Extravascular manifestations of Takayasu arteritis: focusing on the features shared with spondyloarthritis

Abstract

Background: Takayasu arteritis (TAK) is a systemic disease characterized by large vessel involvement. Although the vascular characteristics of TAK are well characterized, there is no well-organized study demonstrating the extravascular manifestations of TAK. We aimed to evaluate the characteristics of extravascular manifestations of TAK, and to identify the association between vascular and extravascular manifestations of TAK.

Methods: TAK patients from two independent cohorts between January 2012 and October 2017 were included in the study. Patient characteristics were retrospectively collected from the electronic dataset. The computed tomography scans of all subjects were reviewed to evaluate the pattern of vascular involvement and presence of sacroiliitis. Clinical findings including uveitis, skin lesions, oral ulcers, arthritis, and inflammatory bowel disease (IBD) were reviewed. Logistic regression analysis was performed to evaluate the association between vascular and extravascular manifestations.

Results: For the 268 TAK patients, the mean age at diagnosis was 41.2 ± 14.2 years and 88.1% were female. The extravascular manifestation of TAK was observed in 19.0% of patients, the most common being arthritis including sacroiliitis (11.9%) followed by recurrent oral ulcers (8.6%) and IBD (2.6%). A multivariate logistic regression analysis revealed type IIB vascular involvement (adjusted odds ratio (OR) 2.956, 95% confidence interval (CI) 1.337-6.537, p = 0.007) and the erythrocyte sedimentation rate (ESR) (adjusted OR 1.014, 95% CI 1.003-1.025, p = 0.012) as significantly associated with the presence of axial and peripheral arthritis.

Conclusions: Extravascular manifestations of TAK were observed in up to one-fifth of patients. The most common extravascular manifestation was arthritis, which was associated with a type IIB vascular involvement pattern and a high ESR.

Keywords: Arthritis; Extravascular manifestation; Takayasu arteritis.

Fig. 1

Computed tomography (CT) images of Takayasu arteritis (TAK) patient who exhibited sacroiliitis as an extravascular manifestation. Female patient, 29 years old, negative for HLA-B27. a Complete occlusion in left subclavian artery (arrowhead). b Concentric wall thickening in left common carotid artery (arrowhead). c Sclerosis in both sacroiliac joints and erosion with joint space widening suggesting grade III sacroiliitis. d Vertebral corner inflammations, especially in lumbar spines (L2 and L5)