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Age specific clinical manifestations and vascular involvements in childhood-onset Takayasu arteritis
Yingjie Xu1, Congying Wang2,3, Wenquan Niu4
1Department of Rheumatology, Children's Hospital Capital Institute of Pediatrics, Beijing, China.
Insights
Childhood-onset Takayasu arteritis (cTAK) presents differently across age groups. Infants show fever and coronary issues, while adolescents experience headaches and involve larger arteries, aiding early diagnosis.
Area of Science:
- Pediatric rheumatology
- Vascular inflammation
- Rare childhood diseases
Background:
- Limited research exists on childhood-onset Takayasu arteritis (cTAK) characteristics during growth and development.
- Understanding age-specific cTAK patterns is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the age-specific clinical manifestations and vascular involvement in childhood-onset Takayasu arteritis.
- To identify patterns that can aid in the early diagnosis of cTAK.
Main Methods:
- A cohort of 111 cTAK patients was analyzed, recruited between January 2009 and December 2021.
- Patients were categorized into four age groups: infant, toddler/preschool, school-age, and adolescent.
- Clinical data, inflammatory markers, and vascular imaging findings were compared across age groups.
Main Results:
- Infants presented with fever, elevated inflammatory markers (CRP, WBC, PLT), and coronary artery involvement.
- Adolescents were more prone to headache, dizziness, fatigue, and involvement of the superior mesenteric, carotid, and celiac trunk arteries.
- Younger patients, particularly infants, received less glucocorticoid treatment; 73% achieved remission.
Conclusions:
- Clinical manifestations and vascular involvement in cTAK vary significantly by age group.
- Age-specific patterns, though lacking specificity, offer valuable clues for early cTAK diagnosis.
- Recognizing these distinct patterns can improve diagnostic accuracy and patient outcomes.
Background:
Limited studies focused on characteristics of childhood-onset Takayasu arteritis (cTAK) throughout growth and development.
Methods:
111 cTAK patients were recruited from six tertiary hospitals across China from January 2009 to December 2021. Patients were classified into infant group (<12 months), toddler and preschool group (≥12 months, <72 months), school-age group (≥72 months, <144 months) and adolescent group (≥144 months).
Results:
Infantile cTAK patients tended to had a significantly higher proportion presenting with fever (91.7%, P-trend <0.001), and had significantly higher levels of C-reactive protein (CRP), white blood cells (WBC), platelet (PLT), and lower hemoglobin (HGB) compared to the other three groups (all P < 0.0125). Adolescent patients were more likely to present with headache (33.3%), dizziness (24.2%) and fatigue (51.5%; all P-trend < 0.001). Infantile patients were more likely to have coronary artery involvement (75.0%, P trend < 0.001). Adolescent patients were more likely to have superior mesenteric artery (36.4%, P trend = 0.005), carotid artery (30.3%, P trend = 0.003), and celiac trunk artery stenosis (27.3%, P trend = 0.005).Younger patients, especially infants, had a lower proportion of glucocorticoids use (P trend = 0.001). 73.0% (81/111) of patients were in remission, with a median follow-up time of 2.00 [2.00, 5.00] years.
Conclusion:
The age-specific patterns identified in this study offered valuable insights for a comprehensive understanding of cTAK.
Impact:
Infantile Takayasu arteritis patients tended to present with fever, elevated inflammatory biomarkers and coronary artery involvement. Adolescent patients were more likely to present with headache, dizziness and fatigue, with superior mesenteric artery, carotid artery involvement and celiac trunk artery stenosis. Clinical manifestations and vascular involvement of childhood-onset Takayasu arteritis differ across age groups. The clinical manifestations of childhood-onset Takayasu arteritis lack specificity. The age-specific patterns identified in this study may provide clues for early diagnosis.
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