title: Takayasu Arteritis in the pediatric population: a contemporary United States-based single center cohort.
abstract: BACKGROUND
  Takayasu Arteritis is an idiopathic, chronic, large vessel vasculitis involving the aorta and its primary branches. Few studies have been done in pediatric patients to date with the largest case series of US patients published in 2003 consisting of only 6 patients.
  
  
  METHODS
  A retrospective chart review was performed on all patients seen at Cleveland Clinic Children's up until 2012 who met EULAR/PRINTO/PRES classification criteria for childhood Takayasu Arteritis.
  
  
  RESULTS
  Twenty-one patients with a mean follow up of 2.3 years were studied. Weight loss, fatigue, and anorexia were the most common presenting complaints. 57.1% of patients were hypertensive at first visit. The most common examintation finding was diminished pulses (61.9%), followed by bruits, and then murmurs. Thoracic aorta stenosis was the most common vascular abnormality. Seven of twenty-one patients responded well to methotrexate and prednisone alone. Ten of twenty-one patients required an additional medication for symptom and disease control (infliximab most commonly). About two-thirds of patients required at least one anti-hypertensive medication. Eight of the twenty-one patients required surgical intervention for severe disease refractory to medications (renal artery stenosis being the most common indication). Almost all patients reported symptomatic improvement after surgical intervention. Two of the eight patients required a second surgery for return of symptoms. Disease sequelae included arterial aneurysms, resolved heart failure, and hypertensive emergencies.
  
  
  CONCLUSIONS
  Our study emphasizes that constitutional symptoms coupled with objective findings of diminished pulses, bruits, and hypertension should raise clinical suspicion for Takayasu Arteritis in pediatric patients. Pharmacologic therapy alone can be successful in controlling disease progression, however surgery was successful in minimizing symptoms when medical therapies failed.
authors: Cleveland Clinic Children's, Cleveland, Ohio, USA.
authors: Heidi S
authors: HS
authors: Szugye
authors: Center for Pediatric Rheumatology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
authors: Andrew S
authors: AS
authors: Zeft
authors: Center of Pediatric Rheumatology, Center for Pediatric Rheumatology, Cleveland Clinic Children's, 9500 Euclid Avenue/Desk A111, Cleveland, OH 44195, USA.
authors: Steven J
authors: SJ
authors: Spalding
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001011:Aorta / Q000473:pathology / Q000503:physiopathology; D001027:Aortography / Q000379:methods; D002648:Child; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology; D000069285:Infliximab; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use*; D011674:Pulse / Q000379:methods; D012189:Retrospective Studies; D013625:Takayasu Arteritis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States / Q000453:epidemiology
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D011241:Prednisone; D008727:Methotrexate
keywords: Children; Cleveland Clinic Children’s Center for Pediatric Rheumatology; Takayasu Arteritis; United States; Vasculitis