Aıda Malek MAHDAVI, Nadereh RASHTCHIZADEH, Hadıseh KAVANDI, Mehrzad HAJIALILO, Sousan KOLAHI, Mohammad-reza NAKHJAVANI, Alı-asghar EBRAHIMI, Seyedmostafa SEYEDMARDANI, Mansour SALESI, Mohsen SOROUSH, Alıreza KHABBAZI

Clinical characteristics and long-term outcome of Takayasu arteritis in Iran: a multicentre study

Background/aim: This study aimed to evaluate the demographic, clinical, angiographic and prognostic characteristics of Takayasu arteritis TA in Iran. Materials and methods: A total of 75 patients with TA based on the American College of Rheumatology 1990 criteria for TA classification referred to the Rheumatology Centres, were followed-up from 1989 to 2019. Demographic, clinical, angiographic and prognostic characteristics were collected at baseline and last visit. Results: The mean age was 31.9 ± 9.8 years at the disease onset. Female to male ratio was 14. The median latency in diagnosis was 24 months. Pulse discrepancy in the arms, blood pressure discrepancy in the arms, limb claudication, hypertension and constitutional symptoms were the most common clinical features. The most common angiographic type at the time of diagnosis was Type I 42.7% . The most frequent arterial lesion was stenosis 89.4% . Subclavian, carotid and aortic arteries were the most commonly involved arteries. New lesions developed in 28.6% of patients during the 5.25-year follow-up. Vasculitis-induced chronic damage was observed in all patients. Disease activity decreased and vascular damage remained stable throughout the follow-up period. Conclusions: The clinical features and angiographic type of TA in Iran are different from most Asian countries. Differences in angiographic and clinical features may lead to delayed diagnosis. The issue of delay in diagnosis should create awareness among health care providers that TA is not a very rare disease in Iranians and failure to pay attention to warning symptoms may delay the diagnosis.

Keywords:

Takayasu arteritis, Birmingham Vasculitis Activity Score BVAS, Indian Takayasu Clinical Activity Score ITAS, Vasculitis Damage Index VDI, outcome, remission, Iran.,

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1. Seyahi E. Takayasu arteritis: an update. Current Opinion in Rheumatology 2017; 29 (1): 51-56. doi: 10.1097/ BOR.0000000000000343
2. Onen F, Akkoc N. Epidemiology of Takayasu arteritis. La Presse Médicale 2017; 46 (7-8 Pt 2): 197-203. doi: 10.1016/j. lpm.2017.05.034
3. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis and Rheumatism 1990; 33 (8): 1129-1134. doi: 10.1002/art.1780330811
4. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. International Journal of Cardiology 1996; 54 (Suppl): 155-163. doi: 10.1016/ s0167-5273(96)02813-6
5. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS et al. Takayasu arteritis. Annals of Internal Medicine 1994; 120 (11): 919-929. doi: 10.7326/0003-4819-120-11-199406010-00004
6. Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B et al. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Annals of the Rheumatic Disease 2009; 68 (12): 1827-1832. doi: 10.1136/ard.2008.101279
7. Misra R, Danda D, Rajappa SM, Ghosh A, Gupta R et al. Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology (Oxford, England)) 2013; 52 (10): 1795-1801. doi: 10.1093/ rheumatology/ket128
8. Exley AR, Bacon PA, Luqmani RA, Kitas GD, Gordon C et al. Development and initial validation of the Vasculitis Damage Index for the standardized clinical assessment of damage in the systemic vasculitides. Arthritis and Rheumatism 1997; 40 (2): 371-380. doi: 10.1002/art.1780400222
9. Flossmann O, Bacon P, de Groot K, Jayne D, Rasmussen N, et al. Development of comprehensive disease assessment in systemic vasculitis. Annals of the Rheumatic Diseases 2007; 66 (3): 283-292. doi: 10.1136/ard.2005.051078
10. Park MC, Lee SW, Park YB, Chung NS. Clinical characteristics and outcomes of Takayasu’s arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scandinavian Journal of Rheumatology 2005; 34 (4): 284-292. doi: 10.1080/03009740510026526
11. Yang L, Zhang H, Jiang X, Zou Y, Qin F, Song L, et al. Clinical Manifestations and Long-term Outcome for Patients with Takayasu Arteritis in China. The Journal of Rheumatology 2014; 41 (12): 2439-2446. doi: https://doi.org/10.3899/ jrheum.140664
12. Jing Li, Fei Sun, Zhe Chen, Yang Y, Zhao J et al. The clinical characteristics of Chinese Takayasu’s arteritis patients: a retrospective study of 411 patients over 24 years. Arthritis Research & Therapy 2017; 19 (1): 107. doi: 10.1186/s13075- 017-1307-z
13. Goel R, Danda D, Joseph G, Ravindran R, Kumar S et al. Long-term outcome of 251 patients with Takayasu arteritis on combination immunosuppressant therapy: single centre experience from a large tertiary care teaching hospital in southern India. Seminars in Arthritis and Rheumatism 2018; 47 (5): 718-726. doi: 10.1016/j.semarthrit.2017.09.014
14. Bicakcigil M, Aksu K, Kamali S, Ozbalkan Z, Ates A et al. Takayasu’s arteritis in Turkey - clinical and angiographic features of 248 patients. Clin and Experimental Rheumatology 2009; 27 (1 Suppl 52): 59-64.
15. Karageorgaki ZT, Bertsias GK, Mavragani CP, Kritikos HD, Spyropoulou-Vlachou M et al. Takayasu arteritis: epidemiological, clinical, and immunogenetic features in Greece. Clin and Experimental Rheumatology 2009; 27 (1 Suppl 52): 33-39
16. Vanoli M, Daina E, Salvarani C, Sabbadini MG, Rossi C, et al. Takayasu’s arteritis: a Study of 104 Italian patients. Arthritis and Rheumatism 2005; 53 (1): 100-107. doi: 10.1002/art.20922
17. Petrovic-Rackov L, Pejnovic N, Jevtic M, Damjanov N. Longitudinal study of 16 patients with Takayasu’s arteritis: clinical features and therapeutic management. Clinical Rheumatology 2009; 28 (2): 179-185. doi: 10.1007/s10067-008- 1009-7
18. Gudbrandsson B, Molberg Ø, Garen T, Palm Ø. Prevalence, incidence and disease characteristics of Takayasu arteritis differ by ethnic background; data from a large, population-based cohort resident in Southern Norway. Arthritis Care & Research (Hoboken) 2017; 69 (2): 278-285. doi: 10.1002/acr.22931
19. Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L et al. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine 2010; 89 (1): 1-17. doi: 10.1097/ MD.0b013e3181cba0a3
20. Schmidt J, Kermani TA, Bacani AK, Crowson CS, Cooper LT et al. Diagnostic features, treatment, and outcomes of Takayasu arteritis in a US cohort of 126 patients. Mayo Clinic Proceedings 2013; 88 (8): 822-830. doi: 10.1016/j.mayocp.2013.04.025
21. Soto ME, Espinola N, Flores-Suarez LF, Reyes PA. Takayasu arteritis: clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival and prognosis. Clinical and Experimental Rheumatology 2008; 26 (3 Suppl 49): 9-15.
22. Sato EI, Hatta FS, Levy-Neto M, Fernandes S. Demographic, clinical, and angiographic data of patients with Takayasu arteritis in Brazil. International Journal of Cardiology 1998; 66 (Suppl 1): 67-70. doi: 10.1016/s0167-5273(98)00152-1