Takayasu’s Arteritis: Is Age a Differential Factor in the Diagnosis, Follow-Up, and Treatment of the Disease?Takayasu Arteritis; Glucocorticoids; Diagnosis
Arterite de Takayasu; Glucocorticoides; Diagnóstico
Takayasu Arteritis; Glucocorticoids; Diagnosis
Arterite de Takayasu; Glucocorticoides; Diagnóstico
Takayasu’s arteritis (TAK) is a large-vessel inflammatory vasculitis, mainly affecting the aorta, its main divisional branches, and pulmonary arteries, being classically presenting in females aged 20 to 40 years.1 - 3 TAK often presents with nonspecific symptoms such as fever, fatigue, abdominal pain, and weight-loss.1 , 3
TAK is a difficult condition to deal with. Early identification of this disease is difficult and necessitates clinical suspicion and vigilance. Radiologic methods can identify diseased vessels but fail to distinguish between active and chronic lesions.4Systemic vasculitis can lead to irreversible scars in affected organs, which may be caused by disease activity and/or therapeutic approaches such as corticosteroids and other immunosuppressives.5Glucocorticoids remain the most effective and serve as a cornerstone first-line treatment.6
Since TAK is a typical condition of young adults, there are few studies in populations outside this age range. Few studies suggest that the life stages of the TAK course can vary with age.7 , 8 The authors of the article “Characteristics of Older Patients with Takayasu’s Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study”9related that despite the TAK’s course seeming to vary with age, no studies to date have comparatively evaluated adult individuals with TAK at an older age, raising the question of the implications and possible differences in the approach to this population.
The article9is the first report that older patients with TAK require minimal drug treatment for underlying TAK disease and have greater impairment of functional status. Considering that studies have demonstrated that the juvenile population had lower remission rates than adult patients,8these data suggest that age is an important factor to consider in the diagnosis, follow-up, and treatment of TAK patients.
According to the article,9fewer older patients used prednisone and immunosuppressive or immunobiological drugs. Systemic glucocorticoids are the first-line treatment for TAK, usually started at high doses and followed by a tapering regimen.10 , 11 However, glucocorticoid therapy is frequently associated with irreversible scars in affected organs,5and their chronic treatment is associated with severe adverse effects, such as diabetes, hypertension, early cardiovascular disease, infections, and osteoporosis.12
The article9data point out that the elderly population may not benefit from glucocorticoid therapy, which would be beneficial since the elderly commonly have comorbidities that can be aggravated by chronic therapy with glucocorticoids.
Even though the elderly population requires minimal drug treatment, the article9demonstrated that older patients have greater impairment of functional status. However, the study does not allow us to conclude if the functional impact was caused by an increase in the chronicity of the disease or is correlated with advanced age and a higher prevalence of comorbidities.
The study,9 ,for the first time, highlighted that elderly TAK patients require different approaches since age-related factors and the high incidence of comorbidities can lead to confusion in diagnosing and assessing TAK’s activity. In addition, the study reinforces the findings in the literature that the life stages of the TAK course vary with age and propose that age is an important factor to be considered in the approach to TAK patients.
References
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2 Ziadi J, Ben Hammamia M, Sobhi M, Ben Mrad M, Denguir R. Revascularization Of Supra-Aortic Trunks in Takayasu’s Arteritis. J Med Vasc. 2019;44(4):260-5. French. doi: 10.1016/j.jdmv.2019.04.002.
» https://doi.org/10.1016/j.jdmv.2019.04.002 -
3 Holton-Burke R, Laurenzano S, Phillips S, Stover LB, Radhakrishna S, Khare M. Takayasu’s Arteritis in a Patient with Preexisting Autoimmune Disease. Clin Pediatr (Phila). 2021;60(4-5):210-3. doi: 10.1177/0009922821999471.
» https://doi.org/10.1177/0009922821999471 -
4 Alnabwani D, Patel P, Kata P, Patel V, Okere A, Cheriyath P. The Epidemiology and Clinical Manifestations of Takayasu Arteritis: A Descriptive Study of Case Reports. Cureus. 2021;13(9):e17998. doi: 10.7759/cureus.17998.
» https://doi.org/10.7759/cureus.17998 -
5 Exley AR, Bacon PA, Luqmani RA, Kitas GD, Gordon C, Savage CO, et al. Development and Initial Validation of the Vasculitis Damage Index for the Standardized Clinical Assessment of Damage in the Systemic Vasculitides. Arthritis Rheum. 1997;40(2):371-80. doi: 10.1002/art.1780400222.
» https://doi.org/10.1002/art.1780400222 -
6 Podgorska D, Podgorski R, Aebisher D, Dabrowski P. Takayasu Arteritis - Epidemiology, Pathogenesis, Diagnosis and Treatment. J Appl Biomed. 2019;17(1):20. doi: 10.32725/jab.2018.005.
» https://doi.org/10.32725/jab.2018.005 -
7 Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu Arteritis. Ann Intern Med. 1994;120(11):919-29. doi: 10.7326/0003-4819-120-11-199406010-00004.
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8 Jales-Neto LH, Levy-Neto M, Bonfa E, Carvalho JF, Pereira RM. Juvenile-Onset Takayasu Arteritis: Peculiar Vascular Involvement and More Refractory Disease. Scand J Rheumatol. 2010;39(6):506-10. doi: 10.3109/03009741003742730.
» https://doi.org/10.3109/03009741003742730 - 9 Oliveira JCS, Santos AM, Aguiar MF, Gonçalves Junior J, Souza AWS, Pereira, RMR, et al. Characteristics of Older Patients with Takayasu’s Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study. Arq Bras Cardiol. 2023; 120(1):e20220463.
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10 Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, Groot K, Gross W, et al. EULAR Recommendations for the Management of Large Vessel Vasculitis. Ann Rheum Dis. 2009;68(3):318-23. doi: 10.1136/ard.2008.088351.
» https://doi.org/10.1136/ard.2008.088351 -
11 JCS Joint Working Group. Guideline for Management of Vasculitis Syndrome (JCS 2008). Japanese Circulation Society. Circ J. 2011;75(2):474-503. doi: 10.1253/circj.cj-88-0007.
» https://doi.org/10.1253/circj.cj-88-0007 -
12 Regola F, Uzzo M, Toniati P, Trezzi B, Sinico RA, Franceschini F. Novel Therapies in Takayasu Arteritis. Front Med. 2022;8:814075. doi: 10.3389/fmed.2021.814075.
» https://doi.org/10.3389/fmed.2021.814075
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Short Editorial related to the article: Characteristics of Older Patients with Takayasu’s Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study
