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Characteristics of Takayasu Arteritis Patients with Severe Ischemic Events.

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

SIE are common in patients with TAK and occur early in the disease. With aggressive treatment, patients with SIE had a favourable prognosis.

Authors+Show Affiliations

From the Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, ON, Canada; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. R. Yu was funded by the Canadian Rheumatology Association (CRA)-Pfizer Summer Research Studentship. The authors declare no other conflicts of interests. Address correspondence to Dr. Lillian Barra Division of Rheumatology, Department of Medicine, St. Joseph's Health Care London, University of Western Ontario, 268 Grosvenor Street, Room D2-160, London, ON, Canada, N6A 4V2 Email: lillian.barra@sjhc.london.on.ca.From the Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, ON, Canada; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. R. Yu was funded by the Canadian Rheumatology Association (CRA)-Pfizer Summer Research Studentship. The authors declare no other conflicts of interests. Address correspondence to Dr. Lillian Barra Division of Rheumatology, Department of Medicine, St. Joseph's Health Care London, University of Western Ontario, 268 Grosvenor Street, Room D2-160, London, ON, Canada, N6A 4V2 Email: lillian.barra@sjhc.london.on.ca.From the Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, ON, Canada; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. R. Yu was funded by the Canadian Rheumatology Association (CRA)-Pfizer Summer Research Studentship. The authors declare no other conflicts of interests. Address correspondence to Dr. Lillian Barra Division of Rheumatology, Department of Medicine, St. Joseph's Health Care London, University of Western Ontario, 268 Grosvenor Street, Room D2-160, London, ON, Canada, N6A 4V2 Email: lillian.barra@sjhc.london.on.ca.From the Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, ON, Canada; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. R. Yu was funded by the Canadian Rheumatology Association (CRA)-Pfizer Summer Research Studentship. The authors declare no other conflicts of interests. Address correspondence to Dr. Lillian Barra Division of Rheumatology, Department of Medicine, St. Joseph's Health Care London, University of Western Ontario, 268 Grosvenor Street, Room D2-160, London, ON, Canada, N6A 4V2 Email: lillian.barra@sjhc.london.on.ca.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31615911

Citation

Yu, Richard Ying, et al. "Characteristics of Takayasu Arteritis Patients With Severe Ischemic Events." The Journal of Rheumatology, 2019.
Yu RY, AlSolimani R, Khalidi N, et al. Characteristics of Takayasu Arteritis Patients with Severe Ischemic Events. J Rheumatol. 2019.
Yu, R. Y., AlSolimani, R., Khalidi, N., Pagnoux, C., & Barra, L. (2019). Characteristics of Takayasu Arteritis Patients with Severe Ischemic Events. The Journal of Rheumatology, doi:10.3899/jrheum.190407.
Yu RY, et al. Characteristics of Takayasu Arteritis Patients With Severe Ischemic Events. J Rheumatol. 2019 Oct 15; PubMed PMID: 31615911.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics of Takayasu Arteritis Patients with Severe Ischemic Events. AU - Yu,Richard Ying, AU - AlSolimani,Roaa, AU - Khalidi,Nader, AU - Pagnoux,Christian, AU - Barra,Lillian, AU - ,, Y1 - 2019/10/15/ PY - 2019/10/17/entrez JF - The Journal of rheumatology JO - J. Rheumatol. N2 - OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: SIE are common in patients with TAK and occur early in the disease. With aggressive treatment, patients with SIE had a favourable prognosis. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/31615911/Characteristics_of_Takayasu_Arteritis_Patients_with_Severe_Ischemic_Events L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=31615911 DB - PRIME DP - Unbound Medicine ER -