Background Takayasu arteritis (TA) is an orphan idiopathic inflammatory disease. A major pitfall in TA is the absence of a reliable modality to describe disease evolution and activity. Morphological vascular progression represents a significant clinical outcome, given the prognostic impact of cardiovascular complications.
Objectives We verified if variables currently used in clinical practice as well as functional imaging data could predict the concurrent morphological progression.
Methods We used Magnetic Resonance Angiography (MRA) as the reference for the assessment of disease evolution and morphological progression and we performed an exhaustive follow-up of patients with multiple MRA assessments. We selected and retrospectively evaluated 16 TA patients, for which 38 couples of MRA examinations performed within 24 months were available. Morphological progression within each couple was defined as the occurrence of new lesion(s) or worsening of at least one of the pre-existing lesions. Wall contrast enhancement (CE) was expressed as the difference of CNR (Contrast to Noise Ratio) pre- and post- infusion of contrast medium.
Results Morphological progression occurred in 18 out of 38 couples of MRA examinations, despite effective treatment selected based on the most recent information available in the literature. All variables commonly used in the clinical practice failed to predict TA progression, except for maximum neutrophils values and radiological progression in the year preceding the first MRA of each couple. Wall CE at the first MRA examination within each couple was not associated with progression at the following MRA examination.
Conclusions Most clinical, laboratory and functional imaging variables, currently associated with TA activity, fail to predict the vascular progression. Since they well reflect the activation of cardinal systemic inflammatory pathways, our data suggest that other inflammatory pathways contribute to the clinical outcomes of TA patients. Their identification and as such the identification of more effective targeted molecular therapies represent a major unmet medical need.
Disclosure of Interest None declared
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