ObjectivesCardiovascular complications are the main causes of morbidity and mortality in the course of Takayasu arteritis (TA).In addition to the occlusive vasculitis,hypertension and accelerated atherosclerosis are possibly other factors playing role in the ethiopathogenesis of these complications.Although,strict management of traditional cardiovascular risk factors is advocated to diminish the effect of cardiovascular complications,we still do not know whether traditional risk factors and other comorbid conditions are increased or operative.In this study we looked at the frequency of traditional atherosclerotic risk factors and comorbid conditions among patients with TA and suitable diseased and healthy controls.MethodsWe studied 88 (77F,11M) consecutive TA patients and 71 (66F,5M) SLE patients,between May and November 2016.In addition,age and gender matched, 96 (80F, 16M) healthy controls were included.Study participants were interviewed with the help of a standardized questionnaire that assess the presence or absence of traditional atherosclerotic risk factors and several comorbid conditions according to the Charlson comorbidity index.Additionally,Framingham coronary heart disease risk score was calculated.ResultsSmoking was more frequent among the healthy controls,whereas hypertension and family history of cardiovascular diseases were more common among TA patients.Patients with SLE were found to have less hyperlipidemia.The Framingham risk scores did not differ among the groups.Pericardial/pleural and renal diseases were more frequently observed in SLE patients,whereas cardiovascular diseases and chronic lung diseases were more common in TA patients.Inflammatory bowel diseases were only observed in TA patients.Takayasu arteritisSLEHealthy controlsP value(n=88; 77F/11 M)(n=71; 66 F/5 M)(n=96; 80 F/16 M)Age, mean ± SD44±1242±1245±11NSAge at disease onset, mean ± SD31±1229±11–NSSmoking (current and past), n (%)27 (31)30 (42)47 (49)<0.05Hyperlipidemia, n (%)32 (44)15 (25)41 (48)0.018Hypertension, n (%)47 (53)23 (32)22 (23)<0.01Diabetes mellitus, n (%)8 (9)6 (7)15 (16)NSMedian [IQR] Framingham risk score3 [1–9]3 [1–5]3 [2–7]NSFamilial history of cardiovascular diseases, n (%)41 (47)15 (21)22 (23)<0.01Cardiovascular diseases, n (%)47 (53)13 (18)1 (1)<0.01Valvular heart disease, n (%)34 (39)12 (17)7 (7)<0.01Chronic pulmonary diseases, n (%)11 (13)1 (2)5 (6)<0.05Pleural/pericardial diseases, n (%)7 (8)14 (20)0<0.01Renal diseases, n (%)10 (11)19 (27)8 (8)<0.05Other accompanying rheumatologic diseases and amyloidosis, n (%)10 (11)15 (21)1 (1)<0.01Inflammatory bowel diseases, n (%)9 (11)00<0.01Inflammatory upper/lower back pain, n (%)21 (24)23 (32)6 (6)<0.01Family history of rheumatologic diseases, n (%)26 (30)25 (35)4 (4)<0.01ConclusionsTraditional atherosclerotic risk factors are not increased in TA.Comorbidities in these patients are mainly due to the complications of vascular involvement.The frequency of inflammatory bowel diseases and inflammatory upper/lower back pain is substantially high and deserves further res...

BackgroundCase reports or small case series suggest that Takayasu arteritis (TA) can co-exist with various chronic inflammatory disorders. Inflammatory bowel disease [(IBD; Crohn's disease (CD) or ulcerative colitis (UC)] has been the most common association.ObjectivesWe conducted a formal study to look specifically at the frequency of association of such chronic inflammatory disorders in a large cohort of patients with TA followed at a single tertiary center.MethodsThere were 226 (200 F/26 M) patients registered with a diagnosis of TA at the Rheumatology Department of Cerrahpasa Medical Faculty, between 1977 and December 2015. Of these, 17 (8%) had died and 15 (7%) were lost to follow-up. The remaining 194 patients were called back at the outpatient clinic for an interview and for a physical examination. A standardized form sought whether the patient was also diagnosed as IBD, ankylosing spondylitis (AS), Behçet's syndrome (BS), amyloidosis (AA), uveitis, rheumatoid arthritis (RA), systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, psoriatic arthritis, myositis, small vessel vasculitis, a demyelinating or any other autoimmune or inflammatory disorder. The presence of skin-mucosa lesions ascribed to BS and inflammatory back pain were also specifically sought for. In addition to the self-reported information, patient charts and all medical documentation available such as hospitalization reports, imaging studies and blood work were used as a source of information.ResultsOne hundred and fifty-three (136 F/17 M) patients were studied. The mean age at the onset of symptoms was 31±11 years and at the time of TA diagnosis was 34±12 years. Subclavian artery was the most common involved artery (83%), followed by common carotids (75%) and aorta (64%). Currently, while 25 (16%) patients were off treatment, 72 (47%) patients were using glucocorticoids, 47 (31%) azathioprine, 32 (21%) methotrexate and 44 (29%) biological agents.We identified 11 (7%) patients with IBD (CH/UC:7/4), 11 (7%) with AS, and 9 (6%) with BS. Ten patients (6 IBD and 4 BS) were diagnosed simultaneously. The onset of TA preceded AS in 6 patients, IBD in 2, and BS in 1 as shown in Table. Among the remaining 122 patients, when the 31 patients with IBD, AS and BS were excluded, recurrent oral ulcers were present in 19 (16%), erythema nodosum in 13 (11%), arthritis in 12 (10%), papulopustular lesions in 5 (4%), uveitis in 5 (4%), and genital ulcer in 1. Inflammatory back pain was reported by 44 (36%) patients; this was usually in the dorsal spine level alone (n=30), less commonly in both dorsal and lumbar spine (n=10) and in the lumbar spine alone (n=4).In addition, 3 patients had secondary amyloidosis, 1 had RA and 1 morphea. We also observed 2 patients with autoimmune hepatitis and 2 with psoriasis, all having onset after anti-TNF treatment.ConclusionsThis survey shows that TA co-occur with IBD, AS or BS in about 1/5 of the patients, at least in a hospital setting and this seems to be without a clear temporal pattern. The rather high preval...

BackgroundCase reports and series suggest that Takayasu's arteritis (TA) can co-exist with various inflammatory disorders.ObjectivesWe conducted a formal study to look specifically at the frequency of inflammatory disorders and symptoms in a large cohort of TA followed by a single tertiary center.MethodsThere were 238 patients registered with a diagnosis of TA. Of these, 19 died, 18 were lost to follow-up and 3 did not wish to response our questionnaire. The remaining 198 patients were called back at the outpatient clinic. A standardized form sought whether the patient was also diagnosed as inflammatory bowel disease (IBD), ankylosing spondylitis (AS), Behçet's syndrome (BS), amyloidosis, uveitis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (pSS), Sjögren syndrome, psoriatic arthritis, inflammatory myositis, small vessel vasculitis, autoimmune/demyelinating or any other inflammatory disorder.ResultsOverall, 198 (175 F/ 23 M) patients were studied. The mean age at the time of TA diagnosis was 34±12 years. Subclavian artery was the most common involved artery (84%), followed by common carotids (78%) and aorta (65%). Currently, while 25 (16%) patients were off treatment, 72 (47%) patients were using glucocorticoids, 47 (31%) azathioprine, 32 (21%) methotrexate and 44 (29%) biological agents.We identified in total 37 (19%) patients with inflammatory diseases (IBD: n=12; AS: n=15; and BS: n=10). Table shows their demographic characteristics. Among the remaining 161 patients, the most frequent feature was inflammatory back pain (36%), followed by recurrent oral ulcers (15%), erythema nodosum (11%), arthritis (10%), papulopustular lesions (7%), uveitis (4%), and genital ulcer (1%). It was noted that inflammatory back was mostly located on the dorsal area. Regarding autoimmune diseases, we also observed RA (n=3), psoriasis (n=2), autoimmune hepatitis (n=2), SS (n=1) and SSc (n=1).Table 1.Demographic features of 37 TA patients with inflammatory bowel disease (IBD), ankylosing spondylitis (AS) or Behçet's syndrome (BS)Concomitant diseaseF/MMean age at TA diagnosis (SD)Mean age at concomitant disease (SD)Time of TA diagnosis in relation to concomitant disease AS (n=15)13/231±827±11Simultaneous (n=3)TA preceded (n=7)AS preceded (n=5)IBD (n=12)11/133±931±9Simultaneous (n=9)TA preceded (n=1)IBD preceded (n=2)BS (n=10)7/335±1332±13Simultaneous (n=5)TA preceded (n=1)BS preceded (n=4)ConclusionsTA does co-occur with IBD, AS or BS in about 1/5 of the patients, at least in a hospital setting and without a clear temporal pattern. This could be due to the close association of TA with MHC class-1 diseases. In addition, the high prevalence of inflammatory back pain in the dorsal spine in TA needs further scrutiny.Disclosure of InterestNone declared