Ab0586 takayasu Arteritis: Review of Diagnostic and Classification Criteria in a 9 Case Series

Abstract

Background:Takayasu arteritis (TA) is a rare large vessel vasculitis that affects the aorta (Ao) and its main branches. Early diagnosis and the rapid establishment of treatment are key points in the prognosis of the disease. Despite the existence of different classification and diagnostic criteria, early diagnosis of TA continues to be a challenge.Objectives:1) To analyze the concordance between the different classification and diagnostic criteria in patients with TA, 2) To describe the demographic, clinical and analytical characteristics of TA.Methods:Retrospective observational study that included all patients diagnosed with TA according to medical criteria between 1981 and 2018, visited in a Rheumatology unit. Demographic, clinical, analytical and image data were collected. It is assumed that the vascular territories affected and the type of vascular involvement can be evaluated by angio-CT, angio-MRI and PET-CT with contrast iv. in case angiography is not performed. Ishikawa diagnostic criteria, 1990 ACR classification criteria and Ishikawa’s diagnostic criteria modified by Sharma were evaluated.Results:We included 9 patients (77.8% women) diagnosed with TA. The age at diagnosis was 33.3 ±16.3 years with a time of evolution of 5.1 ±9.4 years. The other variables are shown in Table 1.VariablesCRP, mg/L, mean (SD)42,8 (65,37)ESR, mm/h, mean (SD)33,3 (35,3)HTA, n (%)4 (44,4)Limb claudication, n (%)4 (44,4)BP difference >10 mmHg, n (%)5 (55,6)Vascular pain, n (%)4 (44,4)Constitutional clinic, n (%)3 (33,3)Arthromyalgia, n (%)1 (11,1)Cefalea, n (%)2 (22,2)Syncope, n (%)1 (11,1)Decreased artery pulse, n (%)5 (55,6)Paresthesia, n (%)2 (22,2)Bruit, n (%)4 (44,2)The most frequent vascular territories afected were abdominal Ao (7), descending thoracic Ao (5) and iliac arteries (5). The most common type of arterial lesion was stenosis (8) followed by dilation and aneurysm. 6 patients were treated with corticotherapy as an induction treatment, 5 required chronic immunosuppression and 6 patients required surgery.When reviewing the criteria we observed that all patients met the ACR criteria and 7 patients met the modified criteria by Sharma. However, the agreement with Ishikawa’s diagnostic criteria was poor since 7 patients did not meet them. The different criteria are shown in Table 2. Ishikawa, n (%) 1990 ACR, n (%) Modified Ishikawa, n (%)Age ≤40 yrs7 (77,8)Age <40 yrs7 (77,8)Left subclavian lesion4 (44,4)Left subclavian lesion4 (44,4)Claudication of extremities5 (55,6)Right subclavian lesión3 (33,3)Right subclavian lesion3 (33,3)Decreased brachial artery pulse4 (44,4)Clinic at least 1 month duration,9 (100)VSG ≥20 mm/h4 (66,6)BP difference >10 mmHg5 (55,6)VSG >20 mm/h4 (66,6)Carotid artery tenderness0Bruit over subclavian arteries or Ao4 (44,4)Carotid artery tenderness0HTA4 (44,4)Arteriogram abnormality9 (100)HTA4 (44,4)Aortic regurgitation3 (37,5)Aortic regurgitation3 (37,5)Pulmonary artery lesion0Pulmonary artery lesion0Common carotid lesion2 (22,2)Common carotid lesion2 (22,2)Distal brachiocephalic trunk lesion2 (22...