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Patterns of clinical presentation in Takayasu's arteritis
Kaitlin A Quinn1, K Bates Gribbons2, Simon Carette3
1Division of Rheumatology, MedStar Georgetown University Hospital, Washington DC, USA; Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA.
Seminars in Arthritis and Rheumatism
|May 28, 2020
Summary
Takayasu's arteritis presents diversely at diagnosis, challenging the traditional triphasic disease model. Understanding these varied presentations is key for effective Takayasu's arteritis management.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Takayasu's arteritis (TAK) is a rare, chronic inflammatory condition affecting large arteries.
- The typical disease progression, a "triphasic pattern," lacks systematic evaluation.
- Clinical heterogeneity at diagnosis is recognized but not well-characterized.
Purpose of the Study:
- To systematically evaluate the patterns of clinical presentation in Takayasu's arteritis at diagnosis.
- To assess the validity of a proposed "triphasic pattern" of disease progression.
Main Methods:
- Prospective recruitment of 275 Takayasu's arteritis patients from NIH and VCRC.
- Categorization of patients based on diagnosis presentation: constitutional, carotidynia, vascular, ischemic event, or asymptomatic.
- Assessment of clinical characteristics and preceding symptoms for triphasic pattern identification.
Main Results:
- Diverse presentations observed: constitutional (8%), carotidynia (13-15%), vascular symptoms (43-47%), ischemic event (28-30%), asymptomatic (2-6%).
- Younger patients presented with constitutional symptoms or ischemic events; older patients were asymptomatic.
- Relapse rates were highest in carotidynia cases; only 19% with ischemic events reported a triphasic pattern.
Conclusions:
- Takayasu's arteritis exhibits significant clinical heterogeneity at diagnosis.
- Patients do not consistently follow a sequential triphasic disease progression.
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