Background/Purpose: Takayasu’s arteritis (TA) is a rare vasculitis. Although it appears to be most common in Asia countries, research on Chinese TA patients with large sample size was still deficient in recent years. This study on Chinese TA patients aimed to not only evaluate demographic, clinical, laboratory, and radiological features but also the responses to treatments.
Methods: 216 patients in China diagnosed as TA between the year 2000 and 2011 were retrospectively evaluated.
Results: The mean age of all patients was 27 years (14 – 65) and 84.2% were female. Vascular bruit, headache, diminished or absent pulse, malaise, hypertension, and dizziness were presented in 75%, 60.2%, 56.5%, 51.9%, 49.5%, and 48.1% of the patients, respectively. The active TA patients had more frequent involvement of the fever, claudication, hypertension, retinopathy, dyslipidemia, and heart failure than did the inactive group. According to the angiographic findings, the distribution of all patients was as follows, 45.4% Type I, 14.4% Type IIa, 5.1% Type IIb, 2.3% Type III, 6.5% Type IV, and 26.4% Type V arteritis. Most patients (61.1%) were treated with pharmacotherapy, while the others received interventional therapy (26.4%) or surgical operation (12.5%). And in those patients treated by medicine, 76.7% showed effective improvement. Especially, in patients received prednisone joint with immunosuppressive agents, 84.2% responded well.
Conclusion: Our study indicated that TA could non-accidentally happen in people over 40 years old. It also revealed that, in all expressions, vascular symptoms occurred more frequently than systemic symptoms. Moreover, fever, claudication, hypertension, and retinopathy were more typical in active TA patients. When monitoring disease activity, erythrocyte sedimentation rate and C-reactive protein were useful. Most of our patients received medicine treatments after definite diagnosis. And the outcome revealed that glucocorticoids and immunosuppressive agents were notablely effective.
Table 1 Characteristics of TA patients
|
Characteristics |
All patients |
Inactive patients |
Active patients |
p |
|||
|
|
n=216 |
n=53 |
n=163 |
|
|||
|
Sex Female no. (%) |
182 |
(84.2) |
44 |
(83.0) |
138 |
(84.6) |
|
|
Age median, yrs |
27 |
33 |
25 |
|
|||
|
Disease duration, median month |
10 |
9 |
11 |
|
|||
|
Disease onset age, years |
|
|
|
|
|
|
|
|
≤18 no. (%) |
47 |
(21.8) |
|
|
|
|
|
|
19–40 no. (%) |
148 |
(68.5) |
|
|
|
|
|
|
≥41 no. (%) |
21 |
(9.7) |
|
|
|
|
|
|
Symptoms at initial diagnosis |
|
|
|
|
|
|
|
|
Constitutional findings, no. (%) |
|
|
|
|
|
|
|
|
Fever |
82 |
(38) |
7 |
(13.2) |
75 |
(46.0) |
0.002# |
|
Malaise |
112 |
(51.9) |
26 |
(49.1) |
86 |
(52.8) |
0.639 |
|
Myosalgia |
15 |
(6.9) |
3 |
(5.7) |
12 |
(7.4) |
0.672 |
|
Arthralgia |
52 |
(24.1) |
12 |
(22.6) |
40 |
(24.5) |
0.779 |
|
Chest pain |
43 |
(19.9) |
10 |
(18.9) |
33 |
(20.2) |
0.827 |
|
Weight loss |
10 |
(4.6) |
2 |
(3.8) |
8 |
(4.9) |
0.733 |
|
Vascular findings, no. (%) |
|
|
|
|
|
|
|
|
Vascular pain |
59 |
(27.3) |
15 |
(28.3) |
44 |
(27) |
0.853 |
|
Diminished or absent pulse |
122 |
(56.5) |
26 |
(49.1) |
96 |
(58.9) |
0.209 |
|
Vascular bruit |
162 |
(75) |
35 |
(66) |
127 |
(77.9) |
0.083 |
|
Claudication |
47 |
(21.8) |
5 |
(9.4) |
42 |
(25.8) |
0.037# |
|
Cardiac findings, no. (%) |
|
|
|
|
|
|
|
|
Hypertension |
107 |
(49.5) |
14 |
(26.4) |
93 |
(57.1) |
0.019# |
|
Cardiopalmus |
25 |
(11.6) |
6 |
(11.3) |
19 |
(11.7) |
0.947 |
|
Dyspnea on exertion |
10 |
(4.6) |
1 |
(1.9) |
9 |
(5.5) |
0.274 |
|
Eye findings, no. (%) |
|
|
|
|
|
|
|
|
Retinopathy |
21 |
(9.7) |
1 |
(1.9) |
20 |
(12.3) |
0.039# |
|
Blurred vision |
45 |
(20.8) |
11 |
(20.8) |
34 |
(20.9) |
0.987 |
|
Sudden visual loss |
13 |
(6.0) |
3 |
(5.7) |
10 |
(6.1) |
0.900 |
|
Neurologic findings, no. (%) |
|
|
|
|
|
|
|
|
Dizziness |
104 |
(48.1) |
25 |
(47.2) |
79 |
(48.5) |
0.870 |
|
Headache |
130 |
(60.2) |
30 |
(56.6) |
100 |
(61.3) |
0.540 |
|
Cutaneous findings, no. (%) |
|
|
|
|
|
|
|
|
Erythema nodosum |
4 |
(1.9) |
0 |
(0.0) |
5 |
(3.1) |
0.197 |
|
Cutaneous ischemic ulcer |
2 |
(0.9) |
0 |
(0) |
2 |
(1.2) |
0.418 |
|
Co-morbidity |
|
|
|
|
|
|
|
|
Anemia, no. (%) |
113 |
(52.3) |
25 |
(47.2) |
88 |
(54.0) |
0.388 |
|
Dyslipidemia, no. (%) |
44 |
(20.4) |
5 |
(9.4) |
39 |
(23.9) |
0.038# |
|
Heart failure, no. (%) |
13 |
(6.0) |
0 |
(0) |
13 |
(8.0) |
0.040# |
|
Cerebral infarction, no. (%) |
8 |
(3.7) |
1 |
(1.9) |
7 |
(4.3) |
0.420 |
|
Diabetes mellitus, no. (%) |
4 |
(1.9) |
1 |
(1.9) |
3 |
(1.8) |
0.983 |
|
Thyroid diseases, no. (%) |
25 |
(11.6) |
5 |
(9.4) |
20 |
(12.3) |
0.575 |
|
Lab |
|
|
|
|
|||
|
Hb, mean ± SD, g/l |
117.2±19.1 |
120.2±20.1 |
113.2±23.1 |
0.892 |
|||
|
PLT, mean ± SD, *109/L |
275.7±119.6 |
270.7±112.6 |
268.7±150.6 |
0.901 |
|||
|
ESR, mean ± SD, mm/h |
53.11±45.5 |
23.9±45.5 |
69.9±125.5 |
0.024# |
|||
|
CRP, median mg/dl |
2.68±3.34 |
1.2±6.2 |
4.4±20.9 |
0.031# |
|||
|
IgG, median mg/dl |
1230 |
1154 |
1320 |
0.827 |
|||
|
IgA, median mg/dl |
338 |
364 |
332 |
0.736 |
|||
|
IgM, median mg/dl |
139 |
126 |
140 |
0.534 |
|||
#P <0.05
Table 2 Selction of treatment strategies on diagnosis of different lesion types
|
Lesion type |
no. (%) |
Medicine |
Interventional therapy no. (%) |
Operation |
||||
|
Type I |
98/216 |
(45.4) |
59/98 |
(60.2) |
23/98 |
(23.5) |
16/98 |
(16.3) |
|
Type II a |
31/216 |
(14.4) |
14/31 |
(45.2) |
`13/31 |
(41.9) |
4/31 |
(12.9) |
|
Type II b |
11/216 |
(5.1 ) |
7/11 |
(63.6) |
3/11 |
(27.3) |
1/11 |
(9.1) |
|
Type III |
5/216 |
(2.3) |
4/5 |
(80.0) |
1/5 |
(20.0) |
0/5 |
(0) |
|
Type IV |
14/216 |
(6.5) |
12/14 |
(85.7) |
2/14 |
(14.3) |
0/14 |
(0) |
|
Type V |
57/216 |
(26.4) |
36/57 |
(63.2) |
15/57 |
(26.3) |
6/57 |
(10.5) |
|
Total |
216/216 |
(100) |
132/216 |
(61.1) |
57/216 |
(26.4) |
27/216 |
(12.5) |
Table 3 Features of corticosteroid and immunosuppressive therapy
|
Drugs |
N number |
Effectiveness |
||
|
|
no. (%) |
no. (%) |
||
|
Pred |
27/132 |
(20.5) |
16/27 |
(59.3) |
|
CTX |
3/132 |
(2.3) |
1/3 |
(33.3) |
|
Pred+CTX |
65/132 |
(49.2) |
58/65 |
(89.2) |
|
Pred+MTX |
13/132 |
(9.8) |
11/13 |
(84.6) |
|
Pred+CTX+MTX |
8/132 |
(6.1) |
5/8 |
(62.5) |
|
Pred+HCQ |
3/132 |
(2.3) |
2/3 |
(66.7) |
|
Pred+AZA |
2/132 |
(1.5) |
2/2 |
(100) |
|
Pred+CysA |
2/132 |
(1.5) |
1/2 |
(50.0) |
|
Pred+TGV |
2/132 |
(1.5) |
1/2 |
(50.0) |
|
Anti-TNFα+MTX |
1/132 |
(0.8) |
1/1 |
(100) |
|
Others |
6/132 |
(4.5) |
3/6 |
(50.0) |
|
Total |
132/132 |
(100) |
101/132 |
(76.5) |
Pred: prednisone, CTX:Cyclophosphamide, MTX:Methotrexate, HCQ:Hydroxychloroquine; AZA:Azathioprine, CysA:Cyclosporine-A,TGV:Thunder god vine
Disclosure:
X. Liu,
None;
T. Zhang,
None;
X. Zhuang,
None;
K. Yuan,
None;
X. Shu,
None;
G. Wang,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/takayasus-arteritis-features-and-management-of-216-patients-in-china/