title: Diagnostic features, treatment, and outcomes of Takayasu arteritis in a US cohort of 126 patients.
abstract: OBJECTIVE
  To describe the clinical features, treatment, and outcomes in a longitudinal cohort of patients with Takayasu arteritis (TAK).
  
  
  METHODS
  We retrospectively studied patients with newly diagnosed TAK evaluated from January 1, 1984, through December 31, 2009.
  
  
  RESULTS
  The cohort included 126 patients who were predominantly white (85/103; 82.5%) and female (115/126; 91%). The median age at diagnosis was 31.6 years (interquartile range, 22.9-39.8 years). Median delay in diagnosis was 17.5 months (interquartile range, 7-41.8 months). Thirty-one patients (25%) were 40 years or older at diagnosis. Median delay in diagnosis for patients 40 years or older was 44.8 months compared with 28.3 months for those younger than 40 years (P<.001). Limb claudication was the presenting symptom in 64 of 123 patients (52%). Hata type V arteriographic abnormalities were the most common (57/100; 57%). Renal artery abnormalities were observed in 24 of 41 patients (58%) with new-onset hypertension. Inflammatory markers were elevated at diagnosis in 85 of 119 patients (71%). Vascular interventions were performed in 69 patients (55%). Seventy-nine patients (63%) were followed up for more than 1 year (median follow-up, 5.5 years; interquartile range, 2.9-10.0 years). In this subset, treatment consisted of corticosteroids in 73 patients (92%) and additional immunosuppressants in 52 patients (66%). At 5 years, 96% experienced at least one remission of any duration. The overall survival was 97% at 10 years and 86% at 15 years. Mortality was increased compared with the general population (standardized mortality ratio, 3.0; 95% CI, 1.0-8.9).
  
  
  CONCLUSIONS
  There continues to be an unacceptably long delay in the diagnosis of TAK. Awareness of TAK in patients older than 40 years is needed. Morbidity was high despite immunosuppressive treatment. Survival was decreased in this cohort.
authors.affiliation: Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Internal Medicine and RECIF, Amiens University Hospital, and INSERM U-1088, Jules Verne University of Picardy, Amiens, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Schmidt
authors.forename: Tanaz A
authors.initials: TA
authors.lastname: Kermani
authors.forename: A Kirstin
authors.initials: AK
authors.lastname: Bacani
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Cooper
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Warrington
mesh_terms: D000328:Adult; D017668:Age of Onset; D000792:Angiography; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007383:Intermittent Claudication / Q000209:etiology*; D008297:Male; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D017678:Sex Distribution; D013625:Takayasu Arteritis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data
chemical_list: D007166:Immunosuppressive Agents; D002097:C-Reactive Protein
keywords: ACR; American College of Rheumatology; C-reactive protein; CRP; ESR; GCA; HR; IQR; SMR; TAK; Takayasu arteritis; erythrocyte sedimentation rate; giant cell arteritis; hazard ratio; interquartile range; standardized mortality ratio