Assessment of Damage in Takayasu's Arteritis

Tanaz A Kermani; Antoine G Sreih; David Cuthbertson; Nader A Khalidi; Curry L Koening; Carol A Langford; Carol A McAlear; Paul A Monach; Larry Moreland; Christian Pagnoux; Rennie L Rhee; Philip Seo; Kenneth J Warrington; Peter A Merkel; Vasculitis Clinical Research Consortium

doi:10.1093/rheumatology/keae333

Assessment of Damage in Takayasu's Arteritis

Rheumatology (Oxford). 2024 Jun 17:keae333. doi: 10.1093/rheumatology/keae333. Online ahead of print.

Authors

Affiliations

¹ Division of Rheumatology, University of California, Los Angeles, CA, USA.
² Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.
³ Bristol Myers Squibb, Lawrenceville, NJ, USA.
⁴ Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, USA.
⁵ Division of Rheumatology, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada.
⁶ Division of Rheumatology, University of Texas Dell Medical School, TX, USA.
⁷ Division of Rheumatology, Cleveland Clinic, Cleveland, OH, USA.
⁸ Section of Rheumatology, VA Boston Healthcare System, MA.
⁹ Division of Rheumatology, University of Colorado, CO, USA.
¹⁰ Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada.
¹¹ Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA.
¹² Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
¹³ Division of Rheumatology and Division of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 38885370
DOI: 10.1093/rheumatology/keae333

Abstract

Objectives: To evaluate damage and clinical characteristics associated with damage in Takayasu's arteritis (TAK).

Methods: Patients with TAK enrolled in a multicentre, prospective, observational study underwent standardized damage assessment every 6 months using the Vasculitis Damage Index (VDI) and the Large-Vessel Vasculitis Index of Damage (LVVID).

Results: The study included 236 patients with TAK: 92% female, 81% Caucasian; median (25th, 75th percentile) disease duration = 2.6 (0.12, 6.9) years. Eighty-four percent had follow-up: median (25th, 75th) duration 4.1 (1.9, 7.5) years.Items of damage were present in 89% on VDI, 87% on LVVID, in the peripheral vascular (76% VDI, 74% LVVID), cardiac (40% VDI, 45% LVVID) systems. During follow-up, 42% patients had new damage;, including major vessel stenosis/arterial occlusion (8%), limb claudication (6%), hypertension (7%), aortic aneurysm (4%), and bypass surgery (4%). Disease-specific damage accounted for >90% new items. Older age, relapse, and longer duration of follow-up were associated with new damage items; a higher proportion of patients without new damage were on methotrexate (p< 0.05). Among 48 patients diagnosed with TAK within 180 days of enrolment, new damage occurred in 31% on VDI and 52% on LVVID. History of relapse was associated with new damage in the entire cohort while in patients with a recent diagnosis, older age at diagnosis was associated with new damage.

Conclusion: Damage is present in > 80% of patients with TAK even with recent diagnosis and >40% of patients accrue new, mainly disease-specific damage. Therapies for TAK that better control disease activity and prevent damage should be prioritized.

Keywords: Damage; Large-Vessel-Vasculitis Index of Damage; Takayasu’s arteritis; Vasculitis Damage Index.