Is Takayasu's arteritis more severe in children?

Abstract

Objective. Takayasu's arteritis (TAK) is a chronic vasculitis, affecting predominantly the aorta and/or its major branches. The aim of this study was to compare the differences between childhood and adult onset TAK.Methods. We retrospectively evaluated 179 TAK patients followed between August 2005 and July 2019. Demographic characteristics, laboratory features, disease activity, echocardiographic data at diagnosis and treatment regimens in the disease course were compared between the paediatric and adult onset patients. Results. Twenty-five paediatric-onset (<18 years of age at diagnosis) and 154adult-onset patients (≥18 years of age at diagnosis) were enrolled. The mean age at diagnosis for children and adults were 13.6±4 and 35.6±13, respectively. Paediatric onset TAK patients had more intense inflammation at the time of diagnosis reflected in their clinical findings. Acute phase reactants were high in all paediatric patients and significantly higher in patients with paediatric-onset TAK (p=0.006 and p=0.005, respectively). Abdominal predominant disease was more common in the paediatric group, in contrast, focal disease and aortic arch predominant disease were more common in the adult group. Ascending aortic dilatation, left ventricular hypertrophy and moderate-severe aortic insufficiency were more frequent in echocardiography findings of paediatric onset TAK patients. In comorbidities, hypertension was more common in paediatric TAK patients during followup, whereas cerebrovascular disease was more common in adult patients. Conclusion. Our paediatric onset TAKpatients presented with a more severe inflammation and more widespread vascular involvement. Multicentre studies from different geographic areas are needed to verify our observation and understand the underlying causes. Methods Study protocol and patientsWe retrospectively evaluated the medical records of TAK patients followed at

Age, sex and angiographic type-related phenotypic differences in inpatients with Takayasu arteritis: A 13-year retrospective study at a national referral center in China

“…It has been reported that the distribution of vascular involvement is different between childhood-onset and adult-onset TAK patients ( 8 , 33 , 44 ). Childhood-onset TAK patients presented with more severe inflammation and more widespread vessel lesions ( 44 ). According to the Numano classification, a similar tendency was recognized in our study.…”

An Update on Childhood-Onset Takayasu Arteritis

“…Children with TAK present with more systemic inflammation and more widespread vascular disease than adults. However, relapses and accrued damage are high and equally frequent in both groups and seem to be associated with longer duration of symptoms ( 44 , 52 , 61 ).…”

“…Children have more commonly arterial hypertension, less claudication of the upper extremities, and less carotidynia. This reflects the vascular disease pattern, which more often affects the aorta and the infra-diaphragmatic renal and mesenteric arteries in children, but more frequently the aortic arch in adults ( 5 , 52 , 61 , 62 ). Higher disease activity scores such as the Indian TAK Clinical Activity Score (ITAS 2010) at diagnosis have been reported in the pediatric compared to the adult population, but this does not seem to be associated with accrued damage over time ( 52 , 54 , 62 ).…”

Childhood rheumatic diseases: bites not only the joint, but also the heart

“…Takayasu arteritis is a common primary vasculitis in children with a median age of onset of 12 to 14 years [ 3 , 4 , 83 , 84 ]. It constitutes 14% to 32% of all Takayasu arteritis cases [ 3 , 4 , 85 , 86 ]. Cardiac involvement is present in 40% of Takayasu arteritis [ 85 ].…”

“…Myocarditis has mainly been described based on endomyocardial biopsy and autopsy with paucity from echocardiographic studies [ 91 , 92 ]. Pericardial effusion is present in 4.3%—12% [ 4 , 84 , 86 ].…”