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The fine line between Takayasu arteritis and giant cell arteritis

Clinical Rheumatology volume 34, pages 721–727 (2015)Cite this article

Abstract

The objective of this study is to describe a series of patients above the age of 50 years with large vessel arteritis and vascular involvement typical of TAK. A retrospective review of 18 patients (median age 64 years) with emphasis on clinical characteristics, laboratory values, and vascular involvement by CT, MRI, or planar angiography. Five patients fulfilled the ACR criteria for GCA, five for TAK, three both GCA and TAK, while five patients did not fulfill the criteria for either disease. The dominant presenting symptoms were constitutional, while only a few patients had cranial or peripheral symptoms. Sixty-one percent had physical signs of vascular compromise. Temporal artery biopsy showed giant cell arteritis in six out of nine biopsies. Arterial involvement: 78 % had either involvement of the ascending aorta, the aortic arch, descending or/and abdominal aorta, 9 carotid, 12 subclavian, 5 axillary, 3 renal, 7 iliac, and 2 femoral arteries; 7 mesenteric or celiac trunk. All the patients were treated with prednisone and 50 % with steroid-sparing drug. Nine out of 15 patients (60 %) achieved remission after 1 year of follow-up. No substantial differences in the distribution of vascular involvement, type of treatment, or outcome measures were observed between patients fulfilling criteria for GCA or TAK. Vascular involvement typical of TAK in patients above the age of 50 years with large vessel arteritis seems to be more frequent than previously assumed. Our findings support the assumption that TAK and GCA represent a spectrum of the same disease.

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Acknowledgment

In the memory of Dr. Pauzner Rachel who was a dedicated and enthusiastic internist and rheumatologist, extremely devoted to her patients, especially interested in the field of Takayasu arteritis and antiphospholipid syndrome and who made a significant contribution to this article. Esther Eshkol is thanked for editorial assistance. This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This research received no specific funding.

Conflict of interest

The authors declare that they do not have any competing interests.

Author’s contribution

Ari Polachek recruited participants, collected and interpreted the data, and wrote and approved the final report. Rachel Pauzner, David Levartovsky, Galia Rosen, Gideon Nesher, Gabriel Breuer, Marina Anouk, Uri Arad, Hagit Sarvagyl-Maman, Ilana Kaufman, and Dan Caspi recruited patients and approved the final report. Ori Elkayam designed the study, recruited patients, interpreted the data, and wrote and approved the final report.

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Affiliations

  1. Department of Rheumatology, Tel Aviv Sourasky Medical Center, 6 Weizman st, Tel Aviv, 64239, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel

    Ari Polachek, David Levartovsky, Marina Anouk, Uri Arad, Hagit Sarvagyl-Maman, Ilana Kaufman, Dan Caspi & Ori Elkayam

  2. Department of Internal Medicine, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Rachel Pauzner

  3. Department of Radiology, Tel-Aviv Medical Center, Tel-Aviv, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Galia Rosen

  4. Unit of rheumatology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel

    Gideon Nesher & Gabriel Breuer

Authors
  1. Ari Polachek
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  2. Rachel Pauzner
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  3. David Levartovsky
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  5. Gideon Nesher
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  7. Marina Anouk
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  8. Uri Arad
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  9. Hagit Sarvagyl-Maman
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  10. Ilana Kaufman
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  11. Dan Caspi
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  12. Ori Elkayam
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Correspondence to Ari Polachek.

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Polachek, A., Pauzner, R., Levartovsky, D. et al. The fine line between Takayasu arteritis and giant cell arteritis. Clin Rheumatol 34, 721–727 (2015). https://doi.org/10.1007/s10067-014-2813-x

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  • DOI: https://doi.org/10.1007/s10067-014-2813-x

Keywords

  • Giant cell arteritis
  • Takayasu
  • Vasculitis