Skip to main content

Advertisement

SpringerLink
Log in

Clinical presentation, treatment and outcome of Takayasu’s arteritis in southern Chinese: a multicenter retrospective study

  • Cohort Studies
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

To study the clinical presentation, treatment and outcome of southern Chinese patients with Takayasu’s arteritis (TA). This is a retrospective chart review study of 78 patients managed in 14 public hospitals in Hong Kong between the years 2000 and 2010. Patients were identified from the hospital registry using the ICD-10 diagnostic code of the disease. The classification of TA was based on the American College of Rheumatology (ACR) or modified Ichikawa’s criteria. Demographic data, clinical presentation, angiographic findings, pattern of vascular involvement (Numano’s classification), treatment and outcome of these patients were presented. 78 patients were studied (82% women, age at presentation 34.2 ± 14 years). The estimated point prevalence of TA was 11/million population. The commonest initial manifestations were hypertension (62%) and vascular ischemic symptoms (38%). Systemic symptoms occurred in nine (12%) patients only. The proportion of patients fulfilling the angiographic subtypes of the Numano’s classification was: types I (13%), IIa (4%), IIb (12%), III (12%), IV (20%) and V (39%), respectively. Thirty-two patients (41%) were treated with high-dose glucocorticoids (GCs) and 22 patients (28%) received additional non-GC immunosuppressive drugs. Vascular complications occurred in 26 (33%) patients and revascularization surgery was performed in 23(29%) patients. Three (4%) patients died of vascular complication at a median of 8 years after disease onset. TA is rare in southern Chinese patients of Hong Kong. Most patients present with ischemic symptoms during the stenotic phase of the disease. Although mortality is low, a significant proportion of patients developed vascular stenosis that required surgical interventions. More awareness of TA as a differential diagnosis of non-specific systemic symptoms with elevated inflammatory markers in younger patients is needed for earlier diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johannes WJ, Bijlsma (2009) EULAR compendium on rheumatic diseases. Skin and autoimmune rheumatic diseases. BMJ Publishing Group, London, pp 420–443

    Google Scholar 

  2. Serra R, Butrico L, Fugetto F, Chibireva MD, Malva A, De Caridi G et al (2016) Updates in Pathophysiology, diagnosis and management of Takayasu arteritis. Ann Vasc Surg 35:210–225

    Article  Google Scholar 

  3. Mishima Y (2001) Leriche memorial lecture at 24th World Congress: Takayasu’s arteritis in Asia. Cardiovasc Surg 9:3–10

    Article  CAS  Google Scholar 

  4. Ohigashi H, Haraguchi G, Konishi M, Tezuka D, Kamiishi T, Ishihara T et al (2012) Improved Prognosis of Takayasu arteritis over the past decade—comprehensive analysis of 106 patients. Circ J 76:1004–1011

    Article  Google Scholar 

  5. Cong XL, Dai SM, Feng X, Wang ZW, Lu QS, Yuan LX et al (2010) Takayasu’s arteritis: clinical features and outcomes of 125 patients in China. Clin Rheumatol 29:973–981

    Article  Google Scholar 

  6. Li J, Li H, Sun F, Chen Z, Yang Y, Zhao J et al (2017) Clinical characteristics of heart involvement in chinese patients with Takayasu arteritis. J Rheumatol 44:1867–1874

    Article  Google Scholar 

  7. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM et al (1990) The American College of rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129–1134

    Article  CAS  Google Scholar 

  8. ISHIKAWA K (1988) Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu’s arteriopathy. J Am Coll Cardiol 12:964–972

    Article  Google Scholar 

  9. Hata A, Noda M, Moriwaki R, Numano F (1996) Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 54:S155–S163

    Article  Google Scholar 

  10. Onen F, Akkoc N (2017) Epidemiology of Takayasu arteritis. Press Med 46:e197–e203

    Article  Google Scholar 

  11. Watts R, Al-Taiar A, Mooney J, Scott D, Macgregor A (2009) The epidemiology of Takayasu arteritis in the UK. Rheumatology 48:1008–1011

    Article  Google Scholar 

  12. Goel R, Danda D, Joseph G, Ravindran R, Kumar S, Jayaseelan V et al (2018) Long-term outcome of 251 patients with Takayasu arteritis on combination immunosuppressant therapy: single centre experience from a large tertiary care teaching hospital in Southern India. Semin Arthritis Rheum 47:718–726

    Article  CAS  Google Scholar 

  13. Park MC, Lee SW, Park YB, Chung NS, Lee SK (2005) Clinical characteristics and outcomes of Takayasu’s arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scand J Rheumatol 34:284–292

    Article  Google Scholar 

  14. Khor CG, Tan BE, Kan SL, Tsang EE, Lim AL, Chong EY et al (2016) Takayasu arteritis in major rheumatology centres in Malaysia. J Clin Rheumatol 22:194–197

    Article  Google Scholar 

  15. Moriwaki R, Noda M, Yajima M, Sharma BK, Numano F (1997) Clinical manifestations of Takayasu arteritis in India and Japan-new classification of angiographic findings. Angiology 48:369–379

    Article  CAS  Google Scholar 

  16. Park SJ, Kim HJ, Park H, Hann HJ, Kim KH, Han S et al (2017) Incidence, prevalence, mortality and causes of death in Takayasu arteritis in Korea—a nationwide, population-based study. Int J Cardiol 235:100–104

    Article  Google Scholar 

  17. Watanabe Y, Miyata T, Tanemoto K (2015) Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity. Circulation 132:1701–1709

    Article  Google Scholar 

  18. Lim AY, Lee GY, Jang SY, Gwag HB, Choi SH, Jeon ES et al (2015) Gender differences in clinical and angiographic findings of patients with Takayasu arteritis. Clin Exp Rheumatol 33:S132–S137

    Google Scholar 

  19. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M et al (1994) Takayasu arteritis. Ann Intern Med 120:919–929

    Article  CAS  Google Scholar 

  20. Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Costedoat Chalumeau N et al (2010) Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore) 89:1–17

    Article  Google Scholar 

  21. Dejaco C, Ramiro S, Duftner C, Besson FL, Bley TA, Blockmans D et al (2018)) EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 77:636–643

    Article  Google Scholar 

  22. Kato Y, Terashima M, Ohigashi H, Tezuka D, Ashikaga T, Hirao K et al (2015) Vessel wall inflammation of Takayasu arteritis detected by contrast-enhanced magnetic resonance imaging: association with disease distribution and activity. PLoS One 10(12):e0145855

    Article  Google Scholar 

  23. Grayson PC, Alehashemi S, Bagheri AA, Civelek AC, Cupps TR, Kaplan MJ et al (2018) 18 F-Fluorodeoxyglucose-positron emission tomography as an imaging biomarker in a prospective, longitudinal cohort of patients with large vessel vasculitis. Arthritis Rheumatol 70:439–449

    Article  Google Scholar 

  24. Nakagomi D, Cousins C, Sznajd J, Furuta S, Mohammad AJ, Luqmani R et al (2017) Development of a score for assessment of radiologic damage in large-vessel vasculitis (Combined Arteritis Damage Score, CARDS). Clin Exp Rheumatol 35:139–145

    PubMed  Google Scholar 

  25. Jiang L, Li D, Yan F, Dai X, Li Y, Ma L (2012) Evaluation of Takayasu arteritis activity by delayed contrast-enhanced magnetic resonance imaging. Int J Cardiol 155:262–267

    Article  Google Scholar 

  26. Misra R, Danda D, Rajappa SM, Ghosh A, Gupta R, Mahendranath KM et al (2013) Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology (Oxford) 52:1795–801

    Article  Google Scholar 

  27. Aydin SZ, Yilmaz N, Akar S, Aksu K, Kamali S, Yucel E et al (2010) Assessment of disease activity and progression in Takayasu’s arteritis with disease extent index-Takayasu. Rheumatology 49:1889–1893

    Article  Google Scholar 

  28. Direskeneli H (2017) Clinical assessment in Takayasu’s arteritis: major challenges and controversies. Clin Exp Rheumatol 35:189–193

    PubMed  Google Scholar 

  29. Suwanwela N, Piyachon C (1996) Takayasu arteritis in Thailand: clinical and imaging features. Int J Cardiol 54:S117–S134

    Article  Google Scholar 

  30. Jain S, Kumari S, Ganguly NK, Sharma BK (1996) Current status of Takayasu arteritis in India. Int J Cardiol 54:S111–S116

    Article  Google Scholar 

  31. Li J, Zhu M, Li M, Zheng W, Zhao J, Tian X et al (2016) Cause of death in Chinese Takayasu arteritis patients. Medicine (Baltimore) 95:e 4069

    Article  Google Scholar 

  32. Nakaoka Y, Isobe M, Takei S, Tanaka Y, Ishii T, Yokota S et al (2018) Efficacy and safety of tocilizumab in patients with refractory Takayasu arteritis: results from a randomised, double-blind, placebo-controlled, phase 3 trial in Japan (the TAKT study). Ann Rhem Dis 77:348–354

    Article  CAS  Google Scholar 

  33. Samson M, Espígol-Frigolé G, Terrades-García N, Prieto-González S, Corbera-Bellalta M, Alba-Rovira R et al (2018) Biological treatments in giant cell arteritis and Takayasu arteritis. Eur J Intern Med 50:12–19

    Article  Google Scholar 

  34. Novikov PI, Smitienko IO, Sokolova MV, Alibaz-Oner F, Kaymaz-Tahra S, Direskeneli H et al (2018) Certolizumab pegol in the treatment of Takayasu arteritis. Rheumatology (Oxford) (Epub ahead of print)

Download references

Funding

Funding of this project and writing assistance: Nil.

Author information

Authors and Affiliations

  1. Department of Medicine, Tseung Kwan O Hospital, 2, Po Ning Lane, Hang Hau, Kowloon, Hong Kong SAR, China

    Stella Pui Yan Wong & Stella Pui Yan Wong

  2. Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China

    Chi Chiu Mok, Ka Lung Yu, Chi Chiu Mok & Ka Lung Yu

  3. Department of Medicine, The University of Hong Kong, Hong Kong SAR, China

    Chak Sing Lau & Chak Sing Lau

  4. Tung Wah Groups of Hospital Integrated Diagnostic and Medical Centre, Kowloon, Hong Kong SAR, China

    Man Lung Yip & Man Lung Yip

  5. Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China

    Lai Shan Tam, Priscilla Ching Han Wong, Lai Shan Tam & Priscilla Ching Han Wong

  6. Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China

    King Yee Ying & King Yee Ying

  7. Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China

    Woon Leung Ng & Woon Leung Ng

  8. Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China

    Kam Hung Ng & Kam Hung Ng

  9. Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China

    Moon Ho Leung, Tsz Yan Lee, Moon Ho Leung & Tsz Yan Lee

  10. Department of Medicine, Pok Oi Hospital, Hong Kong SAR, China

    Chi Hung To & Chi Hung To

  11. Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China

    Ka Lai Lee & Ka Lai Lee

  12. Department of Medicine, Ruttonjee Hospital, Hong Kong SAR, China

    Man Choi Wan & Man Choi Wan

  13. Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China

    Chi Keung Sung, Emily Wai Lin Kun, Chi Keung Sung & Emily Wai Lin Kun

  14. Department of Medicine, Yan Chai Hospital, Hong Kong SAR, China

    Kwok Fai Lee & Kwok Fai Lee

Authors
  1. Stella Pui Yan Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chi Chiu Mok
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chak Sing Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Man Lung Yip
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lai Shan Tam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. King Yee Ying
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Woon Leung Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kam Hung Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Moon Ho Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tsz Yan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chi Hung To
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ka Lai Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Man Choi Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ka Lung Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Priscilla Ching Han Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Chi Keung Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Kwok Fai Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Emily Wai Lin Kun
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the Hong Kong Takayasu’s arteritis study group

  • Stella Pui Yan Wong
  • , Chi Chiu Mok
  • , Chak Sing Lau
  • , Man Lung Yip
  • , Lai Shan Tam
  • , King Yee Ying
  • , Woon Leung Ng
  • , Kam Hung Ng
  • , Moon Ho Leung
  • , Tsz Yan Lee
  • , Chi Hung To
  • , Ka Lai Lee
  • , Man Choi Wan
  • , Ka Lung Yu
  • , Priscilla Ching Han Wong
  • , Chi Keung Sung
  • , Kwok Fai Lee
  •  & Emily Wai Lin Kun

Contributions

Study design: Dr. MCC, Dr. KWL. Data collection and interpretation: Dr. WPYS, Dr. MCC, Dr. LCS, Dr. YML, Dr. LST, Dr. YKY, Dr. NWL, Dr. NKH, Dr. LMH, Dr. LTY, Dr. TCH, Dr. LKL, Dr. WMC, Dr. YKL, Dr. WCHP, Dr. SCK, Dr. LKF, Dr. KWL. Statistical analyses of data: Dr. WPYS, Dr. MCC.

Corresponding author

Correspondence to Stella Pui Yan Wong.

Ethics declarations

Ethical approval

New Territories West Cluster Research and Ethics Committee, Hospital Authority, Hong Kong (date of approval: 29-8-2011; NTWC/CREC/967/11). All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

All authors did not have any conflict of interests to be declared.

Additional information

All authors are the members of Takayasu's arteritis study group.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, S.P.Y., Mok, C.C., Lau, C.S. et al. Clinical presentation, treatment and outcome of Takayasu’s arteritis in southern Chinese: a multicenter retrospective study. Rheumatol Int 38, 2263–2270 (2018). https://doi.org/10.1007/s00296-018-4150-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-018-4150-x

Keywords

Search

Navigation