Clinical characteristics of takayasu arteritis: A retrospective study from a tertiary care hospital in North India

Abstract

Introduction: Takayasu's arteritis (TA) is a granulomatous vasculitis of the large vessels, mainly involving the aorta and its branches. The disease has diverse manifestations across various ethnic populations. The epidemiological profile of TA has not been well established in India, with existing studies demonstrating varied clinical findings. Materials and Methods: In this retrospective, hospital record-based study, 30 TA patients, meeting 1990, American College of Rheumatology criteria for TA, were included. The study intended to characterize the demographic profile, clinical characteristics, laboratory parameters, imaging findings, and management profiles of TA, amongst patients presenting to the rheumatology outpatient department of a tertiary care hospital in India. Results: The mean age at presentation was 26.4 ± 11.4 years. The male to female ratio was 1:5. The mean duration from onset of symptoms to point of diagnosis was 8.7 ±5.7 years. Upper limb claudication was the most frequent symptom seen in 23/30 (76.7%) patients, followed by syncope in 12/30 patients (79%). The most common arteries involved were the subclavian artery, carotid artery and the renal arteries (counted together). Type 1 and Type V were the most common angiographic subtypes, each seen in ten (33.3%) patients. Methotrexate was the most frequently used conventional synthetic disease modifying anti-rheumatic drug (csDMARD) and was used in 27/30 (90%) patients. A total of five (16.7%) patients required biological DMARDs (bDMARD) in view of refractory disease, four patients received tocilizumab while one patient received infliximab. Conclusion: TA is a female predominant, large vessel vasculitis. The subclavian arteries, followed by the common carotid and the renal arteries, are the most common vessels involved. Tocilizumab is fast emerging as an effective bDMARD for disease control especially in csDMARD refractory cases.