Clinical characteristics and outcomes of Colombian patients with Takayasu arteritis: A retrospective cohort

Abstract

Introduction

Takayasu arteritis (TAK) is a vasculitis of the great vessels that affects mainly young patients. Cardiovascular morbidity is high due to irreversible damage, end-organ failure, and a late diagnosis. The knowledge of this vasculitis in our country is limited. This study describes clinical, laboratory, and angiographic findings of Takayasu arteritis in Colombia.

Methods

We described a retrospective cohort of patients with Takayasu arteritis in two rheumatology centers in Medellin, Colombia between 2011 and 2018. We assessed the medical records of 43 patients, 88% of whom met Takayasu arteritis 1990 ACR criteria.

Results

Of the forty-three patients, forty-one were female, with a median age of 22 years at diagnosis. Eleven patients were >40 years old. The median delay in diagnosis was 12 months. Systemic manifestations included general malaise (32%), weight loss (23%), and fever (21%). The most frequent vascular symptoms were headache (39%) and upper limb claudication (30%). The most frequent physical examination findings were absent or decreased pulses (76%), hypertension (62%), blood pressure difference (60%), and subclavian murmur (48%). Eighty three percent and 76% of patients had elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), respectively. Angiography (mainly magnetic resonance [MR] angiography) showed stenosis in the left subclavian artery (68%), followed by aortic involvement, including abdominal (62%) and thoracic (52%) segments. Hata–Numano's classification was V (62%), I (16%), and IIa (7%). Renal artery abnormalities, pulmonary artery stenosis, and aortic regurgitation were present in 42%, 14%, and 9%, respectively. Vascular complications were renovascular hypertension (30%), ischemic stroke, chronic kidney disease, and heart failure (all with 18%). Twenty-eight patients (65%) completed the 5-year follow-up. The overall survival rate was 83% in the fifth year, compared to 87.5% in the first.

Conclusions

A high rate of complicated vascular lesions (Hata–Numano V and renal/splanchnic artery disease), ongoing disease activity, and a late diagnosis may be the causes of the increased morbidity observed in this cohort of TAK patients.