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Abacar K, Kaymaz-Tahra S, Bayındır Ö, İnce B, Kutu ME, Yazıcı A, Ediboğlu ED, Demirci-Yıldırım T, Ademoğlu Z, Omma A, Yaşar-Bilge NŞ, Kimyon G, Kaşifoğlu T, Emmungil H, Önen F, Akar S, Cefle A, Alpay-Kanıtez N, Çelik S, İnanç M, Aksu K, Keser G, Direskeneli H, Alibaz-Öner F. Frequency and the effects of spondyloarthritis-spectrum disorders on the clinical course and management of Takayasu arteritis: an observational retrospective study. Clin Rheumatol 2024; 43:1571-1578. [PMID: 38563865 DOI: 10.1007/s10067-024-06939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Extravascular findings of Takayasu arteritis (TAK) often share features with the spondyloarthritis (SpA) spectrum of disorders. However, the characteristics of this overlap and its effect on the vascular manifestations of TAK are not fully known. Therefore, we aimed to investigate the frequency of SpA-related features in TAK patients. MATERIAL AND METHODS In this observational retrospective study, 350 patients with TAK classified according to ACR 1990 criteria, from 12 tertiary rheumatology clinics, were included and evaluated for the presence of axSpA, IBD, or psoriasis. Demographic, clinical features, angiographic involvement patterns, disease activity, and treatments of TAK patients with or without SpA were analyzed. RESULTS Mean age was 45.5 ± 13.6 years and mean follow-up period was 76.1 ± 65.9 months. Among 350 patients, 31 (8.8%) had at least one additional disease from the SpA spectrum, 8 had IBD, 8 had psoriasis, and 20 had features of axSpA. In the TAK-SpA group, TAK had significantly earlier disease onset, compared to TAK-without-SpA (p = 0.041). SpA-related symptoms generally preceded TAK symptoms. Biological treatments, mostly for active vasculitis, were higher in the TAK-SpA group (70.9%) compared to TAK-without-SpA (27.9%) (p < 0.001). Vascular involvements were similar in both. CONCLUSION Our study confirmed that diseases in the SpA spectrum are not rare in TAK. Vascular symptoms appeared earlier in such patients, and more aggressive therapy with biological agents was required in the TAK-SpA group, suggesting an association between TAK and SpA spectrum. Key Points • The pathogenesis of Takayasu arteritis is mediated by an MHC class I alelle (HLA-B*52), similar to spondyloarthritis-disorders. • Extravascular findings of Takayasu arteritis are in the spectrum of spondyloarthritis disease. • This frequent coexistence between Takayasu arteritis and spondyloarthritic disorders suggests a relationship rather than a coincidence.
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Affiliation(s)
- Kerem Abacar
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey.
| | - Sema Kaymaz-Tahra
- Internal Medicine, Rheumatology, Sancaktepe Prof. Dr. İlhan Varank Hospital, Istanbul, Turkey
| | - Özün Bayındır
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Burak İnce
- Istanbul Faculty of Medicine, Internal Medicine, Rheumatology, Istanbul University, Istanbul, Turkey
| | - Muhammet Emin Kutu
- Internal Medicine, Rheumatology, Bakırköy Sadi Konuk Hospital, Istanbul, Turkey
| | - Ayten Yazıcı
- Internal Medicine, Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Elif Durak Ediboğlu
- Internal Medicine, Rheumatology, İzmir Katip Çelebi University, Izmir, Turkey
| | | | - Zeliha Ademoğlu
- Internal Medicine, Rheumatology, Trakya University, Edirne, Turkey
| | - Ahmet Omma
- Internal Medicine, Rheumatology, Ankara Sehir Hospital, Ankara, Turkey
| | | | - Gezmiş Kimyon
- Internal Medicine, Rheumatology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Timuçin Kaşifoğlu
- Internal Medicine, Rheumatology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hakan Emmungil
- Internal Medicine, Rheumatology, Trakya University, Edirne, Turkey
| | - Fatoş Önen
- Internal Medicine, Rheumatology, Dokuz Eylül University, Izmir, Turkey
| | - Servet Akar
- Internal Medicine, Rheumatology, İzmir Katip Çelebi University, Izmir, Turkey
| | - Ayşe Cefle
- Internal Medicine, Rheumatology, Kocaeli University, Kocaeli, Turkey
| | | | - Selda Çelik
- Internal Medicine, Rheumatology, Bakırköy Sadi Konuk Hospital, Istanbul, Turkey
| | - Murat İnanç
- Istanbul Faculty of Medicine, Internal Medicine, Rheumatology, Istanbul University, Istanbul, Turkey
| | - Kenan Aksu
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Gökhan Keser
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Haner Direskeneli
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Öner
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey
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Kaymaz-Tahra S, Bayindir O, Ince B, Ozdemir İsik O, Kutu ME, Karakas O, Yildirim TD, Ademoglu Z, Ediboglu ED, Uludogan BCE, Ilgin C, Bilge NSY, Kasifoglu T, Akar S, Emmungil H, Onen F, Omma A, Kanitez NA, Yazici A, Cefle A, Inanc M, Aksu K, Keser G, Direskeneli H, Alibaz-Oner F. Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis. Semin Arthritis Rheum 2024; 66:152446. [PMID: 38669786 DOI: 10.1016/j.semarthrit.2024.152446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Immunosuppressive (IS) agents are recommended for the first-line treatment of patients with active Takayasu's arteritis (TAK) together with glucocorticoids (GCs). However, there is limited data comparing the efficacy and outcomes of different IS agents for this purpose. OBJECTIVES In this study, we aimed to compare the outcomes of two most frequently used first-line IS agents, namely methotrexate (MTX) and azathioprine (AZA) in TAK patients. METHODS TAK patients who received any IS agent in addition to GCs as the initial therapy were included in this multicentre, retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a matched analysis (cc match) using variables 'age', 'gender' and 'diffuse aortic involvement' was performed between patients who received MTX or AZA as the first-line IS treatment. RESULTS We recruited 301 patients (F/M: 260/41, mean age: 42.2 ± 13.3 years) from 10 tertiary centres. As the first-line IS agent, 204 (67.8 %) patients received MTX, and 77 (25.6 %) received AZA. Less frequently used IS agents included cyclophosphamide in 17 (5.6 %), leflunomide in 2 (0.5 %) and mycophenolate mofetil in one patient. The remission, relapse, radiographic progression and adverse effect rates were similar between patients who received MTX and AZA as the first-line IS agent. Vascular surgery rate was significantly higher in the AZA group (23% vs. 9 %, p = 0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was significantly higher in the MTX group (76% vs 62 %, p = 0.034). Similarly, the rate of vascular surgery was higher in AZA group in matched analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42 %, p = 0.34). IS therapy was discontinued in 18 (12 MTX, 6 AZA) patients during the follow-up period due to remission. Among those patients, two patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of a mean 69.4 (±50.9) months of follow-up. CONCLUSIONS Remission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.
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Affiliation(s)
- Sema Kaymaz-Tahra
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Bahceşehir University, Kadıkoy, Istanbul, Turkey.
| | - Ozun Bayindir
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burak Ince
- Department of Internal Medicine, Division of Rheumatology Istanbul, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozlem Ozdemir İsik
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Muhammet Emin Kutu
- Division of Rheumatology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Karakas
- Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Tuba Demirci Yildirim
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Zeliha Ademoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Elif Durak Ediboglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
| | - Burcu Ceren Ekti Uludogan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Can Ilgin
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nazife Sule Yasar Bilge
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Timucin Kasifoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
| | - Hakan Emmungil
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Fatos Onen
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ahmet Omma
- Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Nilufer Alpay Kanitez
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Ayten Yazici
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Cefle
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Inanc
- Department of Internal Medicine, Division of Rheumatology Istanbul, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kenan Aksu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gokhan Keser
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Celik S, Kutu ME, Bal C, Karadeniz B, Atagunduz P, Soy M. Factors influencing the course of COVID-19 in the inflammatory rheumatic diseases. Clin Exp Rheumatol 2022; 41:758-759. [PMID: 36226619 DOI: 10.55563/clinexprheumatol/3pcfrz] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Selda Celik
- University of Health Sciences, Faculty of Medicine Bakırköy Dr. Sadi Konuk Education and Training Hospital , Department of Rheumatology, Istanbul, Turkey
| | - Muhammet Emin Kutu
- University of Health Sciences, Faculty of Medicine Bakırköy Dr. Sadi Konuk Education and Training Hospital , Department of Rheumatology, Istanbul, Turkey
| | - Cengiz Bal
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Biostatistics, Eskisehir, Turkey
| | - Burcak Karadeniz
- University of Health Sciences, Faculty of Medicine Bakırköy Dr. Sadi Konuk Education and Training Hospital , Department of Rheumatology, Istanbul, Turkey
| | - Pamir Atagunduz
- Marmara University Faculty of Medicine Department of Internal Medicine, Division of Rheumatology. Istanbul, Turkey
| | - Mehmet Soy
- Altinbas University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Bahcelievler Medicalpark Hospital, Istanbul, Turkey.
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