Damage and Predictors of Damage in Takayasu’s Arteritis

Antoine G. Sreih¹, Tanaz A. Kermani², David Cuthbertson³, Simon Carette⁴, Nader A. Khalidi⁵, Curry L. Koening⁶, Carol A. Langford⁷, Carol A. McAlear⁸, Paul A. Monach⁹, Larry W. Moreland¹⁰, Christian Pagnoux¹¹, Philip Seo¹², Kenneth J. Warrington¹³, Steven R. Ytterberg¹³ and Peter A. Merkel^1,14, ¹Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, ²Division of Rheumatology, University of California, Los Angeles, CA, ³Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, ⁴Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ⁵Rheumatology, McMaster University, Hamilton, ON, Canada, ⁶Rheumatology, University of Utah, Salt Lake City, UT, ⁷Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, ⁸University of Pennsylvania, Philadelphia, PA, ⁹Boston University School of Medicine, Boston, MA, ¹⁰Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, ¹¹Rheumatology-Vasculitis clinic, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ¹²Medicine, Johns Hopkins University, Baltimore, MD, ¹³Rheumatology, Mayo Clinic, Rochester, MN, ¹⁴Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania, Philadelphia, PA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: longitudinal studies, takayasu arteritis and vasculitis

Session Information

Date: Sunday, November 5, 2017

Title: Vasculitis Poster I: Large Vessel Vasculitis

Session Type: ACR Poster Session A

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

Background/Purpose: Information regarding the degree and the predictors of damage in patients with Takayasu’s arteritis (TAK) is limited. This study aimed to characterize damage and identify predictors of damage in patients with TAK.

Methods: Patients with TAK enrolled in a multicenter, longitudinal study were included. Measures of disease damage, including the Vasculitis Damage Index (VDI) and the Large-Vessel Vasculitis Index of Damage (LVVID), were assessed at baseline and follow-up visits. Results from patients with a diagnosis of TAK made within 6 months prior to entry to the cohort were also separately analyzed. Kaplan-Meier survival curves were used to analyze development of new damage. Univariate statistics and multivariate Cox regression modeling was used to analyze clinically-relevant baseline predictors of new damage.

Results: The study included 128 patients with TAK: 94% female, 89% Caucasian, and median duration of follow-up 3.5 years (1.9, 6.2). At entry into the cohort, 113 patients (88%) had at least one damage item recorded on VDI and LVVID [VDI median score 3 (IQR: 1-5)] and [LVVID median score: 2 (1-4)]. 31/128 (24%) of patients had a diagnosis of TAK made within 6 months prior to study entry, 81% of whom had at least 1 item documented on VDI and LVVID. During the follow-up period 96 patients (75%) accrued at least one new damage item, most of which occurred in the first year of follow-up (Figure 1). The cardiac and peripheral arterial systems accounted for most of the damage captured at baseline and follow-up. Results of univariate and multivariate analysis of clinically-relevant baseline predictors are shown in Table 1. Patients with new-onset disease (diagnosed ≤ 6 months within study entry) had a higher risk of new damage than patients with longer disease duration. The use of glucocorticoids was not associated with development of new damage.

Conclusion: Damage predominantly related to disease rather than treatment is present in the majority of patients with TAK, even within 6 months of diagnosis. Although damage accrues more commonly early in the disease course, the majority of patients with TAK continue to accrue new damage, mostly related to disease, even after several years of follow-up. Future research should address the question of whether treatment of TAK during the early stages of the disease reduces accumulation of disease-related damage.

Figure 1. Time to development of new damage on the Vasculitis Damage Index or the
Large Vessel Vasculitis Index of Damage in 128 patients with Takayasu’s arteritis

Table 1. Baseline predictors of new damage during follow-up for patients with Takayasu’s arteritis
Predictors of damage	Univariate analysis			Multivariate analysis
	Hazard Ratio	95% CI	p value	Hazard Ratio	95% CI	p value
Age > 35 at baseline	0.940	0.592-1.494	0.794	0.861	0.526-1.411	0.553
Duration of the disease (≤6 months)	2.343	1.397-3.930	0.001	1.957	1.025-3.738	0.041
Presence of damage at baseline	1.943	0.888-4.252	0.096	1.512	0.636-3.595	0.349
Sex	0.698	0.698-0.280	0.439	1.060	0.396-2.835	0.907
Race	1.129	0.540-2.360	0.747	1.381	0.638-2.992	0.412
No disease activity Physician Global Assessment=0	0.629	0.395-1.001	0.050	0.747	0.448-1.246	0.263
No glucocorticoids at baseline	0.729	0.456-1.164	0.185	0.681	0.418-1.109	0.122
No immunosuppressive therapy at baseline	1.579	0.994-2.508	0.053	1.239	0.709-2.164	0.451
No previous flare at baseline	1.471	0.925-2.339	0.102	1.200	0.678-2.124	0.531

Disclosure: A. G. Sreih, None; T. A. Kermani, None; D. Cuthbertson, None; S. Carette, None; N. A. Khalidi, None; C. L. Koening, None; C. A. Langford, None; C. A. McAlear, None; P. A. Monach, None; L. W. Moreland, None; C. Pagnoux, None; P. Seo, GlaxoSmithKline, 5; K. J. Warrington, None; S. R. Ytterberg, None; P. A. Merkel, None.

To cite this abstract in AMA style:

Sreih AG, Kermani TA, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Warrington KJ, Ytterberg SR, Merkel PA. Damage and Predictors of Damage in Takayasu’s Arteritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/damage-and-predictors-of-damage-in-takayasus-arteritis/. Accessed .

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