Background/Purpose:

Takayasu’s arteritis (TA) is a granulomatous inflammation of unknown origin involving the aorta and its major branches. Association and implication of antiphospholipid antibodies (aPL) in the TA disease process remain controversial. The aim of this research was to ascertain if aPL positivity or the presence of Antiphospholipid Syndrome (APS) were predictive of a worse clinical outcome in TA.

Methods:

Clinical data was retrospectively collected on 22 TA patients over an 11 year period (2001-2012). All patients fulfilled the ACR criteria for TA. Patients were categorised into 2 groups: a diagnosis of TA alone or a diagnosis of TA with either persistently positive anticardiolipin antibodies and/or lupus anticoagulant or a concurrent clinical diagnosis of APS. Those with APS met the Sapporo classification criteria.

Screening for lupus anticoagulant was performed using the dRVVT (dilute Russell’s viper venom time) assay in accordance with standard methods. Confirmatory tests used a combination of mixing studies and correction with phospholipid. IgG and IgM anticardiolipin antibodies were measured using a standardized ELISA. Since anti-beta-2-glycoprotein-1 antibodies were not routinely measured clinically during the early stages of the study, they were not included in the analysis.

Adverse clinical outcomes included cerebrovascular accident (CVA),transient ischaemic attack (TIA), loss of vision, vascular lesions (carotid, femoral, renal coronary or other vessels) requiring stenting, angioplasty or other surgical intervention, aortic valve replacement, end-stage renal failure or death.

Results:

59% of patients had TA without aPL (n=13) and 41% had TA with a persistently positive aPL or a concurrent diagnosis of APS (n=9). Overall 7 significant vascular complications occurred in TA patients without aPL including 1 CVA, 1 TIA, 1 carotid endarterectomy and 4 angioplasty/stenting procedures.  8 such events occurred in TA patients with aPL/APS including 2 CVAs, 1 carotid endarterectomy, 1 aortic valve replacement and 4 angioplasty/stenting procedures. No patients developed end-stage renal failure or loss of vision. There were no deaths in this study cohort.

Conclusion:

Persistently positive aPL and APS are present in a significant proportion of TA patients. Our concern was that these individuals may have a worse clinical outcome in terms of vascular complications. This study has shown that this is not the case and that vascular complications and need for intervention are equal in TA patients regardless of aPL positivity.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-implications-of-antiphospholipid-antibodies-in-takayasus-arteritis/