Patterns of clinical presentation in Takayasu's arteritis

Kaitlin A. Quinn, K. Bates Gribbons, Simon Carette, David Cuthbertson, Nader A. Khalidi, Curry L. Koening, Carol A. Langford, Carol A. McAlear, Paul A. Monach, Larry W. Moreland, Christian Pagnoux, Philip Seo, Antoine G. Sreih, Kenneth J. Warrington, Steven R. Ytterberg, Elaine Novakovich, Peter A. Merkel, Peter C. Grayson

Research output: Contribution to journalArticle

Abstract

Objective: Takayasu's arteritis (TAK) is a clinically heterogenous disease. Patterns of clinical presentation in TAK at diagnosis have not been well described, and a “triphasic pattern” of constitutional symptoms evolving into vascular inflammation and fibrosis has been reported but never systematically evaluated. Methods: Patients with TAK were prospectively recruited from the National Institutes of Health (NIH) and the Vasculitis Clinical Research Consortium (VCRC). Based on clinical presentation at diagnosis, patients were divided into five categories: (1) constitutional symptoms alone, (2) carotidynia, (3) other vascular-associated symptoms, (4) major ischemic event, or (5) asymptomatic. Associated clinical characteristics were evaluated in each category. Preceding symptoms were also assessed to determine the presence of a triphasic disease pattern. Results: A total of 275 patients with TAK were included (VCRC=208; NIH=67). Similar heterogeneity of clinical presentation was identified in each cohort: constitutional symptoms (8%), carotidynia (13-15%), other vascular symptoms (43-47%), major ischemic event (28-30%), and asymptomatic (2-6%). An increased relative proportion of males was seen in patients who presented with constitutional symptoms or were asymptomatic at diagnosis (p<0.01). Patients who presented with constitutional symptoms and major ischemic events were youngest at diagnosis. Patients in the asymptomatic group were oldest at diagnosis and often were not treated (p<0.01). Relapse was most frequent in patients who presented with carotidynia (p<0.01). A minority of patients (19%) who presented with a major ischemic event reported a triphasic pattern of disease. Conclusion: There are diverse clinical presentations at diagnosis in TAK. Patients do not necessarily progress sequentially through phases of disease.

Original languageEnglish (US)
Pages (from-to)576-581
Number of pages6
JournalSeminars in Arthritis and Rheumatism
Volume50
Issue number4
DOIs
StatePublished - Aug 2020

Keywords

  • Epidemiology
  • Observational cohort
  • Takayasu's arteritis
  • Vasculitis

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

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  • Cite this

    Quinn, K. A., Gribbons, K. B., Carette, S., Cuthbertson, D., Khalidi, N. A., Koening, C. L., Langford, C. A., McAlear, C. A., Monach, P. A., Moreland, L. W., Pagnoux, C., Seo, P., Sreih, A. G., Warrington, K. J., Ytterberg, S. R., Novakovich, E., Merkel, P. A., & Grayson, P. C. (2020). Patterns of clinical presentation in Takayasu's arteritis. Seminars in Arthritis and Rheumatism, 50(4), 576-581. https://doi.org/10.1016/j.semarthrit.2020.04.012