Takayasu arteritis: active or not, that’s the question

Dikkes, Alexander; Aschwanden, Markus; Imfeld, Stephan; Glatz, Katharina; Messerli, J.; Staub, Daniel; Daikeler, Thomas

doi:10.1093/rheumatology/kex213

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…Finally, the inherent dilemma of studies on the diagnostic accuracy of imaging methods in disease activity assessment of LVV is that a diagnostic gold standard cannot be established. Histological proof of extracranial large vessel inflammation can be obtained only in rare cases, and established clinical scales were either introduced without external validation (NIH score) or validated against physician global assessment and the acute phase response (ITAS score) …”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of positron emission tomography for assessment of disease activity in large vessel vasculitis

Schramm

Ingenhoff

Dechant³

et al. 2018

Int J of Rheum Dis

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Aim To determine the diagnostic yield of 18F‐fluorodeoxyglucose positron emission tomography (PET) in disease activity assessment of large vessel vasculitides (LVV). Methods Patients with LVV who had undergone PET (between 2004 and June 2010) or PET co‐registered with computed tomography (PET/CT; since June 2010) were identified. Clinical disease activity was assessed using established scoring systems. PET images were reviewed by two blinded nuclear medicine physicians. Uptake of the aortic wall was compared to the liver uptake utilizing a visual 4‐point score, with a vessel wall uptake similar or higher than liver uptake considered as active disease. Various target‐to‐background ratios were calculated. Receiver operator characteristics analysis was applied to determine the diagnostic accuracy of PET for detecting clinically active disease. Interobserver agreement of visual readings was measured with Cohen´s kappa. Results Eighty examinations in 62 patients were analyzed, with a mean time between diagnosis and PET of 106 ± 171 weeks. Fifty‐seven cases were finally classified as clinically active and 23 cases as clinically inactive. With a cut‐off value of 1.3, the aorta‐to‐liver ratio yielded a sensitivity and specificity of 84.2% and 82.6% (area under the curve 0.9). Overall, sensitivity and specificity of visual analysis were 68.4% and 91.3%, but sensitivity decreased to 54% in patients treated for more than 3 months. Interobserver agreement of visual rating was excellent (κ: 0.93). Conclusion Positron emission tomography is specific and reliable in disease activity assessment of LVV, but lacks sensitivity for detecting active disease in patients under long‐term immunosuppressive treatment.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of positron emission tomography for assessment of disease activity in large vessel vasculitis

Schramm

Ingenhoff

Dechant³

et al. 2018

Int J of Rheum Dis

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“…In children, elevation of acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) is commonly observed ( 45 , 55 ), but their sensitivity to reflect disease activity is uncertain, and they also lack specificity ( 71 ). In addition, they rapidly normalize and are masked under IL-6 blockade, adding further challenges to disease activity assessment in tocilizumab-treated patients ( 72 ). Anemia and thrombocytosis may be associated with chronic inflammation, particularly in children.…”

Section: Laboratory Features and Serological Biomarkersmentioning

confidence: 99%

“…For anti-TNFα agents, for example, some controversy emerges from reports of patients who developed TAK while they were being treated with a TNFα-inhibitor for another disease and primary non-response or even disease progression has been described under TNFα-, IL-6, and JAK-inhibitors ( 44 , 114 , 115 , 125 – 129 ). Of note, assessment of disease activity is even more challenging in tocilizumab-treated patients, as biologic inflammation may be suppressed and disease activity scores that include acute phase reactants may not be sensitive enough ( 72 , 129 ).…”

Section: Treatmentmentioning

confidence: 99%

An Update on Childhood-Onset Takayasu Arteritis

2022

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Takayasu Arteritis (TAK) is a rare large vessel vasculitis affecting the aorta and its major branches. The heterogeneous and often severe clinical manifestations result from systemic and local inflammation as well as end-organ ischemia. Disease flares are common and contribute to accrued damage over time with significant morbidity and mortality. Newer understanding of the pathogenesis in TAK has paved the way for the use of pathway targeting agents such as tumor necrosis factor (TNF)α- or interleuking (IL)-6-inhibitors with improved disease control. Nevertheless, long-term data are lacking, particularly in children; prognosis often remains guarded and the disease burden high. This article aims at providing a comprehensive review of childhood-onset TAK with a focus on recent publications.

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“…There is, however, an unmet need to identify patients at risk for relapses and those with subclinical activity. This is further emphasised in patients treated with tocilizumab, since CRP, and most likely ESR too, are suppressed independently of clinical activity [73,74]. Already the earliest reports on tocilizumab in LVV highlighted that a normal CRP and absence of clinical symptoms do not equal remission at the level of the artery [75].…”

Section: The Role Of Imaging During Follow-up Do Determine Disease Activitymentioning

confidence: 99%

“…In the future, the additional use of CEUS may facilitate monitoring of disease activity in LV-GCA during follow-up. Several case reports and case series suggest that CEUS can detect disease activity in GCA or Takayasu arteritis [21,74,[81][82][83]. Germano et al demonstrated in 31 patients with large-vessel vasculitis that enhancement of the thickened carotid vessel wall correlated with the grade of vascular inflammation on FDG-PET and was more frequent in clinically active disease [21].…”

Section: The Role Of Imaging During Follow-up Do Determine Disease Activitymentioning

confidence: 99%

The clinical benefit of imaging in the diagnosis and treatment of giant cell arteritis

et al. 2018

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Historically, giant cell arteritis (GCA) was considered to be synonymous with temporal arteritis. However, the disease spectrum of GCA extends much further, and includes vasculitis of the aorta and its branches with or without involvement of the temporal arteries. Imaging is crucial for the diagnosis and follow-up of GCA patients. Large vessel GCA (LV-GCA) often presents as an inflammatory syndrome and is only detected by imaging modalities such as: colour duplex sonography (CDS), computed tomography (CT) / CT angiography (CTA), magnetic resonance imaging (MRI) or 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) / CT. Deciding which imaging modality to use in different clinical situations remains a matter of debate. CDS and MRI enable assessment of the temporal arteries with a presumably higher sensitivity than histology. In the context of a typical presentation, CDS can replace a biopsy. In about a third of patients, the temporal arteries are not involved, thus PET/CT, MRI, CT, or CDS of larger arteries is needed to diagnose GCA. The sensitivity of all modalities is affected by glucocorticoid therapy. Therefore, without delaying therapy, imaging should be performed within a few days of treatment initiation. The use of PET/CT for the work-up of inflammatory syndromes in the elderly reveals vasculitis in approximately 20% of examined patients and uncover relevant diagnoses in the majority of remaining patients. The aorta should be routinely assessed in all GCA patients at diagnosis and during follow-up. MRA or CTA are best suited to characterise structural damage of larger arteries. The role of imaging in monitoring GCA disease activity still needs to be further defined.

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Takayasu arteritis: active or not, that’s the question

Cited by 9 publications

References 7 publications

Diagnostic accuracy of positron emission tomography for assessment of disease activity in large vessel vasculitis

Diagnostic accuracy of positron emission tomography for assessment of disease activity in large vessel vasculitis

An Update on Childhood-Onset Takayasu Arteritis

The clinical benefit of imaging in the diagnosis and treatment of giant cell arteritis

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