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11-07-2018 | Takayasu arteritis | Article

Extravascular manifestations of Takayasu arteritis: focusing on the features shared with spondyloarthritis

Journal: Arthritis Research & Therapy

Authors: Oh Chan Kwon, Sang-Won Lee, Yong-Beom Park, Ji Seon Oh, Sang Hoon Lee, Seokchan Hong, Chang-Keun Lee, Bin Yoo, Yong-Gil Kim

Publisher: BioMed Central

Abstract

Background

Takayasu arteritis (TAK) is a systemic disease characterized by large vessel involvement. Although the vascular characteristics of TAK are well characterized, there is no well-organized study demonstrating the extravascular manifestations of TAK. We aimed to evaluate the characteristics of extravascular manifestations of TAK, and to identify the association between vascular and extravascular manifestations of TAK.

Methods

TAK patients from two independent cohorts between January 2012 and October 2017 were included in the study. Patient characteristics were retrospectively collected from the electronic dataset. The computed tomography scans of all subjects were reviewed to evaluate the pattern of vascular involvement and presence of sacroiliitis. Clinical findings including uveitis, skin lesions, oral ulcers, arthritis, and inflammatory bowel disease (IBD) were reviewed. Logistic regression analysis was performed to evaluate the association between vascular and extravascular manifestations.

Results

For the 268 TAK patients, the mean age at diagnosis was 41.2 ± 14.2 years and 88.1% were female. The extravascular manifestation of TAK was observed in 19.0% of patients, the most common being arthritis including sacroiliitis (11.9%) followed by recurrent oral ulcers (8.6%) and IBD (2.6%). A multivariate logistic regression analysis revealed type IIB vascular involvement (adjusted odds ratio (OR) 2.956, 95% confidence interval (CI) 1.337–6.537, p = 0.007) and the erythrocyte sedimentation rate (ESR) (adjusted OR 1.014, 95% CI 1.003–1.025, p = 0.012) as significantly associated with the presence of axial and peripheral arthritis.

Conclusions

Extravascular manifestations of TAK were observed in up to one-fifth of patients. The most common extravascular manifestation was arthritis, which was associated with a type IIB vascular involvement pattern and a high ESR.
Literature
1.
Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity. Circulation. 2015;132:1701–9. https://​doi.​org/​10.​1161/​circulationaha.​114.​012547.CrossRefPubMed
2.
Terao C, Yoshifuji H, Mimori T. Recent advances in Takayasu arteritis. Int J Rheum Dis. 2014;17:238–47. https://​doi.​org/​10.​1111/​1756-185x.​12309.CrossRefPubMed
3.
Mohammad AJ, Mandl T. Takayasu arteritis in southern Sweden. J Rheumatol. 2015;42:853–8. https://​doi.​org/​10.​3899/​jrheum.​140843.CrossRefPubMed
4.
Dreyer L, Faurschou M, Baslund B. A population-based study of Takayasu’s arteritis in eastern Denmark. Clin Exp Rheumatol. 2011;29:S40–2.PubMed
5.
Watts R, Al-Taiar A, Mooney J, Scott D, Macgregor A. The epidemiology of Takayasu arteritis in the UK. Rheumatology (Oxford). 2009;48:1008–11. https://​doi.​org/​10.​1093/​rheumatology/​kep153.CrossRef
6.
Ueda H, Morooka S, Ito I, Yamaguchi H, Takeda T. Clinical observation of 52 cases of aortitis syndrome. Jpn Heart J. 1969;10:277–88.CrossRefPubMed
7.
Jain S, Kumari S, Ganguly NK, Sharma BK. Current status of Takayasu arteritis in India. Int J Cardiol. 1996;54((Suppl)):S111–6.CrossRefPubMed
8.
Zheng D, Fan D, Liu L. Takayasu arteritis in China: a report of 530 cases. Heart Vessels Suppl. 1992;7:32–6.CrossRefPubMed
9.
Park YB, Hong SK, Choi KJ, Sohn DW, Oh BH, Lee MM, et al. Takayasu arteritis in Korea: clinical and angiographic features. Heart Vessels Suppl. 1992;7:55–9.CrossRefPubMed
10.
Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med. 1994;120:919–29.CrossRefPubMed
11.
Lupi-Herrera E, Sanchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE. Takayasu's arteritis. Clinical study of 107 cases. Am Heart J. 1977;93:94–103.CrossRefPubMed
12.
Numano F. The story of Takayasu arteritis. Rheumatology (Oxford). 2002;41:103–6.CrossRef
13.
Moriwaki R, Noda M, Yajima M, Sharma BK, Numano F. Clinical manifestations of Takayasu arteritis in India and Japan—new classification of angiographic findings. Angiology. 1997;48:369–79. https://​doi.​org/​10.​1177/​0003319797048005​01.CrossRefPubMed
14.
Gan FY, Fei YY, Li MT, Wang Q, Xu D, Hou Y, et al. The characteristics of patients having ankylosing spondylitis associated with Takayasu's arteritis. Clin Rheumatol. 2014;33:355–8. https://​doi.​org/​10.​1007/​s10067-013-2444-7.CrossRefPubMed
15.
Riviere E, Arnaud L, Ebbo M, Allanore Y, Claudepierre P, Dernis E, et al. Takayasu arteritis and spondyloarthritis: coincidence or association? A study of 14 cases. J Rheumatol. 2017;44:1011–7. https://​doi.​org/​10.​3899/​jrheum.​160762.CrossRefPubMed
16.
Kilic L, Kalyoncu U, Karadag O, Akdogan A, Dogan I, Bilgen SA, et al. Inflammatory bowel diseases and Takayasu's arteritis: coincidence or association? Int J Rheum Dis. 2016;19:814–8. https://​doi.​org/​10.​1111/​1756-185x.​12837.CrossRefPubMed
17.
Terao C, Matsumura T, Yoshifuji H, Kirino Y, Maejima Y, Nakaoka Y, et al. Takayasu arteritis and ulcerative colitis: high rate of co-occurrence and genetic overlap. Arthritis Rheumatol. 2015;67:2226–32. https://​doi.​org/​10.​1002/​art.​39157.​ CrossRefPubMed
18.
Loetscher J, Fistarol S, Walker UA. Pyoderma gangrenosum and erythema nodosum revealing Takayasu's arteritis. Case Rep Dermatol. 2016;8:354–7. https://​doi.​org/​10.​1159/​000452829.CrossRefPubMedPubMedCentral
19.
Pascual-Lopez M, Hernandez-Nunez A, Aragues-Montanes M, Dauden E, Fraga J, Garcia-Diez A. Takayasu's disease with cutaneous involvement. Dermatology. 2004;208:10–5. https://​doi.​org/​10.​1159/​000075039.CrossRefPubMed
20.
Gupta M, Singh K, Lehl SS, Bhalla M. Recurrent erythema nodosum: a red flag sign of hidden systemic vasculitis. BMJ Case Rep. 2013;2013 https://​doi.​org/​10.​1136/​bcr-2013-009507.​
21.
McDonald MA, Ojaimi E, Favilla I. Anterior uveitis in a child with Takayasu's arteritis. Clin Exp Ophthalmol. 2004;32:336–9. https://​doi.​org/​10.​1111/​j.​1442-9071.​2004.​00828.​x.CrossRefPubMed
22.
Becker RW, Sohn RL, Poulik JM, Berguer R. Takayasu's arteritis presenting as uveitis in a 5-year-old girl. Ann Vasc Surg. 2005;19:258–62. https://​doi.​org/​10.​1007/​s10016-004-0178-3.CrossRefPubMed
23.
Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. 1990;33:1129–34.CrossRefPubMed
24.
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–8.CrossRefPubMed
25.
van Tubergen A. The changing clinical picture and epidemiology of spondyloarthritis. Nat Rev Rheumatol. 2015;11:110–8. https://​doi.​org/​10.​1038/​nrrheum.​2014.​181.CrossRefPubMed
26.
Rudwaleit M, Haibel H, Baraliakos X, Listing J, Marker-Hermann E, Zeidler H, et al. The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis inception cohort. Arthritis Rheum. 2009;60:717–27. https://​doi.​org/​10.​1002/​art.​24483.CrossRefPubMed
27.
Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 2016;374:2563–74. https://​doi.​org/​10.​1056/​NEJMra1406182.CrossRefPubMed
28.
Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390:73–84. https://​doi.​org/​10.​1016/​s0140-6736(16)31591-4.CrossRefPubMed
29.
Palazzi C, DA S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. 2008;26:S131–4.PubMed
30.
Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol. 1994;21:1883–7.PubMed
31.
Gudbrandsson B, Molberg O, Garen T, Palm O. Prevalence, incidence, and disease characteristics of Takayasu arteritis by ethnic background: data from a large, population-based cohort resident in southern Norway. Arthritis Care Res (Hoboken). 2017;69:278–85. https://​doi.​org/​10.​1002/​acr.​22931.CrossRef
32.
Yang SK, Yun S, Kim JH, Park JY, Kim HY, Kim YH, et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986-2005: a KASID study. Inflamm Bowel Dis. 2008;14:542–9. https://​doi.​org/​10.​1002/​ibd.​20310.CrossRefPubMed
33.
Yazici H, Seyahi E, Hatemi G, Yazici Y. Behcet syndrome: a contemporary view. Nat Rev Rheumatol. 2018;14:107–19. https://​doi.​org/​10.​1038/​nrrheum.​2017.​208.CrossRefPubMed
34.
Criteria for diagnosis of Behcet's disease. International Study Group for Behcet's Disease. Lancet. 1990;335:1078–80.