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Clinical and epidemiological research
Extended report
Distribution of arterial lesions in Takayasu's arteritis and giant cell arteritis
  1. Peter C Grayson1,
  2. Kathleen Maksimowicz-McKinnon2,
  3. Tiffany M Clark2,
  4. Gunnar Tomasson1,
  5. David Cuthbertson3,
  6. Simon Carette4,
  7. Nader A Khalidi5,
  8. Carol A Langford2,
  9. Paul A Monach1,
  10. Philip Seo6,
  11. Kenneth J Warrington7,
  12. Steven R Ytterberg7,
  13. Gary S Hoffman2,
  14. Peter A Merkel1 for the Vasculitis Clinical Research Consortium
  1. 1The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Rheumatic and Immunologic Dis, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  3. 3Department of Biostatistics, University of South Florida, Tampa, Florida, USA
  4. 4Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
  5. 5Division of Rheumatology, McMaster University, Hamilton, Canada
  6. 6Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  7. 7Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Dr Peter A Merkel, Division of Rheumatology, University of Pennsylvania, 8th Floor Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA; pmerkel{at}upenn.edu

Abstract

Objectives To compare patterns of arteriographic lesions of the aorta and primary branches in patients with Takayasu's arteritis (TAK) and giant cell arteritis (GCA).

Methods Patients were selected from two North American cohorts of TAK and GCA. The frequency of arteriographic lesions was calculated for 15 large arteries. Cluster analysis was used to derive patterns of arterial disease in TAK versus GCA and in patients categorised by age at disease onset. Using latent class analysis, computer derived classification models based upon patterns of arterial disease were compared with traditional classification.

Results Arteriographic lesions were identified in 145 patients with TAK and 62 patients with GCA. Cluster analysis demonstrated that arterial involvement was contiguous in the aorta and usually symmetric in paired branch vessels for TAK and GCA. There was significantly more left carotid (p=0.03) and mesenteric (p=0.02) artery disease in TAK and more left and right axillary (p<0.01) artery disease in GCA. Subclavian disease clustered asymmetrically in TAK and in patients ≤55 years at disease onset and clustered symmetrically in GCA and patients >55 years at disease onset. Computer derived classification models distinguished TAK from GCA in two subgroups, defining 26% and 18% of the study sample; however, 56% of patients were classified into a subgroup that did not strongly differentiate between TAK and GCA.

Conclusions Strong similarities and subtle differences in the distribution of arterial disease were observed between TAK and GCA. These findings suggest that TAK and GCA may exist on a spectrum within the same disease.

https://doi.org/10.1136/annrheumdis-2011-200795

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    Footnotes

    • Funding US National Institutes of Health.

    • Competing interests None.

    • Ethics approval Multiple IRB/Ethics Committees in USA and Canada.

    • Provenance and peer review Not commissioned; externally peer reviewed.