Clinical symptoms and associated vascular imaging findings in Takayasu's arteritis compared to giant cell arteritis

Abstract

Objective: To compare the presence of head, neck and upper extremity symptoms in patients with Takayasu's (TAK) and giant cell arteritis (GCA) and their association with vascular inflammation assessed by ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) or arterial damage assessed by magnetic resonance angiography (MRA).

Methods: Patients with TAK and GCA underwent clinical and imaging assessments within 24 hours, blinded to each other. Vascular inflammation was defined as arterial FDG-PET uptake greater than liver by visual assessment. Arterial damage was defined as stenosis, occlusion, or aneurysm by MRA. Clinically reported symptoms were compared with corresponding imaging findings using generalised mixed model regression. Cranial symptoms were studied in association with burden of arterial disease in the neck using ordinal regression.

Results: Participants with TAK (n=56) and GCA (n=54) contributed data from 270 visits. Carotidynia was reported only in patients with TAK (21%) and was associated with vascular inflammation (p<0.01) but not damage (p=0.33) in the corresponding carotid artery. Posterior headache was reported in TAK (16%) and GCA (20%) but was only associated with corresponding vertebral artery inflammation and damage in GCA (p<0.01). Arm claudication was associated with subclavian artery damage (p<0.01) and inflammation (p=0.04) in TAK and with damage in GCA (p<0.01). Patients with an increased burden of damaged neck arteries were more likely to experience positional lightheadedness (p<0.01) or a major central nervous system event (p=0.01).

Conclusion: The distribution of symptoms and association with imaging abnormalities differs in patients with TAK and GCA. These findings may help clinicians predict associated FDG-PET and MRA findings based on a specific clinical symptom.

Clinical trial registration number: NCT02257866.

Keywords: Takayasu’s arteritis; giant cell arteritis; outcome assessment; vasculitis.

Figure 1.

Clinical images from patients with large-vessel vasculitis. A patient with Takayasu’s arteritis who complained of left sided carotidynia had corresponding vascular inflammation by FDG-PET (A) without vascular damage by MRA (B). Fused FDG-PET and angiography images from a patient with giant cell arteritis who complained of a left sided posterior headache demonstrate increased FDG uptake (red) and throughout a stenotic left vertebral artery (white arrows) (C).

Figure 2.

Odds ratio plots comparing the presence of cranial symptoms at any point during the disease course to the cumulative burden of vascular damage by MRA (A) or vascular inflammation by FDG-PET (B) in the four major neck arteries. Associations of each symptom with the burden of neck vessel disease in the carotid and vertebral arteries are displayed. Odds ratios >1 indicate that a specific symptom is associated with increased odds of vascular disease affecting increasingly more of the neck arteries. VL, vision loss; BV, blurred vision; PHA, posterior headache; FHA, frontotemporal headache; CNS, central nervous system event defined as stroke, TIA or syncope; CD, carotidynia; PLH, positional lightheadedness; LH, lightheadedness; MRA, magnetic resonance angiography; FDG-PET, fluorodeoxyglucose positron emission tomography.