Is Takayasu's arteritis more severe in children?

Area of Science:

• Rheumatology
• Pediatric Rheumatology
• Vascular Medicine

Background:

• Takayasu's arteritis (TAK) is a rare, chronic inflammatory disease affecting large arteries, primarily the aorta and its branches.
• Understanding differences in disease presentation and progression between childhood and adult onset is crucial for effective management.

Purpose of the Study:

• To compare the clinical, laboratory, and echocardiographic features of Takayasu's arteritis (TAK) in patients with childhood onset versus adult onset.
• To identify distinct patterns of vascular involvement and comorbidities in pediatric versus adult TAK.

Main Methods:

• Retrospective evaluation of 179 Takayasu's arteritis (TAK) patients diagnosed between August 2005 and July 2019.
• Comparison of demographic data, laboratory markers, disease activity, echocardiographic findings, and treatment regimens between pediatric (<18 years) and adult (≥18 years) onset groups.

Main Results:

• Pediatric onset TAK patients (n=25) exhibited more intense inflammation at diagnosis, with significantly higher acute phase reactants compared to adult onset patients (n=154).
• Abdominal disease was more prevalent in pediatric TAK, while focal and aortic arch disease predominated in adults. Echocardiographic findings like ascending aortic dilatation and left ventricular hypertrophy were more common in children.
• Hypertension was a more frequent comorbidity during follow-up in pediatric TAK, whereas cerebrovascular disease was more common in adults.

Conclusions:

• Pediatric onset Takayasu's arteritis (TAK) is characterized by more severe inflammation and more extensive vascular involvement at presentation.
• Further multicenter studies across diverse geographic regions are warranted to validate these findings and elucidate the underlying etiologies of childhood versus adult TAK.