Characteristics of Takayasu Arteritis Patients with Severe Ischemic Events.J Rheumatol 2019JR
Takayasu arteritis (TAK) is a rare large vessel vasculitis with a high risk of developing severe ischemic events (SIE). Outcomes for TAK patients with SIE are poorly understood. We aim to describe the characteristics of TAK patients experiencing SIE.
All TAK patients with at least one follow-up visit seen between 1988 and 2015 were included from 3 academic centres in Ontario, Canada. Diagnosis was based on American College of Rheumatology (ACR) 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.
Of the 52 TAK patients included in the study, 51 (98%) were female and 22 (42%) were of European descent. The mean age was 31 (standard deviation [SD] 12) at the time of diagnosis and the follow-up time was 6 (SD 5) years. Fifteen (29%) experienced a SIE: 5 CVA, 5 ACS, 1 ischemic cardiomyopathy and 4 limb ischemia. 13/15 (87%) SIE occurred at or before diagnosis. Patients with SIE were more likely than those without SIE to be started on corticosteroids combined with immunosuppressants (p=0.03) and anti-platelet agents (p=0.0003). Outcomes including disease activity and damage scores were similar between patients with and without SIE.
SIE are common in patients with TAK and occur early in the disease. With aggressive treatment, patients with SIE had a favourable prognosis.