Outcome Measures and Biomarkers for Disease Assessment in Takayasu Arteritis

Abstract

Takayasu arteritis (TAK) is a less common large vessel vasculitis where histopathology of involved arteries is difficult to access except during open surgical procedures. Assessment of disease activity in TAK, therefore, relies on surrogate measures. Clinical disease activity measures such as the National Institutes of Health (NIH) score, the Disease Extent Index in TAK (DEI.TAK) and the Indian TAK Clinical Activity Score (ITAS2010) inconsistently associate with acute phase reactants (APRs). Computerized tomographic angiography (CTA), magnetic resonance angiography (MRA), or color Doppler Ultrasound (CDUS) enables anatomical characterization of stenosis, dilatation, and vessel wall characteristics. Vascular wall uptake of 18-fluorodeoxyglucose or other ligands using positron emission tomography computerized tomography (PET-CT) helps assess metabolic activity, which reflects disease activity well in a subset of TAK with normal APRs. Angiographic scoring systems to quantitate the extent of vascular involvement in TAK have been developed recently. Erythrocyte sedimentation rate and C-reactive protein have a moderate performance in distinguishing active TAK. Numerous novel biomarkers are under evaluation in TAK. Limited literature suggests a better assessment of active disease by combining APRs, PET-CT, and circulating biomarkers. Validated damage indices and patient-reported outcome measures specific to TAK are lacking. Few biomarkers have been evaluated to reflect vascular damage in TAK and constitute important research agenda.

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

“…Although DEI.TAK and ITAS2010 were higher at baseline for the cohort from India, the relevance of this is difficult to interpret. DEI.TAK and ITAS2010 do not have universally accepted cut-offs for disease activity [ 53 ]. Hypertension can be scored up to 2 on the DEI.TAK and 3 on the ITAS2010.…”

The role of plateletcrit in Takayasu arteritis: A potential biomarker for disease activity and 6‐month treatment response

“…Disease activity and vascular involvement on imaging were also recorded at baseline and after 6 months of treatment. Disease activity was assessed by the Kerr score, with active disease defined as a Kerr score ≥2 3 . Vascular involvement was evaluated by whole‐body enhanced magnetic resonance angiography (MRA) or computed tomography angiography (CTA) and classified according to the 1996 Numano angiographic TAK classification system 21 .…”

“…Disease activity was assessed by the Kerr score, with active disease defined as a Kerr score ≥2. 3 Vascular involvement was evaluated by whole-body enhanced magnetic resonance angiography (MRA) or computed tomography angiography (CTA) and classified according to the 1996 Numano angiographic TAK classification system. 21 The grading of the severity of vascular involvement was based on the degree of lumen stenosis and wall thickening.…”

“…Takayasu arteritis (TAK) is a chronic inflammatory disease that mainly involves large arteries, causing progressive vascular fibrosis and gradual narrowing of the vessel lumen. Currently, disease activity is usually assessed by measuring the levels of inflammatory markers such as erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP) and by scoring systems such as the Kerr score and Indian Takayasu Clinical Activity Score (ITAS), but these methods have limited sensitivity and specificity 1–4 . They are also not reliable predictors of treatment response and long‐term prognosis.…”

“…Currently, disease activity is usually assessed by measuring the levels of inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and by scoring systems such as the Kerr score and Indian Takayasu Clinical Activity Score (ITAS), but these methods have limited sensitivity and specificity. [1][2][3][4] They are also not reliable predictors of treatment response and long-term prognosis. Systemic or local inflammation may persist in some patients receiving regular treatment, 5,6 and vascular damage may progress despite an evident decrease in inflammatory markers and disease activity scores.…”