Background/Purpose: Few studies compared the demographic, clinical, laboratory and imaging features, and outcomes of Takayasu arteritis (TAK) and large-vessel giant cell arteritis (LV-GCA). Aim of our study was to evaluate the differences between TAK and LV-GCA patients at disease onset and during follow-up.

Methods: This is a retrospective cohort study based on prospectively collected data of consecutive patients diagnosed with large vessel vasculitis (LVV) between January 2005 and December 2016 and followed-up for at least 2 years at our centre. In all patients, the diagnosis of LVV was confirmed by imaging (PET/CT, MR/CT angiography and/or CDUS), and all patients satisfied the inclusion criteria of the GiACTA trial for GCA, or the 1990 American College of Rheumatology classification criteria for TAK. Disease-related signs/symptoms, ESR and CRP levels, GC dosages and immunosuppressant use were recorded at each follow-up visit. Disease activity (active/remission) was evaluated at each visit. We also evaluated the appearance of new lumen changes (thickening, stenosis, occlusion, and/or vessel dilatation) at follow up morphologic imaging studies (CTA, MRA and/or CDUS), and new/increased FDG uptake at follow-up PET/CT.

Results: 186 pts were included (TAK 59 pts, 127 LV-GCA pts). Compared to LV-GCA, TAK patients were more frequently female (91.5 vs 72.4 %, p = 0.003), and presented more frequently arthralgia and myalgia (12% vs 4%, p=0.041), pulse loss (65% vs 17%, p=0.001), vascular bruits (58% vs 30%, p=0.001), limb claudication (27% vs 8%, p=0.003), myocardial infarction/angina (10% vs 2%, p=0.034), and renovascular hypertension (19% vs 0%, p=0.001) at disease onset. Revascularization procedures were required at diagnosis in 20% of TAK and 5% of LV-GCA patients (p=0.001). Compared to TAK, LV-GCA patients had more frequently cranial symptoms (40% vs 9%, p< 0.001), fever (30% vs 12%, p=0.007), polymyalgia rheumatica (29% vs 0%, p=0.001), hypertension (55% vs 10%, p=0.001) at disease onset. LV-GCA patients had higher ESR than those with TAK [mean (SD) 82 (30) vs 54 (30) mm/1h, p=0.001).Considering imaging, TAK patients presented more frequently involvement of innominate artery (40% vs 22%, p=0.011), celiac trunk (36% vs 16%, p=0.019), superior mesenteric artery (36% vs 14%, p=0.019) and renal arteries (37% vs 15%, p=0.005), while LV-GCA patients presented more frequently involvement of the axillary arteries (37% vs 19%, p=0.018), aorta (75% vs 66%, p=0.024) and iliac arteries (31% vs 10%, p=0.002). During follow-up (median duration: TAK 92 months (IQ range 55-147), LV-GCA 70 months (47-101), p = 0.653) TAK patients had lower vascular stenosis and/or occlusion free survival time (FST) (95 vs 158 months, log-rank test 0.002), immunosuppressive FST (38 vs 80 months, log-rank test < 0.001), biologic drugs FST (144 vs 193 months, log-rank test < 0.001) and revascularization procedures FST (191 vs 232 months, log-rank test < 0.001) than LV-GCA patients.

Conclusion: In our large cohort of LVV, patients with LV-GCA differ from those with TAK in clinical and imaging characteristics, and outcomes. Our data suggest that LV-GCA and TAK are two distinct entities, with different pathophysiologic mechanisms or vascular response to injury.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-between-clinical-features-acute-phase-reactants-imaging-between-takayasu-and-lv-gca-patients-at-diagnosis-and-during-follow-up-in-italian-patients-in-monocentric-study/