Long-Term Outcomes and Prognostic Factors of Complications in Takayasu Arteritis

• DOI: 10.1161/circulationaha.116.027094
• Publication Date: 2017-07-13T00:40:32Z
• Authors: Cloé Comarmond; Lucie Biard; Marc Lambert; Arsène Mekinian; Yasmina Ferfar; Jean-Emmanuel Kahn; Ygal Benhamou; Laurent Chiche; Fabien Koskas; Philippe Cluzel; Eric Hachulla; Emmanuel Messas; Matthieu Resche-R...; Patrice Cacoub; Tristan Mirault; David Saadoun
• Keywords: Adult; Male; Adolescent; Aorta, Thoracic; Kaplan-Meier Estimate; Middle Aged; Prognosis; Takayasu Arteritis; Disease-Free Survival; 3. Good health; Young Adult; 03 medical and health sciences; C-Reactive Protein; 0302 clinical medicine; Cardiovascular Diseases; Risk Factors; Disease Progression; Humans; Female; Child; Aged; Proportional Hazards Models; Retrospective Studies

Background: Because of the wide variation in the course of Takayasu arteritis (TA), predicting outcome is challenging. We assess long-term outcome and prognosis factors for vascular complications in patients with TA.

Methods: A retrospective multicenter study of characteristics and outcomes of 318 patients with TA fulfilling American College of Rheumatology and Ishikawa criteria was analyzed. Factors associated with event-free survival, relapse-free survival, and incidences of vascular complications were assessed. Risk factors for vascular complications were identified in a multivariable model.

Results:

The median age at TA diagnosis was 36 [25–47] years, and 276 patients (86.8%) were women. After a median follow-up of 6.1 years, relapses were observed in 43%, vascular complications in 38%, and death in 5%. Progressive clinical course was observed in 45%, carotidodynia in 10%, and retinopathy in 4%. The 5- and 10-year event-free survival, relapse-free survival, and complication-free survival were 48.2% (42.2; 54.9) and 36.4% (30.3; 43.9), 58.6% (52.7; 65.1) and 47.7% (41.2; 55.1), and 69.9% (64.3; 76.0) and 53.7% (46.8; 61.7), respectively. Progressive disease course ( P =0.018) and carotidynia ( P =0.036) were independently associated with event-free survival. Male sex ( P =0.048), elevated C-reactive protein ( P =0.013), and carotidynia ( P =0.003) were associated with relapse-free survival. Progressive disease course ( P =0.017), thoracic aorta involvement ( P =0.009), and retinopathy ( P =0.002) were associated with complication-free survival.

Conclusions: This nationwide study shows that 50% of patients with TA will relapse and experience a vascular complication ≤10 years from diagnosis. We identified specific characteristics that identified those at highest risk for subsequent vascular complications.