Background/Purpose: No previous study has compared clinical, laboratory and imaging features of relapses in Takayasu (TAK) and large vessel giant cell arteritis (LV-GCA). The aim of our study was to compare relapses characteristics in these 2 group of pts.

Methods: We retrospectively evaluated 171 pts LVV (119 LV-GCA and 52 TAK) seen at the Rheumatology Unit of Reggio Emilia Hospital (Italy) between 01.01.2005 and 31.12.2016 and followed-up for at least 2 years. Data of the pts collected at relapses included demographic, clinical, laboratory and imaging (PET/CT scan, MRI/CT angiography and/or arterial US). GCA was diagnosed according to ACR1990 criteria and LV-GCA in the presence of LVV involvement seen at CT and/or MRI and/or ultrasonography and/or PET examinations according to GIACTA criteria. TAK was diagnosed using Ishikawa’s10 diagnostic criteria and its modification by Sharma et al. and ACR classification criteria for TAK. Disease-related signs/symptoms, ESR and CRP levels, and GC dosages were recorded at every follow-up visit. The presence of clinical disease relapses or long term remission were evaluated at every visit. We also evaluated the appearance of new structural lesions (SL) (stenosis, occlusion, and/or vessel dilatation at CTA/MRA and/or US examination) or new inflammatory lesions (IL)(new/increased FDG uptake at PET/TC or parietal thickening increase at US or CTA).

Results: During a median follow-up duration of 76 months we observed 86 TAK relapses and 89 LV-GCA relapses. TAK relapses presented more frequently carotidodynia (8.1 vs 1.1%, p = 0.032), chest pain (10.5 vs 1.1 %, p=0.009), large vessel vasculitis (89.4 vs 59.8%, p=0.001), had higher ESR (45+32 vs 32+29 p=0.009). TAK relapse caused the introduction of BIO therapy more frequently (48.8% vs 16.8%, p=0.001). LV-GCA relapses were characterized by cranial symptoms (16.9 vs 3.5, p=0.005), polymyalgia rheumatica (27.0 vs 0, p=0.001) and appeared after a shorter time from diagnosis (37.4+42 vs 52.8+48.3 months, p= 0.025). At vessel imaging TAK relapses had more anonymous artery involvement (30.7 vs 15.1 %, p =0.043), LV-GCA relapses had more thoracic and abdominal aorta involvement (89.6 vs 54.1, p< 0.001 and 45.8 vs 14.9, p=0001, respectively) At vessel imaging LV-GCA relapses had higher prevalence of IL (4.31 (1.98) vs 2.0 (1.84), p < 0.001). TAK relapses had higher new SL at common carotid artery (20.3 vs 1.9%, p =0.002), anonymous artery (9.5 vs 0, p=0.041) and subclavian artery (23.3 vs 1.9%, p=0.001). LV-GCA relapses had higher prevalence of common carotid(59.6 vs 28.4%, p=0.001) aortic (89.6 vs 56.8%, p< 0.001) and femoral (10.9 vs 1.5%, p=0.038) new IL.

Conclusion: TAK and LV-GCA relapses have different clinical, laboratory and imaging features. In particular TAK relapses were characterized by higher prevalence of new arterial SL while LV-GCA by new arterial IL.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-clinical-laboratory-and-imaging-features-of-relapses-between-takayasu-and-lv-gca-patients-an-italian-monocentric-study/