Yetişkin Hastalarda Takayasu Arteritinin Klinik Seyri, Tedavisi ve Sonuçları: Retrospektif Bir Analiz

Öz

Amaç: Takayasu arteriti TA ’in klinik fenotipi ve seyri, etnisite ve cinsiyet gibi faktörlerden etkilenebilmektedir. Çalışmada erişkin TA hastalarının damar tutulum paternleri, klinik seyri, tedavi yaklaşımları ve sonuçları değerlendirilmiştir.Gereç ve Yöntemler: Kırk TA hastasının klinik, laboratuvar ve radyolojik görüntüleme sonuçları, ve uygulanan tedaviler retrospektif olarak tarandı. Bulgular: Tanı sırasındaki ortalama yaş 42,5±12,9 yıldı ve 31 hasta %77,5 kadındı. En sık görülen semptom ve bulgular halsizlik %65 , kladikasyo %52,5 , kan basıncı farklılığı %50 ve damarda üfürümdü %60 . Yeni anjiyografik sınıflamaya göre en sık tutulum şekli TipV %47,5 idi. İntimal kalınlaşma en sık karotislerde iken, stenoz-oklüzyon ve anevrizmalar subklavian arterlerde görülmekteydi. Hastaların tümü kortikosteroid tedavisi almıştı. Metotreksat ve azatiopürin en çok tercih edilen immünosupresif ajanlardı. Biyolojik ajanlar 21 hastada %52,5 kullanılmıştı. Hastaların %80’inde remisyon sağlanmıştı. Sonuç: Bizim kohortumuzda, TA erkek cinsiyette literatürde bildirilenden daha yüksektir ve vasküler tutulum paternleri abdominal aort tutulum sıklığı ile kuzey Avrupa popülasyonundan farklı olan Asya ve Afrika popülasyonlarına benzerdir. Hastaların çoğunda kortikosteroid, immünosupresif ve/veya biyolojik ajanlarla yapılan kombinasyon tedavileri ile remisyona ulaşılmıştır

Anahtar Kelimeler

• Takayasu arteriti, Tedavi, Remisyon

Clinical Course, Treatment and Results of Takayasu Arteritis in Adult Patients: A Retrospective Analysis

Abstract

Objective: The clinical phenotype and course of Takayasu's arteritis TA may be affected by factors such as ethnicity and gender. The aim of this study was to evaluate the vascular involvement patterns, clinical course, treatment approaches and outcomes of adult TA patients.Material and Methods: The clinical, laboratory and radiological imaging results, and the treatments of 40 TA patients were reviewed retrospectively.Results: The mean age at the time of the diagnosis was 42.5±12.9 years, and 31 77.5% patients were females. The most common symptoms and signs were fatigue 65% , claudication 52.5% , blood pressure differences 50% and murmur on the vessel 60% . According to the new angiographic classification, type V 47.5% was the most frequent type of involvement. Intimal thickening was most common in the carotid arteries, while stenosis-occlusion and aneurysms were more common in the subclavian arteries. All patients received corticosteroid therapy. Methotrexate and azathioprine were the most preferred immunosuppressive agents. Biological agents were used in 21 patients 52.5% . Remission was achieved in 80% of the patients. Conclusion: In our cohort, TA was higher in the male gender than reported in the literature, and the vascular involvement patterns were similar to the Asian and African populations, who are different from the Northern European population as regards abdominal aortic involvement frequency. Remission was achieved in the majority of patients using combination treatment with corticosteroids and immunosuppressive and/or biological agents

Keywords

• Takayasu arteritis, Treatment, Remission

Kaynakça

1. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS. Takayasu arteritis. Ann Intern Med 1994;120:919-29.
2. Watanabe Y, Tetsuro Miyata T Kazuo 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(18):1701- 9.
3. Alibaz-Öner F, Aydın SZ, Direskeneli H. Recent advances in Takayasu’s arteritis. Eur J Rheumatol 2015; 2(1):24-30.
4. Onen F, Akkoc N. Epidemiology of Takayasu arteritis. Presse Med 2017; 46(7-8 Pt 2):e197-e203.
5. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr, Masi AT, McShane DJ, Mills JA, Stevens MB, Wallace SL, Zvaifler NJ, McShane DJ. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990; 33:1129-34.
6. Sharma K, Jain S, Suri S, Numano F. Diagnostic criteria for Takayasu arteritis. Int J Cardiol 1996; 54:141-7.
7. Mekinian A, Resche-Rigon M, Comarmond C, Soriano A, Constans J, Alric L, Jego P, Busato F, Cabon M, Dhote R, Estibaliz L, Koné-Paut I, Landron C, Lavigne C, Lioger B, Michaud M, Ruivard M, Sacre K, Gottenberg JE, Gaches F, Goulenok T, Salvarani C, Cacoub P, Fain O, Saadoun D. French Takayasu network. Efficacy of tocilizumab in Takayasu arteritis: Multicenter retrospective study of 46 patients. J Autoimmun 2018; 91:55-60.
8. Sinha D, Mondal S, Nag A, Ghosh A. Development of a colour Doppler ultrasound scoring system in patients of Takayasu’s arteritis and its correlation with clinical activity score (ITAS 2010). Rheumatology (Oxford) 2013; 52:2196-202.

9. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: New classification. Int J Cardiol 1996; 54 Suppl 2:155-63.
10. Gotway MB, Araoz PA, Macedo TA, Stanson AW, Higgins CB, Ring EJ, Dawn SK, Webb WR, Leung JW, Reddy GP. Imaging findings in Takayasu’s arteritis. AJR 2005; 184:1945-50.
11. Maffei S, Di Renzo M, Bova G, Auteri A, Pasqui AL. Takayasu’s Arteritis: A review of the literature. Intern Emerg Med 2006; 1(2):105-12.
12. Zalewska J, Ignaczak P, Bilińska-Reszkowska H. Takayasu disease. Reumatologia 2009; 47(6):376-80.
13. Birlik M, Kücükyavas Y, Aksu K, Solmaz D, Can G, Taylan A, Akar S, Sari I, Keser G, Onen F, Akkoc N. Epidemiology of Takayasu’s arteritis in Turkey. Clin Exp Rheumatol 2016; 34(3)Suppl 97:33-9.
14. Bicakcigil M, Aksu K, Kamali S, Ozbalkan Z, Ates A, Karadag O, Ozer HT, Seyahi E, Akar S, Onen F, Cefle A, Aydin SZ, Yilmaz N, Onat AM, Cobankara V, Tunc E, Ozturk MA, Fresko I, Karaaslan Y, Akkoc N, Yücel AE, Kiraz S, Keser G, Inanc M, Direskeneli H. Takayasu’s arteritis in Turkey - clinical and angiographic features of 248 patients. Clin Exp Rheumatol 2009; 27(1) Suppl 52:59-64.
15. 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.
16. Sharma BK, Jain S. A possible role of sex in determining distribution of lesions in Takayasu Arteritis. Int J Cardiol 1998; 66 Suppl 1:81-4.
17. Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Costedoat Chalumeau N, Le Thi Huong Boutin D, Cacoub P, Cluzel P, Koskas F, Kieffer E, Piette JC, Amoura Z. Takayasu arteritis in France: A single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore) 2010; 89(1):1-17.
18. Cañas CA, Jimenez CA, Ramirez LA, Uribe O, Tobón I, Torrenegra A, Cortina A, Muñoz M, Gutierrez O, Restrepo JF, Peña M, Iglesias A. Takayasu arteritis in Colombia. Int J Cardiol 1998; 66 Suppl 1:73-9.
19. Hoffman GS, Leavitt RY, Kerr GS, Rottem M, Sneller MC, Fauci AS. Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum 1994; 37(4):578-82.
20. Shelhamer JH, Volkman DJ, Parrillo JE, Lawley TJ, Johnston MR, Fauci AS. Takayasu’s arteritis and its therapy. Ann Intern Med 1985; 103(1):121-6.
21. Valsakumar AK, Valappil UC, Jorapur V, Garg N, Nityanand S, Sinha N. Role of immunosuppressive therapy on clinical, immunological, and angiographic outcome in active Takayasu’s arteritis. J Rheumatol 2003; 30(8):1793-8.
22. Barra L, Yang G, Pagnoux C; Canadian Vasculitis Network (CanVasc). Non-glucocorticoid drugs for the treatment of Takayasu’s arteritis: A systematic review and meta-analysis. A Autoimmun Rev 2018; 17(7):683-93.