Background/Purpose: ITAS2010 (Indian Takayasu Clinical Activity Score) is a new composite index developed to assess clinical activity in Takayasu’s arteritis (TAK), which is weighted for vascular items. In this study, we aimed to investigate the effectiveness of ITAS2010 in the routine clinical follow-up of patients with TAK. 

Methods: Patients (n=33, mean age:40.9±12,4 years, F/M:30/3) classified according to ACR  criteria for TAK were enrolled. ITAS2010 forms were filled cross-sectionally at baseline for all clinical features and 2 follow-up visits prospectively, with intervals of at least 4-6 months, by including only new or worsening symptoms within the past 3 months(1). 

Results: ITAS2010 was similar at baseline for both active and inactive patients [12 (5-20) vs 10 (0-19), respectively]. There was no correlation between ITAS2010 and acute phase reactants (APRs) in this visit. Similarly, change according to PGA was not reflected in ITAS in the second visit [1,15 (0-6) vs 1,4 (0-3), respectively]. Only in the third visit ITAS2010 score was observed to be significantly higher in active [1,62 (0-7)] patients compared to inactives [0,45 (0-3)](p=0,001). The total agreement between ITAS2010 and PGA was 60% (kappa: 0,096, p=0,43) and between ITAS2010 and Kerr et al. was 74% (kappa: 0,18, p=0,035). The total agreement between PGA and Kerr et al. was 71% (kappa: 0,26, p=0,005). Twelve patients were evaluated with imaging in the follow-up period (4 with PET, 8 with MR-Angiography). When we added an extra score on ITAS2010 for high APRs or positive imaging (vascular progression with radiology or increased uptake on major vascular structures with PET), the total agreement between ITAS2010 and PGA increased to 74% (kappa: 0,499, p<0,001), whereas ITAS2010 and Kerr et al. decreased to 51% (kappa: 0,102, p=0,06). 

Conclusion: The agreement between PGA and ITAS2010 was observed to be limited in our study. However, when we combined ITAS2010 with APR or imaging, our results improved. ITAS2010 had a significant discriminatory value according to disease activity in only the third visit in our routine follow-up. These results suggest that ITAS2010 may be valuable in the long-term follow-up of patients with TAK, especially if combined with biomarkers and imaging.

Reference:

1)  Misra R, Danda D, Rajappa SM, Ghosh A, Gupta R, Mahendranath KM, Jeyaseelan L, Lawrence A, Bacon PA; on behalf of the Indian Rheumatology Vasculitis (IRAVAS) group. Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology (Oxford). 2013 Apr 16. [Epub ahead of print]

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-patients-with-takayasus-arteritis-in-routine-clinical-follow-up-with-indian-takayasu-clinical-activity-score-2010itas2010/