Background/Purpose:

Takayasu Arteritis (TA) in India frequently present with complications, indicating the need for a specific damage index to capture the accumulation of disease-related scars over time. Takayasu Arteritis Damage Score (TADS) devised by us is a clinical index for use in these circumstances.

Methods:

Disease extent in TA is assessed using the comprehensive tool, Disease Extent Index for Takayasu Arteritis (DEI.Tak). We modified this established score, using a large database of cases previously assessed by us. Items persisting for more six months, related to accumulating scars, were selected while omitting those used infrequently to produce a shorter form with 42 items focused on CVS, particularly pulse loss and vascular interventions. Drug-related damage were also included. This new TADS form was compared to Vasculitis Damage Index (VDI) and PGO using paper cases. It was then applied to analyze a cohort of 286 cases followed in one clinic over 2 decades.

Results:

The increase in damage/scars over time correlated closely with disease duration, continuing to increase over 20 years. TADS also related to poor outcomes such as pulse loss. In a cohort of 286 TA patients, the mean age at onset of TA symptoms was 33.74 years (8-42). 142 vascular interventions were performed in 102 of this cohort (34 men, 68 women, mean disease duration 8.9 years). The procedures performed were: Carotid angioplasty + stenting – 29, vertebral angioplasty + stenting-6, grafts from ascending aorta to Carotids-4, subclavian angioplasty + stenting- 22, renal angioplasty + stenting-31, Aortic angioplasty + stenting – 15, coronary angioplasty + stenting- 22 and CABG Surgeries-14. The mean follow up period was 144 months. Associated clinical features and drug therapy were recorded. Peri-operative complications included infections- 5.2%, Stroke- 8.8%, Myocardial infarction-4.6% and renal failure-4.8%. Drug toxicity and damage were seen in 30%. There were no deaths due to the procedures and TADS scores continued to rise^.. The patency of stents at 5 and 10 years were 92% and 83% respectively. In the majority (84.7%), drug therapy was also continuing. 32/286 patients died and the scores in fatal disease were higher than in non-fatal cases (7.4 Vs 4.8).

Conclusion:

Damage is a significant factor in TA. Vessel occlusion is a major feature of TA, often requiring vascular interventions. Recording the new disease-specific damage score, TADS helps delineate features associated with pulse loss, long-term stent patency, drug induced damage and mortality.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-takayasu-arteritis-damage-score-tads-to-measure-damage-in-takayasu-arteritis/