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Takayasu arteritis in paediatrics

Published online by Cambridge University Press:  13 December 2017

Marisa Di Santo ,
Erica V. Stelmaszewski  and
Alejandra Villa
Marisa Di Santo*
Affiliation:
Department of Cardiology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
Erica V. Stelmaszewski
Affiliation:
Department of Cardiology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
Alejandra Villa
Affiliation:
Department of Cardiology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
*
Correspondence to: M. D. Santo, Department of Cardiology, Hospital de Pediatría J.P. Garrahan, Agüero 1865 8°A Capital Federal, código postal 1425, Buenos Aires, Argentina. Tel: 54 011 155 476 3884; Fax: +541149410667; E-mail: [email protected]
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Abstract

Takayasu arteritis is an idiopathic chronic granulomatous panarteritis predominantly affecting the aorta and its main branches. Although idiopathic, genetic contribution to disease susceptibility is being increasingly recognised. Rare in children, Takayasu arteritis is a worldwide disease with significant morbidity and mortality. Its diagnosis is a challenge and requires awareness of the condition as clinical features at presentation are non-specific and assessing disease activity is difficult. In the inflammatory stage, treatment is essential to prevent the insidious course and vascular damage: stenotic, occlusive lesions, aneurysms, and aortic regurgitation. New imaging modalities, such as CT scan, MRI, and 18F-fluorodeoxyglucose positron emission tomography, have expanded the possibilities for non-invasive diagnosis and monitoring; however, digital subtraction arteriography remains the gold standard for the diagnosis of Takayasu arteritis. Steroids are the first-line medical treatment. The combined use of methotrexate, cyclophosphamide, azathioprine, mycophenolate mofetil, and biological agents is common. Revascularisation therapy should be considered in uncontrolled hypertension secondary to renal artery stenosis, symptomatic coronary ischaemia, cerebrovascular disease, severe aortic regurgitation, limb ischaemia, and aneurysms at risk of rupture, using surgical or endovascular procedures and taking into consideration that complications, especially restenosis, are frequent. Disease activity increases the likelihood of complications after revascularisation. Surgical intervention has shown better long-term outcomes, although the endovascular approach is evolving. The aim of this review was to describe key points of the diagnosis, treatment, and follow-up of Takayasu arteritis in childhood.

Keywords

Takayasu arteritisangioplastyangiographyischaemiavasculitischildhood
Type
Review Article
Information
Cardiology in the Young , Volume 28 , Issue 3 , March 2018 , pp. 354 - 361
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Copyright
© Cambridge University Press 2017 

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References

1. Kerr, GS, Hallahan, CW, Giordano, J, et al. Takayasu arteritis. Ann Intern Med 1994; 120: 919–929.Google Scholar
2. Brunner, J, Feldman, BM, Tyrrell, PN, et al. Takayasu arteritis in children and adolescents. Rheumatology 2010; 49: 1806–1814.Google Scholar
3. Morales, E, Pineda, C, Martinez-Lavin, M. Takayasu’s arteritis in children. J Rheumatol 1991; 18: 1081–1084.Google ScholarPubMed
4. Watson, L, Brogan, P, Peart, I, et al. Diagnosis and assessment of disease activity in Takayasu arteritis: a childhood case illustrating the challenge. Case Rep Rheumatol 2014; 2014: 603171.Google Scholar
5. Fries, JF, Hunder, GG, Bloch, DA, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Summary. Arthritis Rheum 1990; 33: 1135–113680.Google Scholar
6. Jain, S, Sharma, N, Singh, S, et al. Takayasu arteritis in children and young Indians. Int J Cardiol 2000; 75 (Suppl 1): S153–S157.Google Scholar
7. Tann, OR, Tulloh, RMR, Hamilton, MCK. Takayasu’s disease: a review. Cardiol Young 2008; 18: 250–259.Google Scholar
8. Numano, F. Vasa vasoritis, vascu1itis and atherosclerosis. Int J Cardiol 2000; 75: S1–S8.CrossRefGoogle ScholarPubMed
9. Jeeva, l, Sajid, J, Ali, O, et al. Atypical Takayasu arteritis: a family with five affected siblings. Med Sci Monit 2007; 13: CS101–CS105.Google ScholarPubMed
10. Saruhan-Direskeneli, G, Hughes, T, Aksu, K. Identification of multiple genetic susceptibility loci in Takayasu arteritis. Am J Hum Genet 2013; 93: 298–305.CrossRefGoogle ScholarPubMed
11. Ishikawa, K. Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu’s arteriopathy. J Am Coll Cardiol 1988; 12: 964–972.Google Scholar
12. Sharma, B, Jain, S, Suri, S. Diagnostic criteria for Takayasu arteritis. Int J Cardiol 1996; 54 (Suppl 2): S141–S147.Google Scholar
13. Ozen, S, Ruperto, N, Dillon, MJ, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 2006; 65: 936–941.Google Scholar
14. Ozen, S, Pistorio, A, Iusan, SM, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis 2010; 69: 798–806.Google Scholar
15 Hata, A, Noda, M, Moriwaki, R, Numano, F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 1996; 54 (Suppl): S155–S163.CrossRefGoogle ScholarPubMed
16. Mathew, AJ, Goel, R, Kumar, S, et al. Childhood-onset Takayasu arteritis: an update. Int J Rheum Dis 2016; 19: 116–126.Google Scholar
17. Eleftheriou, D, Batu, ED, Ozen, S, et al. Vasculitis in children. Nephrol Dial Transplant 2015; 30: i94–i103.Google Scholar
18. Moriwaki, R, Numano, F. Takayasu arteritis: follow-up studies for 20 years. Heart Vessels 1992; 7 (Suppl): 138–145.Google Scholar
19. Dagna, L, Salvo, F, Tiraboschi, M, et al. Pentraxin-3 as a marker of disease activity in takayasu arteritis. Ann Intern Med 2011; 155: 425–433.CrossRefGoogle ScholarPubMed
20. Ciéslik, P, Hrycek, A. Long pentraxin 3 (PTX3) in the light of its structure, mechanism of action and clinical implications. Autoimmunity 2012; 45: 119–128.CrossRefGoogle ScholarPubMed
21. Uppal, S, Verma, S. Analysis of the clinical profile, autoimmune phenomena and T cell subsets (CD4 and CD8) in Takayasu’s arteritis: a hospital-based study. ClinExp Rheumatol 2003; 21 (Suppl 32): S112–S116.Google Scholar
22. Perera, AH, Mason, JC, Wolfe, JH. Takayasu arteritis: criteria for surgical intervention should not be ignored. Int J Vasc Med 2013; 2013: 618910.Google Scholar
23. Eleftheriou, D, Varnier, G, Dolezalova, P, et al. Takayasu arteritis in childhood: retrospective experience from a tertiary referral centre in the United Kingdom. Arthritis Res Ther 2015; 17: 36.Google Scholar
24. Mavrogeni, S, Dimitroulas, T, Chatziioannou, SN, Kitas, G. The role of multimodality imaging in the evaluation of Takayasu arteritis. Semin Arthritis Rheum 2013; 42: 401–412.Google Scholar
25. Mavrogeni, S, Manoussakis, MN. Myocarditis and subclavian stenosis in Takayasu arteritis. Int J Cardiol 2011; 148: 223–224. https://www.doi.org/10.1016/j.ijcard.2009.05.008.CrossRefGoogle ScholarPubMed
26. Mavrogeni, S, Servos, G, Smerla, R, et al. Cardiovascular involvement in pediatric systemic autoimmune diseases: the emerging role of noninvasive cardiovascular imaging. Inflamm Allergy Drug Targets 2015; 13: 371–381.Google Scholar
27. Mavrogeni, S, Markousis-Mavrogenis, G, Koutsogeorgopoulou, L, et al. Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases. Int J Cardiol 2017; 1;236: 151–156.Google Scholar
28. Choe, YH, Han, BK, Koh, EM, Do, YS, Lee, WR. Takayasu’s arteritis: assessment of disease activity with contrast enhanced MRA imaging. Am J Roentgenol 2000; 175: 505–511.Google Scholar
29. Andrews, J, Al-Nahhas, A, Pennell, DJ, et al. Non-invasive imaging in the diagnosis and management of Takayasu’s arteritis. Ann Rheum Dis 2004; 63: 995–1000.CrossRefGoogle ScholarPubMed
30. Tso, E, Flamm, SD, White, RD, Schvartzman, PR, Mascha, E, Hoffman, GS. Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum 2002; 46: 1634–1642.Google Scholar
31. Karapolat, I, Kalfa, M, Keser, G, et al. Comparison of F18 FDG PET/CT findings with current clinical disease status in patients with Takayasu’s arteritis. Clin Exp Rheumatol 2012; 31 (Suppl 75): 15–21.Google Scholar
32. Fuchs, M, Briel, M, Daikeler, T, et al. The impact of18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging 2012; 39: 344–353.Google Scholar
33. Sharma, BK, Jain, S, Radotra, BD. An autopsy study of Takayasu arteritis in India. Int J Cardiol 1998; 66 (Suppl 1): S85–S91.Google Scholar
34. Cong, XL, Dai, SM, Feng, X, et al. Takayasu’s arteritis: clinical features and outcomes of 125 patients in China. Clin Rheumatol 2010; 29: 973–981.CrossRefGoogle ScholarPubMed
35. Aydin, SZ, Yilmaz, N, Akar, S, et al. Assessment of disease activity and progression in Takayasu’s arteritis with Disease Extent Index-Takayasu. Rheumatology 2010; 49: 1889–1893.Google Scholar
36. Misra, R, Danda, D, Rajappa, SM, et al. Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology 2013; 52: 1795–1801.Google Scholar
37. Dolezalova, P, Price-Kuehne, FE, Özen, S, et al. Disease activity assessment in childhood vasculitis: development and preliminary validation of the Paediatric Vasculitis Activity Score (PVAS). Ann Rheum Dis 2013; 72: 1628–1633.CrossRefGoogle ScholarPubMed
38. Misra, DP, Sharma, A, Kadhiravan, T, Negi, VS. A scoping review of the use of non-biologic disease modifying anti-rheumatic drugs in the management of large vessel vasculitis. Autoimmun Rev 2017; 16: 179–191.Google Scholar
39. Clemente, G, Hilário, MOE, Lederman, H, et al. Takayasu arteritis in a Brazilian multicentre study: children with a longer diagnosis delay than adolescents. Clin Exp Rheumatol 2014; 32: 128–133.Google Scholar
40. Stern, S, Silva, GC, Reiff, A, Ramos, MPR, Marzan, KA, Terreri, MT. Treatment of pediatric Takayasu arteritis with infliximab and cyclophosphamide: experience from an American-Brazilian cohort study. J Clin Rheumatol 2014; 20: 183–188.Google Scholar
41. Osman, M, Pagnoux, C, Dryden, DM, Storie, D, Yacyshyn, E, et al. The role of biological agents in the management of large vessel vasculitis (LVV): a systematic review and meta-analysis. PLoS One 2014; 9: e115026. Ann Rheumathic Dis 72(Suppl 3).CrossRefGoogle Scholar
42. Lee, GY, Jeon, P, Do, YS, et al. Comparison of outcomes between endovascular treatment and bypass surgery in Takayasu arteritis. Scand J Rheumatol 2014; 43: 153–161.Google Scholar
43. Saadoun, D, Lambert, M, Mirault, T, Resche-Rigon, M. Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience. Circulation 2012; 125: 813–819.CrossRefGoogle ScholarPubMed
44. Miyata, T, Sato, O, Koyama, H, Shigematsu, H, Tada, Y. Long-term survival after surgical treatment of patients with Takayasu’s arteritis. Circulation 2003; 108: 1474–1480.Google Scholar
45. Singh, N, Hughes, M, Sebire, N, et al. Takayasu arteritis in infancy. Rheumatology 2013; 52: 2093–2095.Google Scholar
46. Tyagi, S, Verma, PK, Gambhiret, DS, et al. Early and long-termresults of subclavian angioplasty in aortoarteritis (Takayasu disease): comparison with atherosclerosis. Cardiovasc Interv Radiol 1998; 21: 219–224.Google Scholar