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Published on: September 28, 2015
Aneurysmal Disease in Patients With Takayasu Arteritis
Frédéric Lefebvre1, Carolyn Ross2, Medha Soowamber3
1F. Lefebvre, MD, MSc, Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, and Vasculitis Clinic, Mount Sinai Hospital, Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario; frederic.lefebvre.med@ssss.gouv.qc.ca.
Insights
Aneurysmal disease affects a significant portion of Takayasu arteritis patients, often persisting over time. This condition is linked to increased relapses and requires systematic reporting in studies.
Area of Science:
- Vascular Medicine
- Rheumatology
- Immunology
Background:
- Takayasu arteritis (TA) primarily causes arterial stenosis.
- Aneurysmal lesions are a less common but significant manifestation of TA.
Purpose of the Study:
- To assess the main characteristics of aneurysmal disease in a Canadian cohort of patients with Takayasu arteritis.
- To identify factors associated with aneurysmal development and outcomes in TA.
Main Methods:
- Retrospective monocentric study of patients with TA at Mount Sinai Hospital, Toronto.
- Diagnosis of TA based on clinical findings or 1990 American College of Rheumatology criteria.
- Analysis of patient data including disease duration, comorbidities, and treatment regimens.
Main Results:
- Aneurysmal disease was present in 31% of 74 TA patients, with persistent or new aneurysms noted in most.
- Thoracic aorta aneurysms were most common, followed by abdominal aorta, subclavian, and carotid arteries.
- Patients with aneurysms had higher rates of prior hypertension, fever, seizures, aortic regurgitation, and disease relapses.
Conclusions:
- Aneurysmal disease is a notable feature in a significant subset of Takayasu arteritis patients.
- The presence of aneurysms is associated with increased disease activity and relapse rates.
- Systematic reporting of aneurysmal disease in TA studies is recommended due to potential rupture risk and association with poorer outcomes.
Objective:
Takayasu arteritis (TA) leads to stenotic disease. Aneurysmal lesions are rarer. This study assessed the main characteristics of aneurysmal disease in a Canadian cohort of patients with TA.
Methods:
This monocentric retrospective study included patients with TA followed at the Mount Sinai Hospital Vasculitis Clinic in Toronto. Diagnosis of TA was based on clinical findings and/or satisfied the 1990 American College of Rheumatology classification criteria.
Results:
Seventy-four patients were included. At any time, aneurysmal disease was found in 23 (31%) patients. Median disease duration was 9.0 (IQR 7.0-19.0) years. Prior hypertension (P = 0.02), fever (P = 0.04), and seizure disorders (P = 0.03) were more common. Limb claudication was less frequent (P = 0.01). Persistent and/or new aneurysms were demonstrated in 22/23 patients at follow-up. Thoracic aorta aneurysm (13/22) was most common, followed by abdominal aorta (8/22), subclavian (7/22), and carotid (6/22) artery disease. Aortic valve regurgitation was more frequent (9/23 vs 3/48; P = 0.001). Twenty-one patients had been treated with glucocorticoids (median 6.1 years [IQR 3.7-8.1]). Methotrexate, azathioprine, and leflunomide were repeatedly used. Infliximab (7/23) was used more often (P = 0.04), whereas tocilizumab was received by only 4 patients with aneurysmal disease (P = 0.01). Patients with aneurysms suffered more frequent relapses (2.0 [IQR 0.0-4.0] vs 1.0 [IQR 0.0-2.0], P = 0.04).
Conclusion:
Aneurysmal disease was found in a significant proportion of patients with TA. Given that aneurysms may carry a risk of rupture, and are associated with a higher rate of relapse, this finding should be reported systematically in TA studies.
