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Published on: February 8, 2019
Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis
K Bates Gribbons1, Cristina Ponte2, Simon Carette3
1National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland.
Insights
Computer analysis revealed distinct arterial patterns in Takayasu arteritis (TAK) and giant cell arteritis (GCA). These findings differentiate the two large-vessel vasculitides and can inform classification criteria.
Area of Science:
- Vascular Medicine
- Rheumatology
- Medical Imaging
Background:
- Takayasu arteritis (TAK) and giant cell arteritis (GCA) are large-vessel vasculitides with overlapping clinical features.
- Distinguishing between TAK and GCA is crucial for appropriate patient management and classification.
Purpose of the Study:
- To identify and validate distinct patterns of arterial involvement in TAK and GCA using computational methods.
- To differentiate between TAK and GCA based on their unique vascular disease patterns.
Main Methods:
- K-means cluster analysis was applied to a combined cohort of 1,068 patients with TAK or GCA from the DCVAS and North American cohorts.
- Inclusion criteria required evidence of large-vessel involvement via angiography, ultrasonography, or 18F-FDG PET imaging.
- Identified clusters were validated independently in the North American cohort.
Main Results:
- Six distinct patient clusters were identified and validated, showing shared and divergent arterial patterns between TAK and GCA.
- TAK patients more frequently exhibited abdominal, bilateral subclavian/carotid, or isolated left subclavian artery disease.
- GCA patients were more prone to diffuse disease, bilateral axillary/subclavian involvement, or minimal disease without a clear pattern. GCA also showed higher PET uptake without angiography damage.
Conclusions:
- Distinct arterial involvement patterns exist for TAK and GCA, aiding in their differentiation.
- These identified vascular patterns should be considered for inclusion in future classification criteria for large-vessel vasculitis.
Objective:
To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA).
Methods:
Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort.
Results:
A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage.
Conclusion:
Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis.
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