Clinical Symptoms and Associated Vascular Imaging Findings in Takayasu’s Arteritis Compared to Giant Cell Arteritis

Despina Michailidou¹, Joel S. Rosenblum ², Casey A. Rimland ³, Jamie Marko ⁴, Mark A. Ahlman ⁴ and Peter C. Grayson ⁵, ¹National Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), Bethesda, MD, Division of Rheumatology, University of Washington, Seattle, WA, Seattle, WA, ²National Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), Bethesda, MD, Bethesda, MD, ³National Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), Bethesda, MD, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, Chapel Hill, NC, ⁴Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, Bethesda, MD, ⁵National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health, Bethesda, MD, Bethesda, MD

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: 18FDG PET/CT scan, Angiography, Disease Activity, takayasu arteritis and giant cell arteritis

Session Information

Date: Tuesday, November 12, 2019

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster III: Giant Cell Arteritis

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Takayasu’s arteritis (TAK) and giant cell arteritis (GCA) are the two major forms of large vessel vasculitis. The study objectives were to compare clinical symptoms of the head, neck, and upper extremities between TAK and GCA in association with vascular activity on ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) and arterial damage by magnetic resonance angiography (MRA).

Methods: Patients with TAK and GCA were recruited into a prospective observational cohort. Clinical and imaging assessments were performed within a 24-hour period, blinded to each other. Abnormal PET activity was defined as arterial FDG uptake > liver by visual assessment. Vascular damage was defined as stenosis, occlusion, or aneurysm in specific angiographic territories by MRA. Clinical features present on the day of imaging assessment (carotidynia; posterior neck pain; vertigo; lightheadedness, frontotemporal or posterior headache; arm claudication), were compared to corresponding imaging angiographic abnormalities by MRA and PET in TAK and GCA separately. Presence of clinical features at any point during disease, were studied in association with the number of damaged neck arteries (carotid and vertebral arteries). The association between clinical symptoms and imaging features was assessed by generalized mixed model regression, adjusting for repeated study visits. The association between historical symptoms and number of affected neck arteries was assessed by ordinal regression.

Results: 111 participants (TAK=56; GCA=55) contributed data from 270 study visits. Patients with TAK were more likely to report carotidynia than patients with GCA [12 (21%) vs 0 (0%), p< 0.01]. Clinical features and imaging findings are detailed in the Table. Carotidynia was associated with abnormal activity on FDG-PET (Sensitivity 27%, Specificity 96%, p< 0.01) and less strongly associated with damage on MRA (Sensitivity 11%, Specificity 95%, p=0.02) in TAK. Posterior neck pain was more common in patients with GCA than TAK [10 (18%) vs 4 (7%), p=0.09]. Posterior neck pain was associated with vertebral artery PET activity in GCA (p=0.03). Vertigo was associated with vertebral artery damage in TAK (p< 0.01), whereas lightheadedness was associated with carotid artery damage in GCA (p< 0.01). Posterior headache was associated with vertebral PET activity in GCA (p=0.04). Frontotemporal headache was not associated with carotid PET activity or damage in either disease. Arm claudication was associated with subclavian damage in both TAK and GCA (p< 0.01 and p=0.02 respectively). Patients with increased burden of damaged neck arteries were more likely to experience lightheadedness (p=0.03), positional lightheadedness (p< 0.01), posterior neck pain (p=0.02) or a major CNS event (p< 0.01) at some point during the disease.

Conclusion: The distribution of clinical symptoms and association with vascular imaging abnormalities differs between TAK and GCA. In both diseases, vascular symptoms have low sensitivity and high specificity for imaging abnormalities. These findings may help clinicians predict likely associated PET and MRA findings based on the presence of a specific symptom in patients with TAK and GCA.

TABLE ACR abstract

Disclosure: D. Michailidou, None; J. Rosenblum, None; C. Rimland, None; J. Marko, None; M. Ahlman, None; P. Grayson, None.

To cite this abstract in AMA style:

Michailidou D, Rosenblum J, Rimland C, Marko J, Ahlman M, Grayson P. Clinical Symptoms and Associated Vascular Imaging Findings in Takayasu’s Arteritis Compared to Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/clinical-symptoms-and-associated-vascular-imaging-findings-in-takayasus-arteritis-compared-to-giant-cell-arteritis/. Accessed .

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