Clinical Manifestations of Takayasu Arteritis in India and Japan— New Classification of Angiographic Findings

Abstract

In this retrospective review 102 Indian and 80 Japanese patients with Takayasu arteritis were compared in regard to their clinical manifestations and angiographic findings. Regardless of nationality, most patients were initially affected in their teens or twenties. Japanese patients were female in a larger ratio compared with the ratio in India. Clinically, the two groups exhibited several different features. More Japanese patients were found to be pulseless (P < 0.01) whereas many Indian patients were hypertensive (P < 0.01). Inflammatory conditions in Japanese patients were more severe (P < 0.01) and tended to be more prolonged than those in the Indians. More Japanese patients suffered from aortic regurgitation (P < 0.01), but Indians suffered from hypertension (P < 0.01). Angiographic findings revealed that the aortic arch and its branches were mainly involved in Japanese patients (type I, IIa) whereas the abdominal aorta and its branches were mainly involved in Indian patients (type IV). However, the diffusely involved type (type V) was the one most commonly found in both countries. From the analyses of vascular lesions in both Indian and Japanese patients, 510 and 396, respectively, different progressions of vasculitis are speculated. In Japanese patients, vasculitis generally occurs in the ascending aorta, the aortic arch, and/or its branches and extends into the thoracic and abdominal aorta, subsequently forming various complicated lesions with prolonged inflammatory activity. On the other hand, in Indian patients, vasculitis generally occurs in the abdominal aorta involving renal arteries, subsequently extending into the thoracic aorta within one or two decades, simple vascular lesions being formed. Data analysis suggests that this morbid condition progresses differently in India and Japan, in spite of some common etiologic factor(s).

Childhood‐onset Takayasu arteritis: an update

“…15 The angiographic classification into five classes, with or without involvement of coronary and pulmonary arteries under each subset, was proposed in 1994 and is largely being followed, even for pediatric patients, to date. 16 Members of the Pediatric Rheumatology European Society (PRES) undertook the task of classifying c-TA in 2007, as a component of the combined classification criteria for childhood vasculitides. 1 This criteria mandates one of the following features: decreased peripheral artery pulse(s) or claudication of extremities; blood pressure difference of > 10 mmHg between arms; bruits over the aorta or its major branches; and hypertension, along with evidence of angiographic abnormalities.…”

Pre-pulseless Takayasu Arteritis Presenting with Hypertension

“…18 An absence of the physical findings related to vasculitic lesions, common in the pre-pulseless period, should not rule out the disease. 18 The commonest mode of presentation of TA among Indian-origin patients is hypertension (83%), 7 along with headache and left ventricular hypertrophy 4,6,7 as in this case. Her hypertension is explained as occurring as a result of AR, not coarctation, as the stenosis only involved the more distal part of the descending thoracic aorta and not the usual site of coarctation, which is just distal to the left subclavian artery.…”

Systemic Vasculitis With Lesion of Large Vessels as a Cause of Art Erial Hypert Ension in a Patient of Young Age

“…В описанном наблюдении у больной отсут-ствовали классические клинические проявления АТ (разница систолического АД на 2 руках, ослабление/ исчезновение пульса на лучевой артерии, характерные симптомы для I типа васкулита), что было связано, вероятно, с IV типом васкулита. На протяжении болез-ни ведущим клиническим симптомом оставалась лишь АГ, которая носила кризовый характер, несмотря Ангиографическая классификация артериита Такаясу [7,8] Angiographic classification of Takayasu»s arteritis [7,8] [7,8]. I, IIa, IIb, III, IV, V denotes the type of aorta involvement О п и с а н и е с л у ч а я на адекватную гипотензивную терапию, что требовало дифференциальной диагностики в рамках вазореналь-ной АГ, тромботических осложнений, врожденных аневризматических пороков развития аорты, систем-ных заболеваний соединительной ткани, в том числе антифосфолипидного синдрома.…”

“…таблицу, рис. 3) [7,8]. Согласно этой классификации в представленном случае наблюдается IV тип поражения ветвей аорты, характеризующийся вовлечением в патологический процесс брюшной аорты и почечных артерий.…”