Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Long-Term Surgical and Medical Outcome in Takayasu Arteritis: Vascular Procedures Performed in Active Patients Have a Poor Outcome
Bicakcigil, Muge, Aksu, Kenan, Kamali, Sevil, Akar, Servet, Karadag, Omer, Ozer, Huseyin T., Onen, Fatos
Takayasu's arteritis (TA) is a rare chronic inflammatory disease of unknown etiology. There are only a few reports discussing the follow-up, course and surgical and medical prognosis of TA patients.We aimed to evaluate long-term outcome of medical and surgical treatments in TA.
184 patients (F/M: 171/13), mean age: 40.9 years followed at 13 Rheumatology centers are prospectively evaluated in terms of clinical and vascular prognosis. Mean follow-up time was 76 months.We defined active disease using NIH guidelines, and remission and sustained remission were assessed according to criteria defined by Hoffman et al.
The great majority of 184 patients (79%) required other immunosuppressive agents, in addition to glucocorticosteroids to achieve and maintain disease remission. After the treatment, remission was observed in 89% of the patients and 51% of those patients that maintain disease remission had sustained remission at the last visit, whereas 18% were still currently active. In 78 (42%) patients, relapse was observed during follow-up. After initiation of treatment, first remission was achieved at 11.3 months. During follow-up, in 127 patients sustained remission was observed at least once.
In serial angiographic evaluations, angiographic progression was observed in 28 % of the patients. Regression analysis have shown relationship only with complete remission duration (p=0.02, OR=0.9 CI=0.920.99) and progression. Patients showing progression had significantly less sustained remission duration (66 months vs 32 months, p=0.02). Outcome of angiographically followed 77 vascular interventions were evaluated in terms of restenosis and complications. Restenosis was observed in 27 (35%). There was a significant relationship with the disease activity at the time of vascular procedure in terms of restenosis in regression analysis (p=0.04, OR=3.6, CI=113) Restenosis was observed significantly lower in the group with medical treatment started before intervention 8/34 (23%), compared to the non-treated group 19/45 (45%)(p = 0.04). Restenosis was also observed more frequently in active TA patients at the time of procedure compared to inactives(active: 21/45 (80%) vs inactive 6/30 (20%), p= 0.02). During follow-up 10 (5.4%) patients died.
Although glucocorticoids and immunosuppressive treatments are effective in the treatment of TA and complete remission could be achieved in 69% of the patients. Angiographic progression was observed less in patients that have longer periods of sustained remission. This observation suggests that new therapeutic agents in TA treatment. Our results also showed that in terms of restenosis, vascular interventions must be performed at inactive stages and in patients under treatment, except in emergency cases.
To cite this abstract, please use the following information:
Bicakcigil, Muge, Aksu, Kenan, Kamali, Sevil, Akar, Servet, Karadag, Omer, Ozer, Huseyin T., et al; Long-Term Surgical and Medical Outcome in Takayasu Arteritis: Vascular Procedures Performed in Active Patients Have a Poor Outcome [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1973