that commonly affect the cardiovascular system. We report an infrequent co-occurrence of both these diseases in an adolescent male. It may appear that in some individuals, the rheumatic fever may act as a trigger for the development of large vessel vasculitis. This possibility should be considered in patients on follow-up if they develop fresh features of cardiovascular compromise despite appropriate medical, interventional, or surgical therapy for rheumatic heart disease.
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Affiliation(s)
- P Vaideeswar
- Department of Pathology (Cardiovascular and Thoracic Division), Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - G Sabnis
- Dr. KK Datey Department of Cardiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Hassold N, Dusser P, Laurent A, Lemelle I, Pillet P, Comarmond C, Mekinian A, Lambert M, Mirault T, Benhamou Y, Belot A, Jeziorski E, Reumaux H, Sibilia J, Desdoits A, Espitia O, Faye A, Quartier P, Saadoun D, Koné-Paut I. Clinical spectrum and outcome of Takayasu's arteritis in children. Joint Bone Spine 2024; 91:105735. [PMID: 38631524 DOI: 10.1016/j.jbspin.2024.105735] [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: 03/20/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES We aimed to compare clinical spectrum and outcome between adults and children with Takayasu's arteritis (TAK) in a European population. METHODS We made a nationwide retrospective observational study between 1988 and 2019. All adult patients met the ACR diagnostic criteria for TAK and all children met the EULAR/PRINTO/PRES criteria for paediatric TAK. RESULTS We identified 46 children and 389 adults with TAK. The male to female ratio was 34/46 (0.74) in the paediatric group compared to 241/274 (0.88) in the adult group (P<0.05). Children presented with significantly more systemic symptoms; i.e., fever (P<0.05), fatigue (P<0.001), weight loss (P<0.001), abdominal pain (P<0.05), and myalgia (P<0.05) while adults had more upper limb claudication (P<0.01). Topography of the lesions differed significantly between the two groups: adults had more damage at the cerebral vasculature (P<0.01), upper and lower limbs (P<0.001) while children had more kidney lesions (P<0.05). Children TAK had more frequent (P<0.01) and higher (P<0.001) biological inflammation than adults. Children received higher dose-weight of corticosteroids (P=0.001) and less biotherapy (P<0.010) at diagnosis. Relapses (P<0.05) and death (8.6% vs 4.9%) were more frequent in children TAK than in adults. CONCLUSION Paediatric TAK seems more severe than adult TAK. Therefore, paediatrics patients may require closer monitoring and systemic use of biological treatment.
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Affiliation(s)
- Nolan Hassold
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France.
| | - Perrine Dusser
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France
| | - Audrey Laurent
- Department of paediatric rheumatology, Femme-Mère-Enfant Hospital, HCL, Lyon, France
| | - Irene Lemelle
- Department of paediatric oncology, Hôpitaux de Brabois, CHU, Nancy, France
| | - Pascal Pillet
- Department of paediatrics, Pellegrin Hospital, CHU, Bordeaux, France
| | - Cloé Comarmond
- Department of internal medicine, Lariboisière Hospital, AP-HP, Paris, France
| | - Arsene Mekinian
- Department of internal medicine, Saint-Antoine Hospital, AP-HP, Sorbonne université, Paris, France
| | - Marc Lambert
- Department of internal medicine, Claude-Huriez Hospital, CHU, Lille, France
| | - Tristan Mirault
- Department of vascular medicine, George-Pompidou Hospital, AP-HP, Paris, France
| | - Ygal Benhamou
- Department of internal medicine, Charles-Nicolle Hospital, CHU, Rouen, France
| | - Alexandre Belot
- Department of paediatric rheumatology, Femme-Mère-Enfant Hospital, HCL, Lyon, France
| | - Eric Jeziorski
- Department of paediatrics, Arnaud-de-Villeneuve Hospital, CHU, Montpellier, France
| | - Héloïse Reumaux
- Department of paediatrics, Jeanne-de-Flandre Hospital, CHRU, Lille, France
| | - Jean Sibilia
- Department of rheumatology, Arlin d'Alsace Hospital, CHU, Strasbourg, France
| | - Alexandra Desdoits
- Department of paediatrics, Hôpital de la Côte-de-Nacre, CHU, Caen, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, 44000 Nantes, France
| | - Albert Faye
- Department of general paediatrics, infectious diseases and internal medecine, Robert-Debré Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Pierre Quartier
- Department of paediatric rheumatology, Necker Hospital, AP-HP, Paris, France
| | - David Saadoun
- Department of internal medicine, La Pitié-Salpétrière Hospital, AP-HP, Sorbonne université, Paris, France
| | - Isabelle Koné-Paut
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France
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Bahal M, Kumar G, Mane S, Chavan S, Gupta A. Early-Onset Takayasu Arteritis in Childhood: A Case Report. Cureus 2024; 16:e53885. [PMID: 38465111 PMCID: PMC10925017 DOI: 10.7759/cureus.53885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Takayasu arteritis is a chronic, idiopathic, inflammatory disease mainly affecting medium and large vessels with a significant rate of morbidity and mortality. The vessels most frequently affected are the aorta and its branches; branches originating from the aortic arch include right brachiocephalic trunk and its branches, left common carotid artery, left subclavian artery, coronary arteries from the ascending aorta, celiac trunk, right and left renal arteries, superior and inferior mesenteric arteries from the descending aorta, and right and left iliofemoral arteries. Local and systemic inflammation along with end organ ischemia is attributed to severe clinical manifestations associated with this condition. Although Takayasu arteritis is more commonly diagnosed in adults, this study highlights the unusual occurrence of childhood-onset Takayasu arteritis (TAK), presenting a unique set of diagnostic challenges. We present a case of a seven-year-old female patient who manifested atypical symptoms, such as absent pulses and malignant hypertension at an early age, leading to a delayed diagnosis. The patient's clinical course, including diagnostic workup and imaging studies such as CT or MR angiography, is thoroughly discussed. This study emphasizes the importance of recognizing the subtleties of Takayasu arteritis in children. The disease may initially masquerade as other common conditions, such as peripheral arterial disease, coarctation of aorta, renal artery stenosis, chronic renal disease, and increased intracranial pressure, thereby hindering timely diagnosis and appropriate intervention. This case underscores the importance of considering Takayasu arteritis as a differential diagnosis in children, presenting with unexplained constitutional symptoms or signs of systemic vasculitis, emphasizing the need for multidisciplinary collaboration and tailored therapeutic intervention to optimize the outcome in this rare and potentially debilitating condition.
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Affiliation(s)
- Mridu Bahal
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Gaurav Kumar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shailaja Mane
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sanjay Chavan
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Aryan Gupta
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Jin J, Zhao Y, Gao X, Wang P, Liu Y, Pan Y, Fan Z, Yu H. A retrospective study of infantile-onset Takayasu arteritis: experience from a tertiary referral center in China. Front Cardiovasc Med 2024; 11:1249305. [PMID: 38357518 PMCID: PMC10864990 DOI: 10.3389/fcvm.2024.1249305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
Objective Takayasu artery (TAK) is a chronic inflammatory disease that mainly affects the aorta and its major branches and is rarely reported in infants. We aimed to summarize the clinical features of infant TA (I-TA) in a tertiary care center. Methods We performed a retrospective study involving 10 infants diagnosed with TAK. A comprehensive evaluation of clinical, laboratory, radiographic features, disease activity, treatment and outcomes was carried out. Results A consecutive cohort was composed of 8 girls and 2 boys, with an age at diagnosis of 11.1 (1.7-36) months. The median time to diagnosis and the average time to follow-up were 9.5 days (2-235 days) and 10.9 (1-21) months, respectively. The most common initial manifestations were malaise (80%), fever (70%), hypertension (50%) and rash (30%). The mean Pediatric Vasculitis Activity Score (PVAS), Takayasu Clinical Activity Score (ITAS-2010) and ITAS-A scores were 2.8/63, 2.6/51, and 5.6/54, respectively. All patients had aberrant laboratory parameters. The most common lesions were in the thoracic aorta (60%) and abdominal aorta (60%). Corticosteroids combined with cyclophosphamide followed by long-term mycophenolate mofetil were initiated in most cases (70%). Biologics were attempted in 5 cases. Mortality was 40%. Conclusions It is challenging to diagnose TAK in infants in a timely manner. Considering the more vessels involved, more severe inflammation and higher mortality, aggressive treatment is warranted in infants. GCs and CYC treatment seem to be effective.
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Affiliation(s)
- Jing Jin
- Department of Rheumatology and Immunology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Zhao
- Department of Ultrasonography, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xiucheng Gao
- Department of Image, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Panpan Wang
- Department of Rheumatology and Immunology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yingying Liu
- Department of Rheumatology and Immunology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yuting Pan
- Department of Rheumatology and Immunology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Zhidan Fan
- Department of Rheumatology and Immunology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Haiguo Yu
- Department of Rheumatology and Immunology, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Kushwah S, Ramanan AV, Bagri NK. Infantile Takayasu arteritis: how is it different? Rheumatology (Oxford) 2023; 62:2946-2947. [PMID: 36975614 DOI: 10.1093/rheumatology/kead131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Sunil Kushwah
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, University of Bristol, Bristol, UK
| | - Narendra Kumar Bagri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Cardiac involvement and cardiovascular risk factors in pediatric primary systemic vasculitides. Clin Rheumatol 2023; 42:673-686. [PMID: 36369404 DOI: 10.1007/s10067-022-06434-2] [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: 08/29/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
Pediatric primary systemic vasculitides are a complex group of diseases. Vasculitis subgroups are mainly determined according to the size of the predominantly affected vessels. In patients with primary systemic vasculitis, the location of vascular involvement, the size of the vessels, the extent of vascular damage, and the underlying pathology determine the disease phenotype and severity. Cardiac involvement is rare in some pediatric vasculitis, such as IgA vasculitis and polyarteritis nodosa, while it is more common in some others like Kawasaki disease and Takayasu arteritis. On the other hand, chronic inflammation in the setting of systemic vasculitis forms a major cardiovascular risk factor. Accelerated atherosclerosis and the tendency to thrombosis are the main issues determining the cardiovascular risks in pediatric systemic vasculitis. Early diagnosis and treatment are essential in these patients to minimize morbidity and mortality. In this review, we aimed to raise physicians' awareness of cardiac involvement and cardiovascular risks in pediatric patients with primary systemic vasculitis.
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