Juvenile-onset Takayasu arteritis: peculiar vascular involvement and more refractory disease.
OBJECTIVE
To compare prognosis parameters and arterial site involvement in Takayasu arteritis (TA) patients with disease onset at age ≤ 18 and ≥ 21 years.


METHODS
Sixty-two TA patients [American College of Rheumatology (ACR) and European League Against Rheumatism/Paediatric Rheumatology European Society (EULAR/PreS) criteria] were enrolled consecutively and divided into two groups according to disease onset, and matched for disease duration: juvenile TA patients aged ≤ 18 years (n = 17) and adult TA patients aged ≥ 21 years (n = 45). The protocol evaluated the following prognostic factors: aortic insufficiency, ischaemic retinopathy, severe systemic hypertension, and arterial aneurysms. In addition, death and remission [defined as stable disease > 6 months (no complaints without immunosuppressive and prednisone use) and normal erythrocyte sedimentation rate (ESR)] were also analysed. Stenosis and aneurisms were investigated by magnetic angioresonance or arteriography and angiographic classification was defined according to Hata criteria.


RESULTS
Mean disease duration was similar in the juvenile and adult TA groups (13.50 ± 10.73 vs. 13.80 ± 7.17 years, p = 0.092) and a trend to a lower predominance of female gender in the juvenile TA group was observed (64.71% vs. 88.89%, p = 0.056). The prognosis was distinct in the two groups, with juvenile patients having a lower frequency of disease remission (23.53% vs. 55.56%, p = 0.04) and a significantly higher frequency of aneurism (41.0% vs. 11.1%, p = 0.013). Almost half of the juvenile TA patients had left renal stenosis, a frequency significantly higher than in the adult TA group (41.18% vs. 11.10%, p = 0.013), whereas the stenosis frequency was comparable in all other vascular sites evaluated. No differences were observed between the two groups regarding the frequency of aortic insufficiency, ischaemic retinopathy, severe systemic arterial hypertension, vascular procedures, and mortality. Angiographic classification revealed a similar distribution of arterial involvement in both groups (p > 0.05).


CONCLUSIONS
Juvenile TA patients have distinct characteristics, with a peculiar renal vascular involvement, the presence of aneurism, and a more refractory disease compared with adult TA patients.
Jales-Neto
L H
LH
Division of Rheumatology and Clinical Hospital, Faculty of Medicine, University of São Paulo, Brazil.
Levy-Neto
M
M
Bonfa
E
E
de Carvalho
J F
JF
Pereira
R M R
RM
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology; D001799:Blood Sedimentation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology; D058437:Hypertensive Retinopathy / Q000175:diagnosis / Q000209:etiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D013625:Takayasu Arteritis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents; D011241:Prednisone