Clinical Features and Risk Factors for Active Tuberculosis in Takayasu Arteritis: A Single-Center Case-Control Study

Abstract

BackgroundsTakayasu arteritis (TAK) is a chronic, granulomatous vasculitis correlated with tuberculosis (TB). The two diseases share similar pathological characteristics and clinical manifestations which increase the difficulty to diagnose. Active tuberculosis (ATB) has implications for treatment strategies in TAK patients. Therefore, the investigation of clinical features and potential risk factors of ATB in TAK patients is vital.MethodsThe study reviewed hospitalized patients diagnosed with TAK in our hospital from 2008, to 2021. TAK patients with ATB were enrolled as the case group. The control group was randomly selected in a 3:1 ratio. The clinical characteristics of TAK patients with and without ATB were compared. Multivariate logistic regression analysis was performed to determine risk factors for ATB in TAK patients.ResultsWe reviewed 1,789 patients and ultimately identified 30 (1.7%) ATB cases. TAK patients with ATB were more prone to develop symptoms including fever (p=0.001), fatigue (p=0.003), cough (p=0.037), expectoration (p<0.001), weight loss (p=0.003), and night sweating (p<0.001). Increased level of hypersensitive C reactive protein (hsCRP, p=0.001), decreased level of albumin (p=0.031), and higher positive rate of T-SPOT.TB test (p<0.001) were observed in the case group. Multivariate logistic regression analysis revealed that hsCRP >8 mg/L (OR 9.108; 95% CI, 1.096–75.711; p=0.041) and positive T-SPOT.TB result (OR 68.669; 95% CI, 7.291–646.738; p<0.001) were risk factors for ATB in TAK patients. The proportion of patients undergoing subsequent surgery for Takayasu arteritis was lower in patients with ATB (p<0.001).ConclusionOur study suggested that the diagnosis of ATB should be considered when TAK patients experienced symptoms including fever, fatigue, weight loss, etc. hsCRP >8 mg/L and positive T-SPOT.TB result were identified as independent risk factors for ATB in TAK patients.

Tuberculosis and Takayasu arteritis: a case report

“…Fortunately, she did not develop severe complications such as dissecting aneurysm, ocular, or skin TB complications reported in some cases [ 20 – 22 ]. We insist on the importance of focusing on and treating TB infections before starting corticosteroids and immunosuppressive treatment mainly in countries with high prevalence of TB [ 23 ]. Although there is no evidence that anti-TB therapy prevents TAK progression or its complications, the combination of corticosteroids and anti-TB drugs was efficient to control the disease activity observed in our patient [ 24 ].Glucocorticoids should be combined with immunosuppressive drugs including methotrexate, cyclophosphamide, or mycophenolate mofetil to control disease activity [ 15 ].…”

Age, sex and angiographic type-related phenotypic differences in inpatients with Takayasu arteritis: A 13-year retrospective study at a national referral center in China

“…This is a retrospective study conducted at Peking Union Medical College Hospital, which is a national referral center proficient in diagnosing and managing TAK with multidisciplinary team collaboration (9,(16)(17)(18)(19)(20) in China. This study was carried out in accordance with the tenets of the Helsinki Declaration and was approved by the Review Board of PUMCH (S-K2122).…”

“…A total of 852 TAK patients were finally recruited (670 female, 182 male), and the F:M ratio was 3.7:1. The median age (Q1,Q3) at onset was 25 (18,33) years for all TAK patients. The age at onset displayed no sex difference, with a median age at onset of 25 (17,33) for males and 25 (19,32) for females (P = 0.347).…”

“…Moreover, aortic and renal artery involvement were more frequently observed in pediatric TAK patients (8). The Chinese TAK cohorts have been limited because the published studies have only investigated the association between demographic characteristics and vascular involvement (9) or have investigated the clinical features with a specific complication (7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). To our knowledge, there are still gaps in understanding the association between the angiographic classifications and phenotypic manifestations.…”

Medium-vessel and large-vessel vasculitis in children

“…Adults with active TB were more likely to have fever, weight loss, cough, fatigue, and night sweating. Latent TB cases were not investigated or reported [22 ▪ ].…”