Takayasu Arteritis Demographic Features, Diagnosis, Clinical Presentation and Angiographic Profile.

INTRODUCTION : Takayasu arteritis is an idiopathic inflammatory disease of the large elastic arteries, seen commonly in young patients and resulting in occlusive or ectatic changes, mainly in the aorta and its major branches1. Pathogenesis of Takayasu arteritis has long been studied, but the cause still remains uncertain. Patients often first notice disease symptoms in the second or third decades of life. Takayasu arteritis can present as pulseless upper extremities and so is commonly referred to as “pulseless disease”. AIM : To study the demographic profile, clinical presentation, diagnostic features, angiographic findings and treatment outcomes of patients with Takayasu arteritis. SPECIFIC OBJECTIVES : 1. To study the demographic profile of Indian patients with Takayasu arteritis. 2. To study the modes of clinical presentation of patients with Takayasu arteritis. 3. Evaluation of the applicability of different diagnostic criteria to Indian patients with Takayasu arteritis. 4. To study the angiographic findings in Takayasu arteritis based on aortography, peripheral and coronary angiography and to asses response to medical therapy and interventions in Takayasu arteritis patients. METHODS : Observational study done in Department of Cardiology, Christian Medical College Vellore, in which we analyzed demographic, clinical, epidemiological, angiographic and treatment data of 125 Takayasu arteritis patients. RESULTS : We studied a total 125 patients with Takayasu arteritis over a period of one and a half years. Their demographic, clinical and angiographic profiles were analysed. The mean age of patients in this study was 32 ± 13 years. The disease showed a predilection for females, with female-to-male ratio of 3.5:1. Type V disease was most common in the present study. A third of the patients had cardinal symptoms and half of the patients had heart related symptoms, of which exertional dyspnoea was most common. About 40% of the patients had neurological symptoms, of which giddiness, blurred vision and syncope were common presentations. Almost 60% of patients were hypertensive, and renal artery stenosis was angiographically seen in 48% of patients. Upper limb ischemia presented as right, left or bilateral upper limb claudication with an equal frequency of 25%, while bilateral lower limb claudication was more common (26%) as compared to isolated right or left lower limb claudication (6% each). 95% of patients met the clinical criteria for diagnosis and 89% of patients had American college of rheumatology score (ACR) ≥ 3. Indian Takayasu Activity Score (ITAS) of ≥3 was found in 95% of patients. Angiography showed 60% involvement of arch vessels, 30% involvement of abdominal aorta and 36% involvement of its major branches. Coronary and pulmonary artery involvement was seen in 14% and 6% respectively. Statistically significant (p= 0.029) higher carotid intima-medial thickness >0.9 mm was found in active disease state. Patients follow up showed good response to both medical and interventional therapy for the disease. Almost half of the patients had active state of disease at the first visit and this decreased to 25% at the last follow-up visit. A third of the patients showed good response and half of the patients showed satisfactory response to medical treatment. About half of the patients had good response to interventional treatment and a third showed satisfactory response to interventional treatment in present study