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Presentation and clinical course of pediatric-onset versus adult-onset Takayasu arteritis—a systematic review and meta-analysis

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Abstract

Takayasu arteritis (TAK) is a less common large-vessel vasculitis which can occur in either children or adults. However, differences between pediatric-onset and adult-onset TAK have not been systematically analyzed. We undertook a systematic review (pre-registered on PROSPERO, identifier CRD42022300238) to analyze differences in clinical presentation, angiographic involvement, treatments, and outcomes between pediatric-onset and adult-onset TAK. We searched PubMed (MEDLINE and PubMed Central), Scopus, major recent international rheumatology conference abstracts, Cochrane database, and clinicaltrials.gov, and identified seven studies of moderate to high quality comparing pediatric-onset and adult-onset TAK. Meta-analysis of 263 pediatric-onset and 981 adult-onset TAK suggested that constitutional features (fever, and in subgroup analyses, weight loss), hypertension, headache, and sinister features of cardiomyopathy, elevated serum creatinine, and abdominal pain were more frequent in pediatric-onset TAK, whereas pulse loss/pulse deficit and claudication (particularly upper limb claudication) were more frequent in adult-onset TAK. Hata’s type IV TAK was more common in pediatric-onset TAK, and Hata’s type I TAK in adult-onset TAK. Children with TAK also appeared to require more intense immunosuppression with more frequent use of cyclophosphamide, biologic DMARDs, tumor necrosis factor alpha inhibitors, and, in subgroup analyses, tocilizumab in pediatric-onset TAK than in adult-onset TAK. Surgical or endovascular procedures, remission, and risk of mortality were similar in both children and adults with TAK. No studies had compared patient-reported outcome measures between pediatric-onset and adult-onset TAK. Distinct clinical features and angiographic extent prevail between pediatric-onset and adult-onset TAK. Clinical outcomes in these subgroups require further study in multicentric cohorts.

Key Points

• Pediatric-onset TAK more commonly presents with constitutional features, hypertension, cardiomyopathy, elevated serum creatinine, and abdominal pain.

• Adult-onset TAK more commonly presents with pulse loss/pulse deficit or claudication (particularly of the upper limbs).

• Angiographic type IV is more common in children, and type I in adults.

• Remission and mortality are similar in pediatric-onset and adult-onset TAK.

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Data availability

All the analyses performed for this systematic review have been reported in the main text or in the supplementary files. Data pertaining to the systematic review shall be shared on reasonable request to the corresponding author (Durga Prasanna Misra, durgapmisra@gmail.com).

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Acknowledgements

Durga Prasanna Misra acknowledges support from Indian Council of Medical Research (Grant No 5/4/1-2/2019-NCD-II) for his research on Takayasu arteritis.

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Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow-226014, India

    Durga Prasanna Misra, Upendra Rathore & Vikas Agarwal

  2. Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India

    Chirag Rajkumar Kopp & Aman Sharma

  3. School of Telemedicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow-226014, India

    Pallavi Patro

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Contributions

The conception and design of the study—DPM, VA, AS; acquisition of data, analysis and interpretation of data—DPM, UR, CRK, PP, VA, AS; drafting the article—DPM, UR, CRK, PP; revising it critically for important intellectual content—VA, AS; final approval of the version to be submitted—DPM, UR, CRK, PP, VA, AS; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved—DPM, UR, CRK, PP, VA, AS.

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Correspondence to Durga Prasanna Misra.

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Misra, D.P., Rathore, U., Kopp, C.R. et al. Presentation and clinical course of pediatric-onset versus adult-onset Takayasu arteritis—a systematic review and meta-analysis. Clin Rheumatol 41, 3601–3613 (2022). https://doi.org/10.1007/s10067-022-06318-5

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