Background Takayasu arteritis (TA) is a large vessel vasculitis with a chronic course, usually causing damage by the time of diagnosis. To our knowledge, there is no reported study assessing the damage related to TA itself or treatment.
Objectives We aimed to evaluate the damage cross-sectionally in TA patients with Vasculitis Damage Index (VDI), a generic tool developed for systemic vasculitides.
Methods A collection of 103 TA patients (92 female) fulfilling ACR criteria and followed-up more than 6 mo from 4 centers in Turkey, were enrolled into the study. All patients underwent detailed examination including eye, vascular imaging, echocardiography and bone dansitometry. Clinical, angiographical and treatment characteristics and damage items of VDI were recorded using a standardized protocol. Disease activity and quality of life (QoL) were evaluated by Kerr criteria and SF-36, respectively. TA patients with persistant disease activity ≥6 mo were considered as resistant. The correlation between VDI scores and disease duration, cumulative glucocorticoid (GC), cyclophosphamide (CYC) duration and doses, and mental (MCS) and physical (PCS) component summary scores of SF-36 were analysed by Pearson correlation test. VDI scores according to the disease resistance and poor QoL (MCS and PCS scores <50) were compared by Mann Whitney U test.
Results The mean age, follow-up time and disease duration were 40±12 years, 71±68 mo and 98±92 mo, respectively. Type I (45%) was the most common type of vascular involvement. Cumulative doses/duration of GC and CYC were 12±11g/70±65 mo and 2,4±6,5g/2,6±7,1 mo, respectively; 40% of them had resistant course. Major vessel stenosis, absent pulses, claudication and hypertension were demonstrated in ≥50% of TA patients, as damage items. Osteoporosis (26%) and cataract (15%) were the main treatment related damages. Cumulative VDI scores in TA cohort were found to be 4.7±2.2, mainly (4.1±1.8) due to disease itself. MCS and PCS scores were calculated as 44±10 and 39±12, respectively. Poor SF-36 MCS scores were demonstrated in 66% and PCS scores in 79% of the patients. VDI scores were found to be correlated with disease duration (p<0.01, r=0.44), cumulative doses of GC (p<0.01, r=0.26) and CYC (p=0.02, r=0.21) and duration of GC (p<0,01 r=0.35). A negative correlation was observed between the VDI and both MCS (p=0,002, r=-0,29) and PCS scores (p<0.001, r=-0,37). The higher VDI scores were detected in the subgroup of patients PCS <50 (5,1±2,1 vs 3±1,5, p<0,01) and resistant disease activity (5,4±2,3 vs 4,2±2, p=0,02).
Conclusions Cross-sectional analysis of this TA cohort with a long disease duration revealed vascular damage scores comparable to the scores of severe systemic necrotizing vasculitides. Majority of TA patients had disease related damage, characterized by peripheral vascular involvement. The longer disease duration and higher GC and CYC exposure were significantly associated with the damage. The severe damage scores (≥5) were observed in TA patients with resistant disease and poor health quality.
Disclosure of Interest None Declared