Prognostic Factors in Takayasu’s Arteritis

Jul 18, 2017
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Authors:
Comarmond C, Biard L, Lambert M, et al.
Citation:
Long-Term Outcomes and Prognostic Factors of Complications in Takayasu’s Arteritis: A Multicenter Study of 318 Patients. Circulation 2017;Jul 12:[Epub ahead of print].
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Study Questions:

What are the long-term outcomes and prognostic factors for vascular complications in patients with Takayasu’s arteritis (TA)?

Methods:

The authors performed a nationwide retrospective study of 318 patients with TA. They assessed for prognostic factors associated with event-free survival, relapse-free survival, and the incidence of complications using a multivariable model.

Results:

The mean age of TA diagnosis was 36 years (interquartile range, 25-47 years), and 86.8% of patients were women. With a median follow-up of 6.1 years, relapses occurred in 43% of patients, vascular complications in 38% of patients, and death in 5% of patients. The 5- and 10- year relapse-free survival rate was 58.6% (95% confidence interval, 52.7-65.1%) and 47.7% (41.2-55.1%), respectively. Male sex, elevated C-reactive protein, and carotidynia were all independently associated with worse relapse-free survival. The 5- and 10-year event-free survival rate was 48.2% (42.2-54.9%) and 36.4% (30.3%-43.9%). Carotidynia was associated with worse event-free survival. A progressive disease course at diagnosis, thoracic aortic involvement, and retinopathy were each independently associated with an increased likelihood of vascular complications.

Conclusions:

The authors concluded that 50% of patients with TA will experience relapse and complications within 10 years of diagnosis.

Perspective:

This report offers important insight into the clinical pattern of TA, a chronic inflammatory vasculitis of large vessels (predominately the aorta and main branches). In addition to offering prognostic information for newly diagnosed patients, this study also suggests key prognostic characteristics for patients most likely to experience relapse or vascular complications. Whether more aggressive treatment (especially immunosuppressive) would offer benefit remains unknown at this time.

Keywords: Aorta, Thoracic, Carotid Arteries, C-Reactive Protein, Disease-Free Survival, Immunosuppressive Agents, Primary Prevention, Prognosis, Recurrence, Stroke, Takayasu Arteritis, Vascular Diseases, Vasculitis


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