Background In Takayasu arteritis (TA) Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are used to monitor disease activity. Thirty percent of patients with active inflammation have normal ESR while 40% without vascular inflammation have elevated ESR.1 Pentraxin 3 (PTX3) produced in vascular wall during inflammation, may be a better biomarker of disease activity.
Objectives To compare PTX3 levels in TA patients with healthy controls and to compare the accuracy of PTX3 levels with high sensitive CRP (hs CRP) and ESR in distinguishing active from inactive disease.
Methods Cross sectional prospective study conducted from 2014 to 2015.Forty consecutive TA patients fulfilling 1990 American College of Rheumatology criteria for TA and 20 healthy controls were included. Disease activity was assessed by Physician Global Assessment (PGA), Indian Takayasu Arteritis Score (ITAS)2 and ITAS-ESR. Serum PTX3 levels (pg/ml) was measured in TA patients and controls, hsCRP (ng/ml)and ESR (mm/hr)were measured in TA patients. Based on PGA patients were divided into active, grumbling and inactive disease.Serum PTX3, hs CRP and ESR were expressed as mean (SD). ROC were constructed for serum PTX3, hs CRP and ESR in differentiating active from inactive disease. p value <0.05 was considered significant. SPSS Software (version 21) was used.
Results Mean age of TA patients and Healthy controls was 27 (7.9), 20 (3.4) years respectively.90% patients were female.Mean disease duration was 3.4 (3.1) years (range 1–12 yrs). Weight loss, fatigue, anorexia were the presenting symptoms followed by claudication. There were 14 patients with active disease, 8 with grumbling disease and 18 with inactive disease.Mean (SD) ITAS in patients with active disease 5.9 (3.5) was significantly higher than in patients with grumbling disease 0.9 (1.2) or inactive disease 0.6 (1). Mean ITAS-ESR in active disease was higher than in grumbling and inactive disease but not different between grumbling and inactive disease.
Conclusions PTX3 performed better than hs CRP and ESR in differentiating active from inactive disease. Grumbling disease could not be differentiated from inactive disease using ITAS/ITAS-ESR. Inflammatory markers did not perform well in differentiating grumbling disease from active or inactive disease in TA.
Lupi-Herrera E et al Takayasu's arteritis. Clinical study of 107 cases. Am Heart J. 1977; 93:94–103
Misra R et al. Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology (Oxford) 2013;52:1795–801
Disclosure of Interest None declared