Presentation: Clinical and Angiographic Features, Treatment and Prognosis of Takayasu’s Arteritis: A Prospective Nationwide Survey in Turkey (2007)

2019 Clinical and Angiographic Features, Treatment and Prognosis of Takayasu’s Arteritis: A Prospective Nationwide Survey in Turkey

PURPOSE
Takayasu’s Arteritis (TA) is a chronic vasculitis of unknown etiology involving mainly the aorta and its major branches with female predominance. It has a worldwide distribution with a variable prevalence and disease expression. Aim of this study is to evaluate clinical and angiographic findings, treatment and long-term outcome of TA in Turkey.
METHODS
109 patients (F/M: 98 /11, Median age at diagnosis: 31.6 years) followed at 10 Rheumatology Centers from 1999 until 2004 were evaluated. All patients were diagnosed with TA according to the angiogram (Classification of International Conference on TA-Tokyo,1994) and fullfilled the 1990 ACR Classification Criteria. Clinical and angiographic findings, medical and surgical treatments and prognosis were assessed according to a pre-defined protocol.
RESULTS
Most common clinical findings at the presentation were vascular bruits (84 %), absence and weakness of pulses (79%) and pain in the extremities (78%). Hypertension developed in 47 patients (41%) during the course of the disease, renal artery stenosis and aortic insufficiency were observed 32% and 22%, respectively. With angiographic findings 51% of the patients were classified as Type V, 39% as type I and 14 with other subtypes. Surgical procedures and percutaneous transluminal angioplasty (PTCA) were performed in 32 patients (29%). Surgical procedures were done in 10 patients before the initiation of immunosuppressive therapy and 11 patients had intervention in the first year. During follow-up with medical treatment, only 7 patients had recurrent surgical procedures and initiation of medical therapy was delayed in 71% of these patients (50.3 months) after first intervention. Ninety-seven patients received glucocorticoids alone or in combination with a cytotoxic agent during their follow-up. Cytotoxic agents were added in 79 patients with a failure to induce remission with steroids alone or as a steroid-sparing agent. Currently 17% of the patients had active disease under treatment. Overall cumulative 5 year survival rate was 96% in our Cohort.
CONCLUSION
Types I and V are the most frequent arterial involvement types in TA patients from Turkey, probably explaining the lower frequencies of renal artery stenosis and hypertension compared to series from Asia. Although a control group is lacking, early and aggresive initiation of the medical therapy with glucocorticoids and cytotoxic agents possibly decreased the requirement for surgical interventions in our study group, compared to previously published series.

 M. Bıcakcigil, None; S. Kamalı, None; M. Inanc, None; K. Aksu, None; I. Fresko, None; G. Keser, None; N. Akkoc, None; Y. Karaarslan, None; S. Kiraz, None; H. Özer, None; E. Tunç, None; E. Yucel, None; H. Direskeneli, None.