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2.
Int J Mol Sci ; 25(12)2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38928233

RESUMO

Takayasu's arteritis (TAK) manifests as an insidiously progressive and debilitating form of granulomatous inflammation including the aorta and its major branches. The precise etiology of TAK remains elusive, with current understanding suggesting an autoimmune origin primarily driven by T cells. Notably, a growing body of evidence bears testimony to the widespread effects of B cells on disease pathogenesis and progression. Distinct alterations in peripheral B cell subsets have been described in individuals with TAK. Advancements in technology have facilitated the identification of novel autoantibodies in TAK. Moreover, emerging data suggest that dysregulated signaling cascades downstream of B cell receptor families, including interactions with innate pattern recognition receptors such as toll-like receptors, as well as co-stimulatory molecules like CD40, CD80 and CD86, may result in the selection and proliferation of autoreactive B cell clones in TAK. Additionally, ectopic lymphoid neogenesis within the aortic wall of TAK patients exhibits functional characteristics. In recent decades, therapeutic interventions targeting B cells, notably utilizing the anti-CD20 monoclonal antibody rituximab, have demonstrated efficacy in TAK. Despite the importance of the humoral immune response, a systematic understanding of how autoreactive B cells contribute to the pathogenic process is still lacking. This review provides a comprehensive overview of the biological significance of B cell-mediated autoimmunity in TAK pathogenesis, as well as insights into therapeutic strategies targeting the humoral response. Furthermore, it examines the roles of T-helper and T follicular helper cells in humoral immunity and their potential contributions to disease mechanisms. We believe that further identification of the pathogenic role of autoimmune B cells and the underlying regulation system will lead to deeper personalized management of TAK patients. We believe that further elucidation of the pathogenic role of autoimmune B cells and the underlying regulatory mechanisms holds promise for the development of personalized approaches to managing TAK patients.


Assuntos
Linfócitos B , Imunidade Humoral , Arterite de Takayasu , Arterite de Takayasu/imunologia , Arterite de Takayasu/terapia , Arterite de Takayasu/tratamento farmacológico , Humanos , Linfócitos B/imunologia , Rituximab/uso terapêutico , Autoimunidade , Animais , Autoanticorpos/imunologia
3.
BMJ Case Rep ; 17(6)2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38901855

RESUMO

Takayasu arteritis is an inflammatory disease of unknown aetiology affecting large vessels. Medium vessel involvement is also well documented; however, neuropathy as a presenting manifestation is rare. In this case report, a young woman in her 20s presented with an 8-month history of intermittent claudication in the right upper limb progressing to rest pain with allodynia in C5-C8 distribution and painless right axillary mass. On examination, she had absent pulses in the right radial, brachial and subclavian artery with audible bruit in the right subclavian and abdominal aorta. CT angiogram showed features suggestive of Takayasu arteritis with a partially thrombosed aneurysm arising from the right axillary artery leading to compression of the right brachial plexus. This patient received treatment with methotrexate and oral corticosteroids. At 3 months follow-up, there was a reduction in the size of the aneurysm, resolution of compressive symptoms and normalisation of inflammatory markers.


Assuntos
Aneurisma , Artéria Axilar , Neuropatias do Plexo Braquial , Arterite de Takayasu , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/tratamento farmacológico , Feminino , Artéria Axilar/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/diagnóstico por imagem , Aneurisma/complicações , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/diagnóstico , Adulto , Angiografia por Tomografia Computadorizada , Metotrexato/uso terapêutico , Metotrexato/administração & dosagem
4.
Medicine (Baltimore) ; 103(18): e37992, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38701260

RESUMO

BACKGROUND: Multiple takayasu arteritis (TA) is a chronic nonspecific large to medium vasculitis disease that mainly accumulates the aorta and its branches. Pulmonary vascular disease is often seen as stenosis and occlusion, and patients may show no moderate to severe pulmonary hypertension (PH). This study aims to summarize the clinical characteristics and analysis of prognostic factors in patients with PH caused by TA. METHODS: Patients diagnosed with aortitis involving the pulmonary artery by pulmonary arteriography or pulmonary artery and total aortic computed tomography arteriography (CTA). All patients underwent detailed clinical assessment, laboratory data collection, and analysis of imaging data. Patients were followed up and factors affecting the prognosis of the pulmonary arteries were analyzed. RESULTS: Most of the patients' complaints were chest tightness, shortness of breath, decreased activity tolerance, hemoptysis and chest pain. 56.90% of the patients were in at the time of admission. Echocardiographic estimation of pulmonary artery systolic pressure was 90.39 ±â€…22.87 mm Hg. In terms of laboratory tests, 39.66%% of the patients had elevated C-reactive protein and erythrocyte sedimentation rate, and amino-terminal natriuretic peptide precursor on admission. In terms of imaging, all patients had pulmonary artery involvement, which was combined with aortic involvement in 31.03%. Nuclide lung perfusion/ventilation imaging of the patients revealed multiple perfusion defects/absences in the segmental and subsegmental distribution of the lungs. Univariate Cox regression model analysis suggested that patients' WHO functional class at admission, age ≧ 51 years at the time of consultation, and amino-terminal natriuretic peptide precursor ≧ 3500 pg/mL were factors affecting the prognosis. Further multifactorial Cox regression model analysis suggested amino-terminal natriuretic peptide precursor ≧ 3500 pg/mL was an independent predictor of poor prognosis with a hazard ratio (HR) value of 5.248. CONCLUSION: Electrocardiogram and echocardiogram may suggest an increased right heart load; some patients have elevated serum inflammatory indexes. Characteristic imaging manifestations include widening of the main pulmonary artery, multiple pulmonary segmental and subsegmental stenoses.


Assuntos
Hipertensão Pulmonar , Artéria Pulmonar , Arterite de Takayasu , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/fisiopatologia , Feminino , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Estudos Retrospectivos , Adulto , Masculino , Prognóstico , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Pessoa de Meia-Idade , Adulto Jovem , Ecocardiografia/métodos , Angiografia por Tomografia Computadorizada/métodos
5.
Rev Assoc Med Bras (1992) ; 70(5): e20231683, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38775535

RESUMO

OBJECTIVE: In this study, we aimed to investigate the role of erythrocyte sedimentation rate, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, red blood cell distribution width, mean platelet volume, monocyte/HDL ratio, and C-reactive protein/albumin ratio in the diagnosis and treatment follow-up of active and remission Takayasu arteritis patients compared with healthy control group. METHODS: This is a retrospective case-control study in which 56 Takayasu arteritis patients and 40 age- and sex-matched healthy control were included. The blood values of Takayasu arteritis patients were analyzed during their active period and post-treatment remission periods, after comparing them with the healthy control. Furthermore, all parameters were evaluated by receiver operating characteristic analysis. RESULTS: Erythrocyte sedimentation rate, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, monocyte/HDL ratio, and C-reactive protein/albumin ratio values were significantly higher in active Takayasu arteritis patients compared with healthy control and remission Takayasu arteritis groups. In the receiver operating characteristic analysis performed in active Takayasu arteritis and Takayasu arteritis patients in remission, C-reactive protein had the highest power to indicate disease activity, followed by C-reactive protein/albumin ratio, erythrocyte sedimentation rate, and monocyte/HDL ratio. When Takayasu arteritis in remission was compared with the healthy control, a significant difference was found between erythrocyte sedimentation rate, C-reactive protein, red blood cell distribution width, and C-reactive protein/albumin ratio, while no significant difference was found between monocyte/HDL ratio values. CONCLUSION: C-reactive protein/albumin ratio and red blood cell distribution width can be used in the diagnosis of Takayasu arteritis, and C-reactive protein/albumin ratio, red blood cell distribution width, and monocyte/HDL ratio measurements can be used in the follow-up. As C-reactive protein/albumin ratio is more powerful than C-reactive protein in differentiating the Takayasu arteritis group from the healthy control group, evaluation of C-reactive protein/albumin ratio together with albumin instead of evaluation of C-reactive protein alone when diagnosing the disease may help us to obtain more accurate results in daily practice.


Assuntos
Sedimentação Sanguínea , Proteína C-Reativa , Monócitos , Arterite de Takayasu , Humanos , Arterite de Takayasu/sangue , Arterite de Takayasu/diagnóstico , Feminino , Proteína C-Reativa/análise , Estudos Retrospectivos , Adulto , Masculino , Estudos de Casos e Controles , Adulto Jovem , Curva ROC , Seguimentos , Biomarcadores/sangue , Pessoa de Meia-Idade , Albumina Sérica/análise , Adolescente
6.
Adv Rheumatol ; 64(1): 43, 2024 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-38807174

RESUMO

INTRODUCTION: Takayasu's arteritis (TAK) patients are at an elevated risk of metabolic syndrome and cardiovascular diseases (CVD). Currently, there are no well-validated biomarkers to assess this risk in this population. Previous research in different cohorts has linked serum levels of osteoprotegerin (OPG) and its polymorphisms to accelerated atherosclerosis and a marker of poor prognosis in CVD. Thus, we assessed this protein as a potential biomarker of CVD in TAK patients. OBJECTIVES: To evaluate the serum levels of OPG and its SNPs (single nucleotide polymorphisms) in TAK patients and healthy controls, and to associate these parameters with clinical data. METHODS: This bicentric cross-sectional study included TAK patients who were compared with healthy individuals (control group). The serum levels of OPG and the frequency of OPG SNPs [1181G > C (rs2073618), 245 A > C (rs3134069), 163T > C (rs3102735), and 209 C > T (rs3134070)] were compared between the both groups and associated with clinical data. RESULTS: In total, 101 TAK patients and 93 controls were included in the study. The serum levels of OPG (3.8 ± 1.9 vs. 4.3 ± 1.8pmol/L, respectively; P = 0.059), and its four polymorphisms were comparable between both groups. In an additional analysis of only TAK patients, serum OPG levels and its four genes were not associated with any CVD parameters, except for higher OPG levels among patients without dyslipidemia. CONCLUSION: No significant differences were observed in serum OPG levels or in the genotype frequencies of OPG SNPs between the patient and control groups. Similarly, no correlation was found between laboratory parameters and clinical data on CVD risk in TAK patients.


Assuntos
Biomarcadores , Osteoprotegerina , Polimorfismo de Nucleotídeo Único , Arterite de Takayasu , Humanos , Arterite de Takayasu/genética , Arterite de Takayasu/sangue , Osteoprotegerina/sangue , Osteoprotegerina/genética , Estudos Transversais , Feminino , Masculino , Adulto , Estudos de Casos e Controles , Biomarcadores/sangue , Pessoa de Meia-Idade
7.
Zhonghua Yan Ke Za Zhi ; 60(5): 454-456, 2024 May 11.
Artigo em Chinês | MEDLINE | ID: mdl-38706085

RESUMO

A 47-year-old male patient with a history of Takayasu arteritis presented with prominent symptoms of left eyeball fixation, protrusion, and visual loss. Orbital magnetic resonance imaging revealed hyperintensity on diffusion-weighted imaging of the left optic nerve, with corresponding low signal on apparent diffusion coefficient maps, suggestive of acute infarction of the left optic nerve. Combined with the patient's cranial magnetic resonance imaging findings, the diagnosis of cavernous sinus syndrome was established.


Assuntos
Seio Cavernoso , Imagem de Difusão por Ressonância Magnética , Nervo Óptico , Arterite de Takayasu , Humanos , Masculino , Pessoa de Meia-Idade , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/patologia , Nervo Óptico/diagnóstico por imagem , Síndromes do Seio Cavernoso
8.
J Autoimmun ; 146: 103242, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38761452

RESUMO

OBJECTIVE: To assess the prognosis and outcome of patients with isolated carotid vasculitis. METHODS: We performed a retrospective multicenter study of 36 patients (median age at diagnosis was 37 [IQR 27-45] years and 11 [31 %] patients were men) with initial presentation as isolated carotid vasculitis. Study endpoints included vascular complications, relapses, and progression to large vessel vasculitis (i.e. Giant cell arteritis or Takayasu). RESULTS: The most frequent involvement was the left internal carotid artery (39 %), and 81 % had stenosis. After a median follow-up of 32 months [IQR 12-96], 21 (58 %) patients had a vascular event, including 31 % of new onset vascular lesions and 25 % of stroke/transient ischemic attack. Patients with stroke had less carotidynia at diagnosis (33 % vs 74 %, p = 0.046), higher significant carotid stenosis (i.e. > 50 %) (89 % vs. 30 %, p = 0.026) and higher severe carotid stenosis (i.e. >70 %) (67 % vs 19 %, p = 0.012), compared to those without stroke. Twenty (52 %) patients experienced relapses. High CRP at diagnosis was associated with relapses (p = 0.022). At the end of follow-up, 21 (58 %) patients were classified as having Takayasu arteritis, 13 (36 %) as isolated carotid vasculitis, and two (6 %) as giant cell arteritis. CONCLUSION: Carotid vasculitis may occur as a topographically limited lesion and is associated with significant rate of vascular complications.


Assuntos
Arterite de Células Gigantes , Humanos , Masculino , Feminino , Prognóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto , Arterite de Células Gigantes/diagnóstico , Arterite de Takayasu/diagnóstico , Recidiva , Vasculite/diagnóstico , Seguimentos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/diagnóstico , Estenose das Carótidas/diagnóstico , Progressão da Doença
9.
Front Immunol ; 15: 1387516, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38784377

RESUMO

Background: It has been well documented that Takayasu arteritis (TAK) and ulcerative colitis (UC) coexist in the same patients. HLA-B*52 characterizes the co-occurrence, which is one of the common genetic features between these two diseases, indicating shared underlying pathologic mechanisms. Anti-integrin αvß6 antibody (Ab) is present in sera of UC patients in a highly specific manner. We investigated if there were any associations between anti-integrin αvß6 Ab and TAK, considering the risk HLA alleles. Methods: A total of 227 Japanese TAK patients were recruited in the current study and their serum samples were subjected to measurement of anti-integrin αvß6 Ab by ELISA. The clinical information, including the co-occurrence of UC, was collected. The HLA allele carrier status was determined by Luminex or genotype imputation. Results: The information about the presence of UC was available for 165 patients, among which eight (4.84%) patients had UC. Anti-integrin αvß6 antibody was identified in 7 out of 8 TAK subjects with UC (87.5%) while only 5 out of 157 (3.18%) TAK subjects without UC had the antibody (OR 121, p=7.46×10-8). A total of 99 out of 218 (45.4%) patients were HLA-B*52 carriers. There was no significant association between the presence of anti-integrin αvß6 Ab and HLA-B*52 carrier status in those without UC (OR 2.01, 95% CI 0.33-12.4, p = 0.189). Conclusions: The prevalence of anti-integrin αvß6 Ab was high in TAK patients with UC, but not in the absence of concomitant UC. The effect of HLA-B*52 on anti-integrin αvß6 Ab production would be minimal.


Assuntos
Antígenos de Neoplasias , Colite Ulcerativa , Integrinas , Arterite de Takayasu , Humanos , Colite Ulcerativa/imunologia , Colite Ulcerativa/genética , Arterite de Takayasu/imunologia , Arterite de Takayasu/genética , Feminino , Integrinas/imunologia , Masculino , Adulto , Pessoa de Meia-Idade , Antígenos de Neoplasias/imunologia , Antígenos de Neoplasias/genética , Antígeno HLA-B52/imunologia , Antígeno HLA-B52/genética , Alelos , Adulto Jovem , Japão/epidemiologia , Genótipo , Autoanticorpos/sangue , Autoanticorpos/imunologia
10.
Cardiovasc Pathol ; 71: 107651, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38679299

RESUMO

BACKGROUND: This study aimed to explore the clinical and pathological features of aortitis in China, which is a rare disease that is often overlooked preoperatively. METHODS: We reviewed the records of 2950 patients who underwent aortic surgery at Wuhan Asia General Hospital from 2016 to 2023. Clinical and pathological data were collected and compared across different groups. RESULTS: Out of 2950 patients, 15 had healed aortitis, 2 were healed Takayasu aortitis (TAK), and 13 were not further classified. Forty-two had active aortitis, including clinically isolated aortitis ([CIA], 42.9%), infectious aortitis ([IA], 26.2%), TAK (16.7%), and Behçet's syndrome ([BS], 14.3%), half of these cases were not recognized preoperatively. All patients who developed perivalvular leakage during follow-up had concurrent non-infectious valvulitis with mixed inflammatory pattern at the time of initial surgery. Seventeen out of 18 patients with CIA survived without complications, as did 8 out of 11 patients with IA, 6 out of 7 patients with TAK, and 2 out of 6 patients with BS. CONCLUSIONS: Half of the aortitis cases were initially diagnosed by pathologists. Noninfectious valvulitis with mixed inflammatory pattern is a risk factor for perivalvular leakage. BS is associated with a higher rate of complications. Patients with CIA have a good prognosis in China, which is different from the West.


Assuntos
Aortite , Arterite de Takayasu , Humanos , Masculino , Feminino , China/epidemiologia , Pessoa de Meia-Idade , Adulto , Aortite/patologia , Aortite/epidemiologia , Aortite/cirurgia , Arterite de Takayasu/epidemiologia , Arterite de Takayasu/patologia , Arterite de Takayasu/complicações , Estudos Retrospectivos , Idoso , Adulto Jovem , Síndrome de Behçet/complicações , Síndrome de Behçet/patologia , Síndrome de Behçet/epidemiologia , Síndrome de Behçet/diagnóstico , Fatores de Risco , Valor Preditivo dos Testes , Resultado do Tratamento , Aorta/patologia , Aorta/cirurgia , Adolescente , Prognóstico , População do Leste Asiático
11.
Clin Rheumatol ; 43(6): 1979-1987, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38598024

RESUMO

OBJECTIVE: The goal of the present study was to investigate the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and disease remission in Takayasu arteritis (TAK) patients. METHODS: This retrospective study included 59 patients in the study group and 80 patients in the validation cohort with TAK. After 6 months of therapy, patients were re-evaluated, and serum 25(OH)D levels were compared before and after treatment. Correlations between changes in 25(OH)D levels and changes in disease activity scores (NIH, ITAS2010, ITAS.A) were analyzed. Additionally, a predictive cut-off value for disease remission was determined. RESULTS: After 6 months of therapy, serum 25(OH)D levels in TAK patients significantly increased compared to baseline [(18.33 ± 7.25)µg/L vs (11.77 ± 4.14) µg/L] (P < 0.001). Positive correlations were observed between the increasing changes in the 25(OH)D level and the decreasing changes in the reduced NIH, ITAS2010, and ITAS.A scores (r = 0.455, P < 0.001; r = 0.495, P < 0.001; and r = 0.352 P = 0.006, respectively). A change of 8.45 µg/L in 25(OH)D level was identified as the predictive cut-off value for TAK remission (sensitivity 54.1%, specificity 90.9%, area under the curve = 0.741). Similarly for patients with normal baseline ESR, sensitivity is 68.0%, specificity is 92.3%, and area under the curve is 0.831, and for patients with normal baseline CRP, sensitivity is 58.3%, specificity is 90.0%, and area under the curve is 0.748. Validation in an additional 80 patients demonstrated a higher remission rate in those with a 25(OH)D level change > 8.45 µg/L. CONCLUSION: Serum 25(OH)D levels significantly increased after treatment in TAK patients, and an increase of ≥ 8.45 µg/L was predictive of disease remission, especially in individuals with normal baseline ESR and/or CRP levels. Key Points • Following treatment, there was a significant increase in serum 25(OH)D levels among TAK patients. • The elevated changes in 25(OH)D levels before and after treatment demonstrated a positive correlation with the reduction in disease activity scores. • In patients with TAK before and after treatment, an elevation in serum 25(OH)D levels exceeding 8.45 µg/L serves as an indicator for disease remission, particularly prominent in individuals with normal baseline ESR and/or CRP levels.


Assuntos
Sedimentação Sanguínea , Proteína C-Reativa , Indução de Remissão , Arterite de Takayasu , Vitamina D , Humanos , Feminino , Estudos Retrospectivos , Masculino , Vitamina D/análogos & derivados , Vitamina D/sangue , Adulto , Arterite de Takayasu/sangue , Arterite de Takayasu/tratamento farmacológico , Proteína C-Reativa/metabolismo , Proteína C-Reativa/análise , Adulto Jovem , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adolescente , Biomarcadores/sangue
12.
Clin Rheumatol ; 43(5): 1571-1578, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38563865

RESUMO

OBJECTIVES: Extravascular findings of Takayasu arteritis (TAK) often share features with the spondyloarthritis (SpA) spectrum of disorders. However, the characteristics of this overlap and its effect on the vascular manifestations of TAK are not fully known. Therefore, we aimed to investigate the frequency of SpA-related features in TAK patients. MATERIAL AND METHODS: In this observational retrospective study, 350 patients with TAK classified according to ACR 1990 criteria, from 12 tertiary rheumatology clinics, were included and evaluated for the presence of axSpA, IBD, or psoriasis. Demographic, clinical features, angiographic involvement patterns, disease activity, and treatments of TAK patients with or without SpA were analyzed. RESULTS: Mean age was 45.5 ± 13.6 years and mean follow-up period was 76.1 ± 65.9 months. Among 350 patients, 31 (8.8%) had at least one additional disease from the SpA spectrum, 8 had IBD, 8 had psoriasis, and 20 had features of axSpA. In the TAK-SpA group, TAK had significantly earlier disease onset, compared to TAK-without-SpA (p = 0.041). SpA-related symptoms generally preceded TAK symptoms. Biological treatments, mostly for active vasculitis, were higher in the TAK-SpA group (70.9%) compared to TAK-without-SpA (27.9%) (p < 0.001). Vascular involvements were similar in both. CONCLUSION: Our study confirmed that diseases in the SpA spectrum are not rare in TAK. Vascular symptoms appeared earlier in such patients, and more aggressive therapy with biological agents was required in the TAK-SpA group, suggesting an association between TAK and SpA spectrum. Key Points • The pathogenesis of Takayasu arteritis is mediated by an MHC class I alelle (HLA-B*52), similar to spondyloarthritis-disorders. • Extravascular findings of Takayasu arteritis are in the spectrum of spondyloarthritis disease. • This frequent coexistence between Takayasu arteritis and spondyloarthritic disorders suggests a relationship rather than a coincidence.


Assuntos
Espondiloartrite Axial , Doenças Inflamatórias Intestinais , Psoríase , Espondilartrite , Arterite de Takayasu , Humanos , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Arterite de Takayasu/complicações , Arterite de Takayasu/epidemiologia , Arterite de Takayasu/diagnóstico , Espondilartrite/complicações , Espondilartrite/epidemiologia , Psoríase/complicações , Doenças Inflamatórias Intestinais/complicações , Progressão da Doença
13.
Semin Arthritis Rheum ; 66: 152446, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38669786

RESUMO

BACKGROUND: Immunosuppressive (IS) agents are recommended for the first-line treatment of patients with active Takayasu's arteritis (TAK) together with glucocorticoids (GCs). However, there is limited data comparing the efficacy and outcomes of different IS agents for this purpose. OBJECTIVES: In this study, we aimed to compare the outcomes of two most frequently used first-line IS agents, namely methotrexate (MTX) and azathioprine (AZA) in TAK patients. METHODS: TAK patients who received any IS agent in addition to GCs as the initial therapy were included in this multicentre, retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a matched analysis (cc match) using variables 'age', 'gender' and 'diffuse aortic involvement' was performed between patients who received MTX or AZA as the first-line IS treatment. RESULTS: We recruited 301 patients (F/M: 260/41, mean age: 42.2 ± 13.3 years) from 10 tertiary centres. As the first-line IS agent, 204 (67.8 %) patients received MTX, and 77 (25.6 %) received AZA. Less frequently used IS agents included cyclophosphamide in 17 (5.6 %), leflunomide in 2 (0.5 %) and mycophenolate mofetil in one patient. The remission, relapse, radiographic progression and adverse effect rates were similar between patients who received MTX and AZA as the first-line IS agent. Vascular surgery rate was significantly higher in the AZA group (23% vs. 9 %, p = 0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was significantly higher in the MTX group (76% vs 62 %, p = 0.034). Similarly, the rate of vascular surgery was higher in AZA group in matched analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42 %, p = 0.34). IS therapy was discontinued in 18 (12 MTX, 6 AZA) patients during the follow-up period due to remission. Among those patients, two patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of a mean 69.4 (±50.9) months of follow-up. CONCLUSIONS: Remission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.


Assuntos
Azatioprina , Imunossupressores , Metotrexato , Arterite de Takayasu , Humanos , Arterite de Takayasu/tratamento farmacológico , Arterite de Takayasu/diagnóstico por imagem , Feminino , Masculino , Adulto , Azatioprina/uso terapêutico , Metotrexato/uso terapêutico , Imunossupressores/uso terapêutico , Estudos Retrospectivos , Pessoa de Meia-Idade , Resultado do Tratamento , Glucocorticoides/uso terapêutico , Glucocorticoides/administração & dosagem
15.
Clin Exp Rheumatol ; 42(4): 843-851, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38607693

RESUMO

OBJECTIVES: Coronary artery calcification (CAC) is frequently observed in Takayasu's arteritis (TAK). Our objective is to calculate the prevalence and severity of CAC in TAK, while evaluating the influence of traditional cardiovascular risk factors, glucocorticoid exposure, and disease activity on CAC. METHODS: This retrospective study involved 155 TAK patients. We measured the Agatston score by coronary computed tomography angiography (CCTA) and categorised all patients into groups with or without CAC (41 vs. 114) to compare clinical characteristics and ancillary findings between the two groups. RESULTS: Among the TAK patients, a total of 41 TAK patients (26.45%) exhibited CAC. Age of onset, disease duration, history of hypertension, history of hyperlipidaemia, Numano V and glucocorticoid use emerged as the independent risk factors for developing CAC in TAK (OR [95% CI] 1.084[1.028-1.142], p=0.003; 1.005 [1.001-1.010], p=0.020; 4.792 [1.713-13.411], p=0.003; 4.199 [1.087-16.219], p=0.037; 3.287 [1.070-10.100], p=0.038; 3.558[1.269-9.977], p=0.016). Nonetheless, CAC was not associated with disease activity. Moreover, the extent of calcification score in TAK showed a positive correlation with the number of traditional cardiovascular risk factors. CONCLUSIONS: We recommend CCTA screening for Numano V classified TAK patients. Glucocorticoid usage significantly escalates the risk of CAC. Therefore, in cases of effectively controlled disease, the inclusion of immunosuppressants aimed at reducing glucocorticoid dosage is advisable.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana , Arterite de Takayasu , Calcificação Vascular , Humanos , Arterite de Takayasu/diagnóstico por imagem , Arterite de Takayasu/epidemiologia , Arterite de Takayasu/tratamento farmacológico , Arterite de Takayasu/complicações , Feminino , Masculino , Estudos Retrospectivos , Adulto , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Prevalência , Índice de Gravidade de Doença , Glucocorticoides/uso terapêutico , Glucocorticoides/efeitos adversos , Adulto Jovem , Fatores de Risco de Doenças Cardíacas
16.
BMJ Case Rep ; 17(4)2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38684359

RESUMO

We present a case of Takayasu's arteritis in a woman in her 30s, who exhibited visual symptoms and ophthalmic manifestations of the disease, specifically Takayasu's retinopathy stage 4, in both eyes. Despite severe narrowing of all branches of the aortic arch and compromised perfusion in both upper limbs, she had no history of intermittent claudication. Doppler study and CT angiography revealed diffuse circumferential wall thickening of bilateral common carotid, subclavian and axillary arteries. Treatment involved retinal laser photocoagulation and immune suppression. This case underscores that advanced Takayasu's retinopathy can be an initial presentation of Takayasu's arteritis even in a state of severely compromised peripheral limb circulation.


Assuntos
Arterite de Takayasu , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Feminino , Adulto , Doenças Retinianas/etiologia , Doenças Retinianas/diagnóstico , Artéria Axilar/diagnóstico por imagem , Artéria Subclávia/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Fotocoagulação a Laser
17.
Indian J Ophthalmol ; 72(5): 637-647, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38648432

RESUMO

Ocular symptoms can be the presenting manifestation of Takayasu arteritis (TA) or could be indicative of disease reactivation. A review of published literature related to posterior segment manifestations of TA by using the keywords "Takayasu arteritis," "ophthalmic manifestations," "retina," "retinopathy," "ocular," "optic nerve," and "optic neuropathy" was performed. In total, 62 case reports and 12 case series were included. The majority of the articles were from Asia (n = 47, 64%). Females outnumbered males in the ratio of 7:1. The mean age of patients was 33 years (range: 8-78 years, SD: 13.5 years). In 58% (n = 41 out of 71) cases, ocular symptoms were the presenting manifestation of the underlying disease. Hypotensive retinopathy was found in 70% of eyes, and hypertensive retinopathy was found in 27%. The mean presenting visual acuity (VA) was +1.03 logMAR (range: -0.12 to 3, SD: 1.07), and at the final follow-up was +1.02 logMAR (range: -0.12 to 3, SD 1.17). VA improved in 34% (n = 29/86), remained stable in 45% (39/86), and worsened in 21% (18/86). The mean follow-up was 9 months (range: 0.5-204, SD: 16 months).


Assuntos
Arterite de Takayasu , Humanos , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/complicações , Segmento Posterior do Olho/patologia , Acuidade Visual , Doenças Retinianas/etiologia , Doenças Retinianas/diagnóstico , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/fisiopatologia
20.
BMJ Case Rep ; 17(3)2024 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-38531553

RESUMO

Autoimmune disorders have a wide spectrum of symptoms, often with multiorgan involvement. Multiple autoimmune disorders also often occur concurrently in the same patient. These two possibilities must be distinguished in patients with multiorgan involvement to ensure early diagnosis and treatment. Here, we report a case of a previously healthy man who presented with simultaneous Takayasu arteritis and Crohn's disease. He presented with heart failure with reduced ejection fraction and severe aortic regurgitation. An echocardiogram demonstrated a greatly dilated aorta, and a diagnosis of Takayasu arteritis was made, confirmed with CT aortogram. Inpatient treatment was begun, but the patient subsequently developed bloody diarrhoea a few days after admission. Colonoscopy done to locate the source of bleeding showed colonic ulcers; a biopsy confirmed a diagnosis of Crohn's disease. The patient was successfully managed with medical management of heart failure, steroids, mesalamine and azathioprine, and has been in remission for the last 2 years.


Assuntos
Doenças Autoimunes , Doença de Crohn , Insuficiência Cardíaca , Arterite de Takayasu , Masculino , Pessoa de Meia-Idade , Humanos , Doença de Crohn/diagnóstico , Arterite de Takayasu/diagnóstico , Azatioprina
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