Clinical presentation, treatment and outcome of Takayasu’s arteritis in southern Chinese: a multicenter retrospective study

Abstract

To study the clinical presentation, treatment and outcome of southern Chinese patients with Takayasu's arteritis (TA). This is a retrospective chart review study of 78 patients managed in 14 public hospitals in Hong Kong between the years 2000 and 2010. Patients were identified from the hospital registry using the ICD-10 diagnostic code of the disease. The classification of TA was based on the American College of Rheumatology (ACR) or modified Ichikawa's criteria. Demographic data, clinical presentation, angiographic findings, pattern of vascular involvement (Numano's classification), treatment and outcome of these patients were presented. 78 patients were studied (82% women, age at presentation 34.2 ± 14 years). The estimated point prevalence of TA was 11/million population. The commonest initial manifestations were hypertension (62%) and vascular ischemic symptoms (38%). Systemic symptoms occurred in nine (12%) patients only. The proportion of patients fulfilling the angiographic subtypes of the Numano's classification was: types I (13%), IIa (4%), IIb (12%), III (12%), IV (20%) and V (39%), respectively. Thirty-two patients (41%) were treated with high-dose glucocorticoids (GCs) and 22 patients (28%) received additional non-GC immunosuppressive drugs. Vascular complications occurred in 26 (33%) patients and revascularization surgery was performed in 23(29%) patients. Three (4%) patients died of vascular complication at a median of 8 years after disease onset. TA is rare in southern Chinese patients of Hong Kong. Most patients present with ischemic symptoms during the stenotic phase of the disease. Although mortality is low, a significant proportion of patients developed vascular stenosis that required surgical interventions. More awareness of TA as a differential diagnosis of non-specific systemic symptoms with elevated inflammatory markers in younger patients is needed for earlier diagnosis.

Impact of Geographic Location on Diagnosis and Initial Management of Takayasu Arteritis: A Tale of Two Cohorts from Italy and India

“…The disparity in gender between cohorts of TAK from Asian and European or North American populations has been noted before. About 10–15% of TAK cohorts from Europe or North America comprise males when compared with nearly 20–25% from Asian cohorts of TAK [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Similarly, younger age at diagnosis has been noted for cohorts from Asia than from Europe or North America [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…About 10–15% of TAK cohorts from Europe or North America comprise males when compared with nearly 20–25% from Asian cohorts of TAK [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Similarly, younger age at diagnosis has been noted for cohorts from Asia than from Europe or North America [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Both cohorts had a similar delay to diagnosis from the first symptom.…”

“…The frequencies of hypertension, renal failure, and renal artery stenosis were much higher in TAK from India than in Italy. Patients with TAK from Europe and North America [ 38 , 43 , 44 , 45 ] tend to have a lesser frequency of hypertension or renal artery involvement than those from Asia [ 39 , 40 ]. Our study also identified a greater prevalence of coronary artery involvement in TAK from Italy than from India.…”

A young lady with inflammation of unknown origin

“…The prevalence of this disease is reportedly higher in Asian countries such as Japan (40 per million of population) as compared with Europe or America (ranges from 0.9 to 33 per million of population). [1,2,17]…”

“…Regarding situation of TAK in Hong Kong, a study was done involving 78 patients identified over 10 years [17]. The estimated point-prevalence was 1.1 in a million with male to female ratio of roughly 1 to 4.…”