TAKAYASU ARTERITIS: PATTERN OF CLINICAL AND RADIOLOGICAL FEATURES, EXPERIENCE FROM PAKISTAN
AbstractBackground: Takayasu arteritis (TKA) is a rare large vessel vasculitis occurring in young adults of less than 50 year of age. We analyse the clinical, radiological features, and treatment regimens in Pakistani patients presenting to a tertiary care center. Methods: A retrospective cross-sectional analysis of TKA patients done at the Rheumatology department of Fatima Memorial Hospital. A comprehensive evaluation of clinical, laboratory, radiographic features and treatment regimens was carried out. Results: A consecutive cohort of 18 patients, with 13 patients (72%) of female gender was studied. Mean age of the cohort was 35.94±2.7 years. A mean delay of 2.32±0.43 years between symptoms and final diagnosis was reported, attributed to alternate diagnosis in 57.1% and late presentation in 42.8% cases. Limb claudication (44.4%), absent pulses (38.9%), were the common initial manifestation. Hypertension (61.5%), blood pressure discrepancy between arms (88.9%) and bruit (72.2%) over major vessels were common systemic features. As per angiographic classification, Type V (44.4%), and Type I (33.3%), were most common pattern of disease in the cohort. Subclavian artery (72.2%), renal artery (33.3%), iliofemoral arteries (27.8%), and coronary artery involvement (16.7%) were the common lesions. Coronary artery lesion was higher in females (p=0.52) while renal artery lesion in males (p=0.27). There was no statistically significant difference in involvement of vessels according to gender (p >0.05). Conclusion: Type V and Type I are the common pattern of TKA. Limb claudication was the most common initial manifestation. Renal artery involvement was seen more commonly in males while coronary artery involvement more commonly in females.
Saritas F, Donmez S, Direskeneli H, Pamuk ON. The epidemiology of Takayasu arteritis: a hospital-based study from northwestern part of Turkey. Rheumatol Int 2016;36(7):911–6.
Soto ME, Espinola‐Zavaleta N, Ramirez‐Quito O, Reyes PA. Echocardiographic follow‐up of patients with Takayasu's arteritis: Five‐year survival. Echocardiography 2006;23(5):353–60.
Gudbrandsson B, Molberg Ø, Garen T, Palm Ø. Prevalence, Incidence, and Disease Characteristics of Takayasu Arteritis by Ethnic Background: Data from a Large, Population‐Based Cohort Resident in Southern Norway. Arthritis Care Res 2017;69(2):278–85.
Reinhold‐Keller E, Herlyn K, Wagner‐Bastmeyer R, Gross WL. Stable incidence of primary systemic vasculitides over five years: results from the German vasculitis register. Arthritis Care Res 2005;53(1):93–9.
Mwipatayi BP, Jeffery PC, Beningfield SJ, Matley PJ, Naidoo NG, Kalla AA, et al. Takayasu arteritis: clinical features and management: report of 272 cases. ANZ J Surg 2005;75(3):110–7.
de Souza AW, de Carvalho JF. Diagnostic and classification criteria of Takayasu arteritis. J Autoimmun 2014;48-49:79–83.
Hellmich B, Agueda A, Monti S, Buttgereit F, De Boysson H, Brouwer E, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2020;79(1):19–30.
Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. Rheumatology (Oxford) 2014;53(5):793–801.
Mekinian A, Saadoun D, Vicaut E,Thietart S,Lioger B,Jego P, et al. Tocilizumab in treatment-naïve patients with Takayasu arteritis: TOCITAKA French prospective multicenter open-labeled trial. Arthritis Res Ther 22, 218 (2020). https://doi.org/10.1186/s13075-020-02311-y.
Jeeva I, Sajid J, Ali O, Bonthron DT, Frossard PM. Atypical Takayasu arteritis: a family with five affected siblings. Med Sci Monit 2007;13(8):CS101–5.
Nazmul-Ahasan HAM, Alam B, Chowdhury MH, Mohammed FR, Nur Z. Takayasu’s arteritis in association with tuberculosis in a young woman. Pak J Med Sci 2009;25(6):1009–11.
Ahmed M, Mansoor S, Assad S, Khan SY, Khan R, Ghani U, et al. Refractory case of Takayasu arteritis in a young woman: A clinical challenge. Cureus 2016;8(11):e872.
Alibaz-Oner F, Turkish Vasculitis Study Group. 228. Clinical Features of Takayasu’s Arteritis from An Inception Cohort: Early Disease Is Characterized by ‘Systemic Inflammation’. Rheumatology 2019;58(Suppl_2):kez062–002.
Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity. Circulation 2015;132(18):1701–9.
Vaideeswar P, Deshpande JR. Pathology of Takayasu arteritis: a brief review. Ann Pediatr Cardiol 2013;6(1):52–8.
Nazareth R, Mason JC. Takayasu arteritis: severe consequences of delayed diagnosis. QJM 2011;104(9):797–800.
Schmidt WA, Nerenheim A, Seipelt E, Poehls C, Gromnica‐Ihle E. Diagnosis of early Takayasu arteritis with sonography. Rheumatology (Oxford) 2002;41(5):496–502.
Goel R, Danda D, Joseph G, Ravindran R, Kumar S, Jayaseelan V, et al. Long-term outcome of 251 patients with Takayasu arteritis on combination immunosuppressant therapy: single centre experience from a large tertiary care teaching hospital in Southern India. Semin Arthritis Rheum 2018;47(5):718–26.
Comarmond C, Biard L, Lambert M, Mekinian A, Ferfar Y, Kahn JE, et al. Long-term outcomes and prognostic factors of complications in Takayasu arteritis: a multicenter study of 318 patients. Circulation 2017;136(12):1114–22.
Bicakcigil M, Aksu K, Kamali S, Ozbalkan Z, Ates A, Karadag O, et al. Takayasu’s arteritis in Turkey - clinical and angiographic features of 248 patients. Clin Exp Rheumatol 2009;27(1 Suppl 52):S59–64.
Li J, Sun F, Chen Z, Yang Y, Zhao J, Li M, et al. The clinical characteristics of Chinese Takayasu’s arteritis patients: a retrospective study of 411 patients over 24 years. Arthritis Res Ther 2017;19(1):107.
Amigo JL, Morera JR, Torres JM, Sintas MR, Vives EG, Valle FM, et al. AB0651 Takayasu Arteritis: Clinical Features and Evolution of a Single Center Experience. BMJ 2015;74(Suppl 2):1116.
Yang L, Zhang H, Jiang X, Song L, Qin F, Zou Y, et al. Clinical features and outcomes of Takayasu arteritis with neurological symptoms in China: a retrospective study. J Rheumatol 2015;42(10):1846–52.
Pyo JY, Park JS, Song CH, Lee SW, Park YB, Lee SK. Takayasu arteritis associated with ulcerative colitis and optic neuritis: first case in Korea. Korean J Intern Med 2013;28(4):491–6.
Wasilewska M, Adamiec R, Hendrich B, Gosk Bierska I. Coexistence of Takayasu’s arteritis and ulcerative colitis. Vasa 2015;44(1):71–4.
Terao C, Matsumura T, Yoshifuji H, Kirino Y, Maejima Y, Nakaoka Y, et al. Brief Report: Takayasu Arteritis and Ulcerative Colitis: High Rate of Co‐Occurrence and Genetic Overlap. Arthritis Rheumatol 2015;67(8):2226–32.
Odunlami GJ, Okunola OO, Olaosebikan H, Aderibigbe AS, Ajibade AI. Takayasu's Arteritis Presenting Atypically in a Female Nigerian. West Afr J Med 2020;37(3):284–9.
Anvari MS, Masoudkabir F, Abbasi K, Boroumand MA, Zarghampour M, Goodarzynejad H. Takayasu’s arteritis presenting with headache and peripheral facial palsy: A case report. J Tehran Heart Cent 2016;11(4):195–7.