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.
Use of Peri-Operative Glucocorticoids and Post-Operative Complications in Patients with Takayasu's Arteritis Undergoing Vascular Surgical Procedures.
Jayakar1, Bijal A., Hoffman3, Gary S., Langford2, Carol A.
The risks and benefits of peri-operative glucocorticoids (POGC) in patients with Takayasu's arteritis (TAK) undergoing vascular surgery have been unclear. We studied the relationship between POGC and disease activity in TAK patients who received vascular surgery to determine if these factors influenced the risk of infection, vascular events, and other complications.
Retrospective chart review of TAK patients undergoing vascular surgery at the Cleveland Clinic from 19792008. Standardized definitions were used for the diagnosis of TAK, disease activity, and POGC. POGC was defined as prednisone use within 1 month prior to or after surgery and analyzed as 0mg, < 20mg, and >=20mg. Variables including POGC, other immunosuppression, disease activity, age at diagnosis, age at surgery, disease duration at surgery and sex were examined by univariate and multivariate analysis using SAS 9.2.
In this study we identified 40 TAK patients who underwent 56 vascular surgical procedures. Mean age at diagnosis was 33.5 years and at surgery was 40 years. Mean duration of disease at surgery was 6.2 years (028.3). Mean time between surgery and last follow-up was 2.1 years (08.7). Active disease was present in 24/56 procedures (43%). Histology was obtained in 42/56 (75%) procedures with 8/42 (19%) being histologically active. Discordance between clinical and histological activity was seen in 17/42 (40%). Erythrocyte sedimentation rate (ESR) was increased in 18/44 (41%) measurements including 12/20 (60%) with active disease and 6/24 (25%) with inactive disease. POGC doses were prednisone=0 in 21/56 (37%), <20mg in 10/56 (18%), >=20mg in 25/56 (45%). 28/56 (56%) were on other immunosuppressives. 42 complications occurred in 30 patients, consisting of 11 infections, 12 vascular events, and 19 other complications. Relapses occurred in 25/56 (45%) with 6 (11%) being within 3 months of surgery. There were 5 deaths, 2 from strokes in the immediate post-operative period. POGC were not associated with a higher frequency of infections (p = 0.84). For inactive TAK, total complications were no lower in those who did not receive POGC (p=0.11). This lack of association remained present for each subgroup: infection (p=0.90), vascular (p=0.22), and other complications (p=0.37). In active TAK, there was no difference in the occurrence of total complications between those on and not on POGC (p=0.67). Although this lack of association was present for other complications (p=0.74), subset analyses were not possible for infection or vascular complications because of absence of an event.
The absence of an increased risk of infection in this study support that POGC can be used in TAK patients felt to have active disease at the time of vascular surgery. These results did not support that POGC should be routinely used in all patients with TAK undergoing surgical procedures as the risk of complications was no different in patients who received this. Performance of surgery is not associated with a high rate of immediate relapse, although relapses are common over time in TAK. ESR and clinical definitions remain imperfect measures of disease activity and underscore the need for better biomarkers in TAK.
To cite this abstract, please use the following information:
Jayakar, Bijal A., Hoffman, Gary S., Langford, Carol A.; Use of Peri-Operative Glucocorticoids and Post-Operative Complications in Patients with Takayasu's Arteritis Undergoing Vascular Surgical Procedures. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1315