Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Disease Assessment in Takayasu's Arteritis: Data from a Literature Search and a Survey of Expert Opinion.
Direskeneli3, Haner, Aydin3, Sibel Z., Merkel2, Peter A., Group1, Turkish Takayasu Study
To study approaches to disease assessment in Takayasu's arteritis (TAK) by summarizing published clinical studies and surveying current expert opinion in Turkey.
A literature search was conducted in "PubMed" with key-words "Takayasu's arteritis", "assessment", "activity", "remission", and "relapse" for studies published in English between 19942010 (case reports and reviews excluded). Informed by the literature review, Turkish rheumatologists (n=34, 20 specialists/academicians and 14 rheumatology fellows) and two foreign experts completed a questionnaire on disease assessment in TAK.
Of the 4004 articles with the key-word "Takayasu's arteritis", items associated with disease assessment and activity were present in 62 studies. Among these, 45% (n=28) focused on clinical issues (case series, treatment, outcome), 32% (n=20) on biomarkers/pathogenesis, and 22% (n=14) on vascular imaging. An NIH study (Kerr et al, 1994) was most commonly cited for a definition of active disease (48%, n=30). Acute-phase response (ESR/CRP) was part of an "active" disease definition in 84% (n=52), constitutional features in 73% (n=45), clinical features of vascular ischemia in 53% (n=33), and angiographic involvement in 58% (n=36). A composite index of activity was used in three studies (BVAS=2, ITAS=1) and a patient-derived outcome tool (SF-36) in two studies.
After a presentation of the results of the literature search, experts were asked to define a "gold-standard" of disease activity in TAK. New vessel/organ involvement determined clinically or by imaging was chosen by 84%, physician global assessment by 13%; no expert named patient global assessment. The most commonly chosen items for a disease-assessment tool were new bruits or arterial imaging changes (both 100%), new extremity claudication (97%), acute-phase reactants (97%), arterial tenderness (94%), fever (88%), and constitutional symptoms (84%). Although experts felt that a dichotomous assessment (active vs. inactive) was not suitable (63%), they also agreed that damage vs. activity (83%) and grumbling vs. highly active disease (80%) cannot be reliably differentiated in TAK. Some organ manifestations present in BVAS and DEI.Tak (a recently-developed TAK-specific tool) were found suitable for TAK (cardiovascular-100%, CNS-93%, renal-87%, abdominal-83%, ocular-83%, musculoskeletal-72%) whereas others were felt to have a limited value (respiratory-50%, cutaneous-47%, ENT-24%, genitourinary-19%). The majority of experts (62%) agreed that an outcome measure could be developed for large-vessel vasculitis for use in research of giant-cell arteritis and TAK that incorporated manifestations of both diseases.
Outcome measures used in research for TAK vary considerably in content and do not consistently include clinical manifestations that experts give a high value to regarding disease assessment, including vascular imaging and biomarkers. These data are helpful in guiding the process of creating an internationally-accepted core set of outcome measures in large vessel vasculitis.
To cite this abstract, please use the following information:
Direskeneli, Haner, Aydin, Sibel Z., Merkel, Peter A., Group, Turkish Takayasu Study; Disease Assessment in Takayasu's Arteritis: Data from a Literature Search and a Survey of Expert Opinion. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1291