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Takayasu Arteritis and Spondyloarthritis: Coincidence or Association? A Study of 14 Cases
Elodie Rivière1,2, Laurent Arnaud1,2, Mikael Ebbo1,2
1From the Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Le Kremlin Bicêtre; INSERM UMR-S 1136, Hôpital Pitié-Salpêtrière; Rheumatology A Department, Hôpital Cochin, University Paris Descartes; Rheumatology, Groupe Hospitalier Diaconesses Croix Saint Simon; Rheumatology Department B, Hôpital Cochin, Paris; Internal Medicine, Centre Hospitalier Universitaire (CHU) Timone, Aix Marseille Université, Marseille; Rheumatology, CHU H. Mondor, Créteil; Rheumatology, Centre hospitalier Le Mans; Rheumatology, Hôpital Salengro, Lille; Rheumatology, GH Pellegrin, Bordeaux; Rheumatology, CHU Gabriel Montpied, Clermont Ferrand, France.
Objective:
Spondyloarthritis (SpA) and Takayasu arteritis (TA) are 2 chronic inflammatory diseases; their coexistence in a single patient is uncommon. The aims of our study were to describe clinical features of patients having SpA associated with TA and to identify some characteristics of the types of patients with SpA associated with TA. We also analyzed treatments used in this context.
Methods:
This French multicenter retrospective survey called for observations on behalf of the Club Rhumatismes et Inflammations, with a standardized questionnaire established by the investigators.
Results:
We included 14 patients (women: 10/14; median age at SpA diagnosis: 43.5 yrs, ranging from 19 to 63). Subtypes of SpA were ankylosing spondylitis (n = 11), psoriatic arthritis (n = 2), and synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome (n = 1). HLA-B27 was positive in 3 cases, negative in 9, and unknown in 2. SpA was diagnosed before TA in 13 cases. Imaging findings compatible with the diagnosis of TA were found with computed tomography (11/14) and/or Doppler ultrasound (10/14). Laboratory tests showed increased acute-phase reactants in all cases (C-reactive protein ≥ 25 mg/l in 71% of the cases). All patients except 1 received corticosteroids and 7 were treated with anti-tumor necrosis factor (anti-TNF).
Conclusion:
Association of SpA and TA is rare but probably not coincidental. Peripheral pulse palpation and vascular auscultation should be systematic and are the first indicators of TA in patients with SpA. Moreover, increased acute-phase reactants during SpA followup should lead to search for TA. Finally, there are therapeutic implications because anti-TNF are efficient in SpA and might be efficient in TA.