Damage Assessment in Takayasu's Arteritis

Antoine G. Sreih¹, Tanaz A. Kermani², David Cuthbertson³, Simon Carette⁴, Gary S. Hoffman⁵, Nader A. Khalidi⁶, Curry L. Koening⁷, Carol A. Langford⁵, Carol McAlear⁸, Paul A. Monach⁹, Larry W. Moreland¹⁰, Christian Pagnoux¹¹, Philip Seo¹², Kenneth J. Warrington¹³, Steven R. Ytterberg¹⁴ and Peter A. Merkel⁸, ¹Department of Rheumatology, University of Pennsylvania, Philadelphia, PA, ²Rheumatology, University of California Los Angeles, Santa Monica, CA, ³Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, ⁴Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ⁵Rheumatology, Cleveland Clinic, Cleveland, OH, ⁶McMaster University, Hamilton, ON, Canada, ⁷Division of rheumatology, George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City and University of Utah, University of Utah School of Medicine, Salt Lake City, UT, ⁸Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, ⁹Section of Rheumatology, Vasculitis Center, Boston University School of Medicine, Boston, MA, ¹⁰Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, ¹¹Rheumatology, Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada, ¹²Division of Rheumatology, Johns Hopkins, Baltimore, MD, ¹³Rheumatology, Mayo Clinic, Rochester, MN, ¹⁴Rheumatology Division, Mayo Clinic, Rochester, MN

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Assessment, longitudinal studies, outcomes, takayasu arteritis and vasculitis

Session Information

Date: Tuesday, November 10, 2015

Title: Vasculitis Poster III

Session Type: ACR Poster Session C

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

Background/Purpose: This
study aimed to describe disease-related damage in Takayasu’s
arteritis (TAK) and evaluate damage assessment tools using data from a large
longitudinal cohort.

Methods: Patients
with TAK enrolled in a prospective, 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. LVVID was developed
specifically for large-vessel vasculitis.
Results from patients with a diagnosis of TAK made within 6 months prior
to study entry were also separately analyzed.

Results: The study included 129 patients with
TAK: 94% female, 89% Caucasian with a median duration of follow-up 3.5 years
(1.9, 6.2). At entry in the cohort, 113 patients (88%) had at least one damage
item recorded on VDI (mean score ± SD: 2.5±1.8)
and 113 (88%) on LVVID (mean score: 3.0±2.5).
During follow-up 49 patients (38%) accrued at least one new damage item as
measured by VDI (mean increase in score: 1.8±1.0) and 47 patients (36%) as
measured by LVVID (mean increase in score: 2.0±1.9). 31/129 patients had a
diagnosis of TAK made within 6 months prior to study entry, 81% of them had at
least 1 item documented on VDI at entry with a mean score of 2.2±1.5 items and
81% on LVVID with a mean score of 2.7±2.1 items.

Organ systems
affected by damage at baseline and follow-up are outlined in the Table. The cardiac, peripheral
vascular, and the “other” sections, including weight gain, accounted for most
of the damage captured at baseline and follow-up. The accrued damage items were
mostly related to the disease (cardiac and peripheral vascular) rather than
treatment (weight gain). There were 25 items never scored on VDI and 8 items
never scored on LVVID. The unscored items were mostly related to the skin, ear,
nose, and throat, pulmonary, and renal systems.

Conclusion: Damage from vasculitis is present in the majority
(>80%) of patients with TAK even within 6 months of diagnosis. Approximately
40% of patients continue to accrue a new damage item, mostly related to
disease, with a mean of 2 items per patient. The cardiac, peripheral vascular,
and “other” sections capture most of the damage in TAK. LVVID appears to
document more damage items overall than VDI. Revision of the VDI or adoption of
the LVVID, along with data-driven approaches to item reduction and weighting,
may improve damage assessment in TAK.

Major organ systems damage in 129 patients with Takayasu’s arteritis as captured by VDI and LVVID
VDI (by organ system)	Baseline N* (%)	Follow-up New** (%)	LVVID (by organ system)	Baseline N* (%)	Follow-up New** (%)
Cardiac	45 (35%)	14 (11%)	Cardiac	55 (43%)	9 (7%)
Peripheral Vascular	97 (75%)	17 (13%)	Peripheral Vascular	101 (82%)	9 (7%)
Musculoskeletal	10 (8%)	2 (2%)	Musculoskeletal	10 (8%)	3 (2%)
Skin	1 (1%)	1 (1%)	Skin	1 (1%)	0 (0%)
Ocular	8 (6%)	0 (0%)	Ocular	7 (5%)	4 (3%)
Ear, Nose, and Throat	0 (0%)	0 (0%)	Ear, Nose, & Throat	1 (1%)	0 (0%)
Gastrointestinal	3 (2%)	2 (2%)	Gastrointestinal	0 (0%)	2 (2%)
Neuropsychiatric	10 (8%)	2 (2%)	Neuropsychiatric	12 (9%)	1 (1%)
Endocrine	4 (3%)	1 (1%)	Endocrine	4 (3%)	2 (2%)
Hematology/Oncology	0 (0%)	2 (2%)	Hematology/Oncology	3 (2%)	3 (2%)
Pulmonary	3 (2%)	1 (1%)	Pulmonary	NA	NA
Renal	0 (0%)	2 (2%)	Renal	NA	NA
Other	9 (7%)	5 (3%)	Other	36 (28%)	12 (9%)
			Weight gain	24 (19%)	8 (7%)
			Damage requiring surgical intervention	12 (9%)	2 (2%)
			Other form of damage	6 (5%)	2 (2%)
Patients with ³1 damage item on VDI	113 (88%)	49 (38)	Patients with ³1 damage item on LVVID	113 (88%)	47 (36%)
N = number with ³1 item captured in that category at baseline; *New = number of new accrued damage items captured in that category during follow-up NA = not applicable due to no items in this organ system appearing in LVVID

Disclosure: A. G. Sreih, None; T. A. Kermani, None; D. Cuthbertson, None; S. Carette, None; G. S. Hoffman, None; N. A. Khalidi, None; C. L. Koening, None; C. A. Langford, None; C. McAlear, None; P. A. Monach, None; L. W. Moreland, None; C. Pagnoux, None; P. Seo, None; 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, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear C, Monach PA, Moreland LW, Pagnoux C, Seo P, Warrington KJ, Ytterberg SR, Merkel PA. Damage Assessment in Takayasu’s Arteritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/damage-assessment-in-takayasus-arteritis/. Accessed .

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