[Clinical characteristics of middle-age and elderly patients with active Takayasu arteritis disease]

Objective: To draw attention to the diagnosis of active Takayasu arteritis (TAK) in middle-aged and elderly patients and to analyze the clinical characteristics of this population. Methods: Clinical data of 106 patients newly diagnosed with TAK at Beijing Chao-Yang Hospital, Capital Medical University, between 2017 and 2025 were retrospectively collected; 11 patients aged over 50 years (2 men and 9 women) were enrolled in this study. Onset characteristics, medical history, clinical manifestations, laboratory findings, and imaging features were collected and analyzed. Disease activity was evaluated, treatment regimens and prognosis were recorded, and all patients underwent at least one follow-up. Results: Among patients first diagnosed with TAK at this single center, middle-aged and elderly patients with active TAK accounted for 10.40% (11/106) during the same period, with a median age at diagnosis of 61 years. Among them, 6 patients (6/11) were over 60 years old. The median time from symptom onset to diagnosis was 13 months (interquartile range: 12, 36 months). Although all 11 patients had multiple arterial involvements, none underwent complete evaluation of all arteries covered by the international criteria. Among the 8 patients who underwent CT pulmonary angiography (CTPA) or chest contrast-enhanced CT, all showed pulmonary artery luminal stenosis. All 8 patients who underwent contrast-enhanced magnetic resonance pulmonary angiography (MRPA) exhibited pulmonary artery wall thickening with enhancement and luminal stenosis. Of the 9 patients who underwent PET-CT, 7 showed pulmonary artery hypermetabolism. Among the 4 patients with elevated levels of multiple autoantibodies, 2 were male (2/2) and 2 were female (22.2% of female patients, 2/9). Moreover, both male patients had severe TAK-related complications (one with an abdominal aortic aneurysm and the other with pulmonary hypertension). Conclusion: Active TAK can occur in individuals over 60 years of age and the disease may be more severe in middle-aged and elderly male TAK patients. Middle-aged and elderly patients with active TAK require comprehensive evaluation of arterial involvement with modalities such as ultrasound, so as to enhance the capability of clinical differential diagnosis. For patients presenting primarily with respiratory symptoms, CTPA and MRPA should be performed to clarify pulmonary artery involvement in TAK.