Takayasu arteritis: Treament and prognosis in a University Center in Brazil

https://doi.org/10.1016/S0167-5273(00)00197-2Get rights and content

Abstract

The aim of this study was to evaluate the treatment and evolution of TA patients in a University Center in Brazil. This is a retrospective and descriptive study, that included all patients with TAs who attended the out-patient clinic at the Univesidade Federal de Sao Palo, between 1993 and 1998. Twenty-four patients were women and 22 where white. The median age at the time of diagnosis was 27 yo. Full arteriography was performed in 28 patients and carotid duplex ultrasound plus computed tomography of aorta was done in two patients. Type I was found in 4, type II-a and type II in one case each, the type IV in 4 cases and the type V in 20 patients. Regarding the treatment only three patients with quiescent disease did not receive any medications. Twenty-seven patients (90%) received prednisone and only ten of these patients achieved disease control. Forth-eight percent of patients who received prednisone showed some side effects. Twelve patients received methotrexate associated to prednisone and 58% of them had a good response. Two patients who did not control disease activity with prednisone plus methotrexate received cyclophosphamide without good results. Some surgical procedure was performed in ten TA patients. Three patients died during the follow-up. This study showed that the majority of TA patients attended at a University Center needed association of prednisone and methotrexate to control disease activity, 30% needed some surgical procedures and that may be a cause of death in a young patient.

Introduction

Takayasu’s arteritis (TA) is a chronic inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. It mainly affects young women and although more frequently noted in Eastern countries, is a worldwide entity with variable prevalence and disease expression in different regions of the world [1].

There are few studies about treatment and prognosis of TA patients in literature. The objective of this study was to evaluate the treatment and evolution of TA patients followed at a multidisciplinary out-patient clinic in a University Hospital in São Paulo, Brazil.

Section snippets

Patients and methods

This is a retrospective and descriptive study. All patients followed at the multidisciplinary out-patient clinic at a University Hospital in São Paulo (Universidade Federal de São Paulo), from 1993 to 1998 who fulfilled the ACR classification criteria for TA [2] were enrolled.

The charts of all patients were revised to collect demographic, clinical and angiographic data. Special attention was given to drug dosage and use duration as well as to a surgical procedures performed.

Disease activity was

Results

Thirty TA patients under follow up at the out-patient clinic were enrolled in the study from 1993 to 1998. Regarding sex and race distribution, the group was constituted of 24 females (80%) and 6 males, 22 whites (73%) and 8 non-whites. The median of age at diagnosis was 27 years old, ranging from 9 to 56 years old. The interval between the onset of symptoms attributable to TA and the diagnosis ranged from 2 up to 348 months, with a median of 24 months. In four patients diagnosis was delayed

Discussion

This study showed that Brazilian TA were predominantly constituted by young female, similar as referred by the majority of studies in American continent [4], [5].

Systemic features like a fever and weight loss were referred by less than 1/3 of patients at the time of diagnosis. During the follow-up the most frequent clinical features observed were upper and lower limbs claudication, arterial and cardiac bruit and hypertension. Each one was found in more than 30% of patients. These data are also

Conclusion

Our data showed that TA patients who attended at a University Center were predominantly young women. Steroid treatment did not result in a good response in most of the patients, requiring association of immunosuppressive drugs, mainly methotrexate. Even then, prolonged remission was not achieved in almost one third of patients. TA is a chronic disease that may cause death in young patients. These data show the need to evaluate other drugs that could present less side effects and more

Acknowledgements

We acknowledge Professor Neusa Pereira da Silva for the English review.

References (9)

There are more references available in the full text version of this article.

Cited by (49)

  • Imaging in Takayasu arteritis

    2015, Indian Journal of Rheumatology
View all citing articles on Scopus
View full text