Takayasu arteritis – Rokowania, prognozy i postęp choroby

Takayasu arteritis
Rokowania, prognozy i postęp choroby

Takayasu arteritis (TAK) jest przewlekłą chorobą zapalną dużych naczyń, charakteryzującą się zmiennym przebiegiem klinicznym i różnorodnymi rokowaniami. 10-letnie przeżycie wynosi około 90%, jednak u pacjentów z dwoma lub więcej powikłaniami spada do 36%, podczas gdy u chorych z jednym lub bez powikłań wynosi 96%. Nawrót choroby i powikłania naczyniowe występują u około 50% pacjentów w ciągu 10 lat od rozpoznania. Kluczowymi czynnikami prognostycznymi są: starszy wiek zachorowania, obecność poważnych powikłań naczyniowych, progresywny przebieg choroby, słabsza odpowiedź zapalna oraz wcześniejsze wystąpienie powikłań. Typ angiograficzny V wiąże się z istotnie wyższym ryzykiem aktywacji choroby (iloraz szans 10,969; 95% CI 1,144-105,182; p=0,038). Udar mózgu lub TIA nie zwiększają ryzyka zgonu w TAK, co potwierdzają analizy skorygowane i dopasowane pod względem czynników prognostycznych.

Prognoza w Takayasu arteritis

Takayasu arteritis (TAK) jest przewlekłą chorobą zapalną dużych naczyń krwionośnych, charakteryzującą się zmiennym przebiegiem klinicznym i różnorodnymi rokowaniami. Długoterminowe obserwacje pacjentów z TAK wskazują na znaczące zróżnicowanie w zakresie przebiegu choroby i jej wpływu na przeżycie chorych.¹²

Wskaźniki przeżycia w Takayasu arteritis

Ogólne wskaźniki przeżycia w Takayasu arteritis są stosunkowo dobre – 10-letnie przeżycie wynosi około 90%. Jednak wskaźniki te ulegają znacznemu pogorszeniu w przypadku wystąpienia poważnych powikłań. U pacjentów z dwoma lub więcej powikłaniami 5-letnie i 10-letnie przeżycie wynosi odpowiednio około 69% i 36%. Natomiast u pacjentów z jednym lub bez powikłań wskaźniki te są znacznie wyższe i wynoszą odpowiednio 100% i 96% dla 5-letniego i 10-letniego przeżycia.³

W dużym wieloośrodkowym badaniu obejmującym 318 pacjentów z TAK, po medianie obserwacji wynoszącej 6,1 roku, nawroty choroby zaobserwowano u 43% pacjentów, powikłania naczyniowe u 38%, a zgon u 5%. Badanie to wykazało, że u 50% pacjentów z TAK w ciągu 10 lat od rozpoznania nastąpi nawrót choroby i wystąpią powikłania naczyniowe.⁴

Czynniki prognostyczne i predyktory wyniku leczenia

Identyfikacja czynników ryzyka niekorzystnego rokowania ma kluczowe znaczenie w prowadzeniu pacjentów z TAK. Dane z badań wskazują na kilka istotnych czynników prognostycznych:⁵

Wiek zachorowania – starszy wiek w momencie rozpoznania jest związany z gorszym rokowaniem⁶
Obecność poważnych powikłań naczyniowych – znacząco pogarsza rokowanie⁷
Progresywny przebieg choroby – pacjenci z szybko postępującą chorobą mają gorsze rokowanie⁸
Słabsza odpowiedź zapalna – paradoksalnie, mniej nasilona odpowiedź zapalna może wiązać się z gorszym rokowaniem⁹
Wcześniejsze wystąpienie powikłań – przyczynia się do zmniejszonego przeżycia, przy czym większość zgonów występuje w pierwszym roku po rozpoznaniu¹⁰

Typ angiograficzny jako czynnik predykcyjny

Zaobserwowano, że typ angiograficzny TAK może mieć istotne znaczenie prognostyczne. Szczególnie typ V (rozległe zajęcie naczyń) wydaje się być ważnym czynnikiem predykcyjnym aktywacji choroby u pacjentów z klinicznie nieaktywnym TAK w momencie rozpoznania. Badania wykazały, że pacjenci z typem V mają znacznie zwiększone ryzyko aktywacji choroby (iloraz szans 10,969, 95% CI 1,144-105,182, p = 0,038).¹¹

Znaczna część pacjentów z klinicznie nieaktywnym TAK w momencie rozpoznania doświadcza aktywacji choroby podczas obserwacji, co podkreśla konieczność regularnego monitorowania, nawet w przypadku pacjentów z pozornie stabilnym przebiegiem choroby.¹²

Przeżycie pacjentów z TAK z udarem lub TIA

Interesującym aspektem prognostycznym jest wpływ udaru mózgu lub przemijającego ataku niedokrwiennego (TIA) na przeżycie pacjentów z TAK. Wbrew intuicyjnemu przekonaniu, dane z badań retrospektywnych sugerują, że ryzyko śmiertelności jest podobne u pacjentów z TAK z udarem/TIA i bez tych powikłań (współczynnik ryzyka nieskorygowany 0,76, 95% CI 0,15-3,99; skorygowany o płeć, wiek zachorowania, opóźnienie do rozpoznania, wyjściową aktywność choroby i liczbę stosowanych konwencjonalnych lub biologicznych/ukierunkowanych syntetycznych leków immunosupresyjnych 1,38, 95% CI 0,19-10,20).¹³¹⁴

Brak różnicy w przeżyciu między pacjentami z TAK z udarem/TIA i bez tych powikłań został potwierdzony również po analizach dopasowanych pod względem czynników prognostycznych (propensity score matching). Na podstawie tych danych wydaje się, że udar w TAK nie zwiększa ryzyka zgonu.¹⁵

Rokowanie u dzieci z Takayasu arteritis

Takayasu arteritis u dzieci (c-TAK) wiąże się ze specyficznym profilem prognostycznym. Duże badanie ambispektywne wykazało wczesną śmiertelność i chorobowość, przy czym 3% pacjentów umiera w pierwszym roku, a około 50% doświadcza co najmniej jednego zdarzenia lub ponownej hospitalizacji w ciągu pierwszych 5 lat po rozpoznaniu.¹⁶

Zidentyfikowano następujące niezależne czynniki ryzyka złego rokowania u dzieci z TAK:¹⁷

Udar mózgu
Podwyższony poziom białka C-reaktywnego (CRP)
Niższy wskaźnik masy ciała (BMI)
Młodszy wiek przy przyjęciu

Natomiast nadciśnienie tętnicze, zajęcie tętnicy nerkowej oraz rewaskularyzacja oparta na glikokortykosteroidach, lekach przeciwnadciśnieniowych i przeciwpłytkowych stanowią główne cechy kliniczne, obrazowe i terapeutyczne c-TAK, które mogą wskazywać na lepsze rokowanie.¹⁸

Przebieg choroby i odpowiedź na leczenie

Przebieg Takayasu arteritis zwykle rozciąga się na wiele lat, z różnym stopniem aktywności. Badania wykazały, że około 20% pacjentów ma jednofazową i samoograniczającą się chorobę, która nie wymaga leczenia immunosupresyjnego. U pozostałych 80% pacjentów TAK ma charakter postępujący lub nawracająco-remisyjny i wymaga leczenia immunosupresyjnego.¹⁹

W badaniu przeprowadzonym przez National Institutes of Health obejmującym 60 pacjentów z TAK wykazano, że u pacjentów, którzy nie mieli jednofazowej choroby i doświadczyli jednego zaostrzenia, leczenie immunosupresyjne prowadziło do remisji u 60%. Spośród tych pacjentów u połowy wystąpił nawrót po zaprzestaniu terapii immunosupresyjnej.²⁰

Jakość życia pacjentów z Takayasu arteritis

Poza wskaźnikami przeżycia, istotnym aspektem rokowania jest jakość życia pacjentów z TAK. Badanie z 2008 roku oceniające jakość życia u pacjentów z TAK wykazało gorsze wyniki w zakresie zdrowia fizycznego i psychicznego w porównaniu z wieloma innymi chorobami przewlekłymi związanymi z chorobą naczyń obwodowych.²¹

Remisja choroby jest jedynym czynnikiem, który pozytywnie wpływa na fizyczną i psychiczną jakość życia, co podkreśla znaczenie skutecznego leczenia w poprawie ogólnego stanu pacjentów.²²

Profilaktyka powikłań naczyniowych

Ścisłe zarządzanie tradycyjnymi czynnikami ryzyka sercowo-naczyniowego, takimi jak dyslipidemia, nadciśnienie tętnicze i czynniki stylu życia, które zwiększają ryzyko chorób sercowo-naczyniowych, jest obowiązkowe w celu zminimalizowania wtórnych powikłań sercowo-naczyniowych. Te powikłania są główną przyczyną zgonów w Takayasu arteritis.²³

Przyszłe prospektywne badania dotyczące udaru/TIA u pacjentów z TAK powinny oceniać jakość życia i inne wyniki zgłaszane przez pacjentów (PROMs) w tej podgrupie pacjentów z TAK, co mogłoby dostarczyć bardziej kompleksowego obrazu wpływu choroby na funkcjonowanie pacjentów.²⁴

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Materiały źródłowe

#1 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is associated with substantial morbidity and may be life-threatening. Its course usually extends for many years, with varying degrees of activity. Approximately 20% of patients have a monophasic and self-limited disease. In others, Takayasu arteritis is progressive or relapsing/remitting and requires immunosuppressive treatment. […] A National Institutes of Health study of 60 patients with Takayasu arteritis showed that 20% of patients had a monophasic illness, self-limiting illness and therefore did not require immunosuppressive treatment. In the remaining 80% of patients, who did not have a monophasic illness and who experienced a single exacerbation, immunosuppressive therapy resulted in remission in 60%. Of these, one half experienced relapse after immunosuppressive therapy was stopped.
#2 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is a chronic relapsing and remitting disorder. The overall 10-year survival rate is approximately 90%; however, this rate is reduced in the presence of major complications. The 5- and 10-year survival rates are approximately 69% and 36%, respectively, in patients with 2 or more complications. The 5- and 10-year survival rates associated with 1 or fewer complications are 100% and 96%, respectively. […] Strict management of traditional cardiovascular risk factors such as dyslipidemia, hypertension, and lifestyle factors that increase the risk of cardiovascular disease is mandatory to minimize secondary cardiovascular complications. These complications are the major cause of death in Takayasu arteritis. […] A 2008 study assessing quality of life with Takayasu arteritis showed worse scores for physical and mental health compared with many other chronic diseases associated with peripheral vascular disease. Disease remission is the only factor that positively influences physical and mental quality of life.
#3 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is a chronic relapsing and remitting disorder. The overall 10-year survival rate is approximately 90%; however, this rate is reduced in the presence of major complications. The 5- and 10-year survival rates are approximately 69% and 36%, respectively, in patients with 2 or more complications. The 5- and 10-year survival rates associated with 1 or fewer complications are 100% and 96%, respectively. […] Strict management of traditional cardiovascular risk factors such as dyslipidemia, hypertension, and lifestyle factors that increase the risk of cardiovascular disease is mandatory to minimize secondary cardiovascular complications. These complications are the major cause of death in Takayasu arteritis. […] A 2008 study assessing quality of life with Takayasu arteritis showed worse scores for physical and mental health compared with many other chronic diseases associated with peripheral vascular disease. Disease remission is the only factor that positively influences physical and mental quality of life.
#4 Long-Term Outcomes and Prognostic Factors of Complications in Takayasu Arteritis: A Multicenter Study of 318 Patients – PubMed
https://pubmed.ncbi.nlm.nih.gov/28701469/
Because of the wide variation in the course of Takayasu arteritis (TA), predicting outcome is challenging. We assess long-term outcome and prognosis factors for vascular complications in patients with TA. […] After a median follow-up of 6.1 years, relapses were observed in 43%, vascular complications in 38%, and death in 5%. […] This nationwide study shows that 50% of patients with TA will relapse and experience a vascular complication 10 years from diagnosis. We identified specific characteristics that identified those at highest risk for subsequent vascular complications.
#5 Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis | RMD Open
https://rmdopen.bmj.com/content/5/2/e001020
The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. […] The presence of major complications, progressive disease course and older age are unfavourable prognostic indicators, as Ishikawa and colleagues demonstrated in a series of prospective observational studies. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis. […] Overall survival rates over time, 92%, 81% and 73%, respectively, at 2, 5 and 10 years after diagnosis, and additionally conducted an analysis based on age of onset of complications. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis.
#6 Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis | RMD Open
https://rmdopen.bmj.com/content/5/2/e001020
The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. […] The presence of major complications, progressive disease course and older age are unfavourable prognostic indicators, as Ishikawa and colleagues demonstrated in a series of prospective observational studies. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis. […] Overall survival rates over time, 92%, 81% and 73%, respectively, at 2, 5 and 10 years after diagnosis, and additionally conducted an analysis based on age of onset of complications. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis.
#7 Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis | RMD Open
https://rmdopen.bmj.com/content/5/2/e001020
The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. […] The presence of major complications, progressive disease course and older age are unfavourable prognostic indicators, as Ishikawa and colleagues demonstrated in a series of prospective observational studies. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis. […] Overall survival rates over time, 92%, 81% and 73%, respectively, at 2, 5 and 10 years after diagnosis, and additionally conducted an analysis based on age of onset of complications. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis.
#8 Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis | RMD Open
https://rmdopen.bmj.com/content/5/2/e001020
The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. […] The presence of major complications, progressive disease course and older age are unfavourable prognostic indicators, as Ishikawa and colleagues demonstrated in a series of prospective observational studies. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis. […] Overall survival rates over time, 92%, 81% and 73%, respectively, at 2, 5 and 10 years after diagnosis, and additionally conducted an analysis based on age of onset of complications. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis.
#9 Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis | RMD Open
https://rmdopen.bmj.com/content/5/2/e001020
The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. […] The presence of major complications, progressive disease course and older age are unfavourable prognostic indicators, as Ishikawa and colleagues demonstrated in a series of prospective observational studies. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis. […] Overall survival rates over time, 92%, 81% and 73%, respectively, at 2, 5 and 10 years after diagnosis, and additionally conducted an analysis based on age of onset of complications. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis.
#10 Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis | RMD Open
https://rmdopen.bmj.com/content/5/2/e001020
The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. […] The presence of major complications, progressive disease course and older age are unfavourable prognostic indicators, as Ishikawa and colleagues demonstrated in a series of prospective observational studies. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis. […] Overall survival rates over time, 92%, 81% and 73%, respectively, at 2, 5 and 10 years after diagnosis, and additionally conducted an analysis based on age of onset of complications. […] Overall, evidence points towards a worse prognosis in patients with major vascular complications, progressive disease course and older age. Early onset of complications contributes to decreased survival, with most deaths occurring in the first year after diagnosis.
#11 Outcome of Takayasu Arteritis with Inactive Disease at Diagnosis: The Extent of Vascular Involvement As a Predictor of Activation | The Journal of Rheumatology
https://www.jrheum.org/content/42/3/489
Substantial portions of patients with clinically inactive TA at the time of diagnosis experienced disease activation during followup. […] Type V disease may be an important predictive factor for disease activation in patients with clinically inactive TA. […] Notably, type V (OR 10.969, 95% CI 1.144105.182, p = 0.038) was significantly associated with an increased risk of disease activation in patients with clinically inactive TA. […] These findings suggest that a type V angiographic pattern may be an important predictor for disease activation.
#12 Outcome of Takayasu Arteritis with Inactive Disease at Diagnosis: The Extent of Vascular Involvement As a Predictor of Activation | The Journal of Rheumatology
https://www.jrheum.org/content/42/3/489
Substantial portions of patients with clinically inactive TA at the time of diagnosis experienced disease activation during followup. […] Type V disease may be an important predictive factor for disease activation in patients with clinically inactive TA. […] Notably, type V (OR 10.969, 95% CI 1.144105.182, p = 0.038) was significantly associated with an increased risk of disease activation in patients with clinically inactive TA. […] These findings suggest that a type V angiographic pattern may be an important predictor for disease activation.
#13 Comparison of Presentation and Prognosis of Takayasu Arteritis with or without Stroke or Transient Ischemic AttackâA Retrospective Cohort Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9697956/
Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. […] Risk of mortality was similar in TAK patients with or without stroke/TIA (hazard ratio unadjusted 0.76, 95% CI 0.153.99; adjusted for gender, age of disease onset, delay to diagnosis, baseline disease activity, and the number of conventional or biologic/targeted synthetic immunosuppressants used 1.38, 95% CI 0.1910.20) even after propensity score-matched analyses. […] Stroke or TIA does not appear to affect survival in TAK patients adversely. […] The lack of difference in survival between TAK patients with or without stroke/TIA was also confirmed after propensity score matching for the same prognostic variables. […] Overall, the literature on stroke/TIA in TAK patients is scant. […] Future prospective studies of stroke/TIA in TAK patients should evaluate the quality of life and other PROMs in this subset of TAK patients.
#14 Comparison of Presentation and Prognosis of Takayasu Arteritis with or without Stroke or Transient Ischemic AttackâA Retrospective Cohort Study
https://www.mdpi.com/2075-1729/12/11/1904
Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. […] Risk of mortality was similar in TAK patients with or without stroke/TIA (hazard ratio unadjusted 0.76, 95% CI 0.15â3.99; adjusted for gender, age of disease onset, delay to diagnosis, baseline disease activity, and the number of conventional or biologic/targeted synthetic immunosuppressants used 1.38, 95% CI 0.19â10.20) even after propensity score-matched analyses. […] Stroke or TIA does not appear to affect survival in TAK patients adversely. […] The lack of difference in survival between TAK patients with or without stroke/TIA was also confirmed after propensity score matching for the same prognostic variables. […] Therefore, based on the information derived from retrospective cohorts, stroke in TAK patients does not appear to increase the risk of death.
#15 Comparison of Presentation and Prognosis of Takayasu Arteritis with or without Stroke or Transient Ischemic AttackâA Retrospective Cohort Study
https://www.mdpi.com/2075-1729/12/11/1904
Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. […] Risk of mortality was similar in TAK patients with or without stroke/TIA (hazard ratio unadjusted 0.76, 95% CI 0.15â3.99; adjusted for gender, age of disease onset, delay to diagnosis, baseline disease activity, and the number of conventional or biologic/targeted synthetic immunosuppressants used 1.38, 95% CI 0.19â10.20) even after propensity score-matched analyses. […] Stroke or TIA does not appear to affect survival in TAK patients adversely. […] The lack of difference in survival between TAK patients with or without stroke/TIA was also confirmed after propensity score matching for the same prognostic variables. […] Therefore, based on the information derived from retrospective cohorts, stroke in TAK patients does not appear to increase the risk of death.
#16
https://www.healio.com/news/rheumatology/20190222/childhood-takayasu-arteritis-carries-3-mortality-rate-in-first-year
Patients with childhood Takayasu arteritis have a 3% mortality rate within the first year after diagnosis, as well as a 50% morbidity rate within the first 5 years, according to findings published in Arthritis Research Therapy. […] This large ambispective study of c-TA reveals an early mortality and morbidity, with 3% of patients dying by the first year and around 50% enduring at least an event or rehospitalization within the first 5 years after diagnosis, Fan and colleagues wrote. Hypertension, renal artery involvement and revascularization based on glucocorticoids, antihypertensive drugs, and antiplatelet agents are the core clinical, imaging and therapeutic features of c-TA with optimistic indications on further prognosis. Stroke, elevated CRP, lower BMI level and younger age at admission are, however, independent risk factor of poor outcomes.
#17
https://www.healio.com/news/rheumatology/20190222/childhood-takayasu-arteritis-carries-3-mortality-rate-in-first-year
Patients with childhood Takayasu arteritis have a 3% mortality rate within the first year after diagnosis, as well as a 50% morbidity rate within the first 5 years, according to findings published in Arthritis Research Therapy. […] This large ambispective study of c-TA reveals an early mortality and morbidity, with 3% of patients dying by the first year and around 50% enduring at least an event or rehospitalization within the first 5 years after diagnosis, Fan and colleagues wrote. Hypertension, renal artery involvement and revascularization based on glucocorticoids, antihypertensive drugs, and antiplatelet agents are the core clinical, imaging and therapeutic features of c-TA with optimistic indications on further prognosis. Stroke, elevated CRP, lower BMI level and younger age at admission are, however, independent risk factor of poor outcomes.
#18
https://www.healio.com/news/rheumatology/20190222/childhood-takayasu-arteritis-carries-3-mortality-rate-in-first-year
Patients with childhood Takayasu arteritis have a 3% mortality rate within the first year after diagnosis, as well as a 50% morbidity rate within the first 5 years, according to findings published in Arthritis Research Therapy. […] This large ambispective study of c-TA reveals an early mortality and morbidity, with 3% of patients dying by the first year and around 50% enduring at least an event or rehospitalization within the first 5 years after diagnosis, Fan and colleagues wrote. Hypertension, renal artery involvement and revascularization based on glucocorticoids, antihypertensive drugs, and antiplatelet agents are the core clinical, imaging and therapeutic features of c-TA with optimistic indications on further prognosis. Stroke, elevated CRP, lower BMI level and younger age at admission are, however, independent risk factor of poor outcomes.
#19 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is associated with substantial morbidity and may be life-threatening. Its course usually extends for many years, with varying degrees of activity. Approximately 20% of patients have a monophasic and self-limited disease. In others, Takayasu arteritis is progressive or relapsing/remitting and requires immunosuppressive treatment. […] A National Institutes of Health study of 60 patients with Takayasu arteritis showed that 20% of patients had a monophasic illness, self-limiting illness and therefore did not require immunosuppressive treatment. In the remaining 80% of patients, who did not have a monophasic illness and who experienced a single exacerbation, immunosuppressive therapy resulted in remission in 60%. Of these, one half experienced relapse after immunosuppressive therapy was stopped.
#20 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is associated with substantial morbidity and may be life-threatening. Its course usually extends for many years, with varying degrees of activity. Approximately 20% of patients have a monophasic and self-limited disease. In others, Takayasu arteritis is progressive or relapsing/remitting and requires immunosuppressive treatment. […] A National Institutes of Health study of 60 patients with Takayasu arteritis showed that 20% of patients had a monophasic illness, self-limiting illness and therefore did not require immunosuppressive treatment. In the remaining 80% of patients, who did not have a monophasic illness and who experienced a single exacerbation, immunosuppressive therapy resulted in remission in 60%. Of these, one half experienced relapse after immunosuppressive therapy was stopped.
#21 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is a chronic relapsing and remitting disorder. The overall 10-year survival rate is approximately 90%; however, this rate is reduced in the presence of major complications. The 5- and 10-year survival rates are approximately 69% and 36%, respectively, in patients with 2 or more complications. The 5- and 10-year survival rates associated with 1 or fewer complications are 100% and 96%, respectively. […] Strict management of traditional cardiovascular risk factors such as dyslipidemia, hypertension, and lifestyle factors that increase the risk of cardiovascular disease is mandatory to minimize secondary cardiovascular complications. These complications are the major cause of death in Takayasu arteritis. […] A 2008 study assessing quality of life with Takayasu arteritis showed worse scores for physical and mental health compared with many other chronic diseases associated with peripheral vascular disease. Disease remission is the only factor that positively influences physical and mental quality of life.
#22 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is a chronic relapsing and remitting disorder. The overall 10-year survival rate is approximately 90%; however, this rate is reduced in the presence of major complications. The 5- and 10-year survival rates are approximately 69% and 36%, respectively, in patients with 2 or more complications. The 5- and 10-year survival rates associated with 1 or fewer complications are 100% and 96%, respectively. […] Strict management of traditional cardiovascular risk factors such as dyslipidemia, hypertension, and lifestyle factors that increase the risk of cardiovascular disease is mandatory to minimize secondary cardiovascular complications. These complications are the major cause of death in Takayasu arteritis. […] A 2008 study assessing quality of life with Takayasu arteritis showed worse scores for physical and mental health compared with many other chronic diseases associated with peripheral vascular disease. Disease remission is the only factor that positively influences physical and mental quality of life.
#23 Takayasu Arteritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/332378-overview
Takayasu arteritis is a chronic relapsing and remitting disorder. The overall 10-year survival rate is approximately 90%; however, this rate is reduced in the presence of major complications. The 5- and 10-year survival rates are approximately 69% and 36%, respectively, in patients with 2 or more complications. The 5- and 10-year survival rates associated with 1 or fewer complications are 100% and 96%, respectively. […] Strict management of traditional cardiovascular risk factors such as dyslipidemia, hypertension, and lifestyle factors that increase the risk of cardiovascular disease is mandatory to minimize secondary cardiovascular complications. These complications are the major cause of death in Takayasu arteritis. […] A 2008 study assessing quality of life with Takayasu arteritis showed worse scores for physical and mental health compared with many other chronic diseases associated with peripheral vascular disease. Disease remission is the only factor that positively influences physical and mental quality of life.
#24 Comparison of Presentation and Prognosis of Takayasu Arteritis with or without Stroke or Transient Ischemic AttackâA Retrospective Cohort Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9697956/
Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. […] Risk of mortality was similar in TAK patients with or without stroke/TIA (hazard ratio unadjusted 0.76, 95% CI 0.153.99; adjusted for gender, age of disease onset, delay to diagnosis, baseline disease activity, and the number of conventional or biologic/targeted synthetic immunosuppressants used 1.38, 95% CI 0.1910.20) even after propensity score-matched analyses. […] Stroke or TIA does not appear to affect survival in TAK patients adversely. […] The lack of difference in survival between TAK patients with or without stroke/TIA was also confirmed after propensity score matching for the same prognostic variables. […] Overall, the literature on stroke/TIA in TAK patients is scant. […] Future prospective studies of stroke/TIA in TAK patients should evaluate the quality of life and other PROMs in this subset of TAK patients.