Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492008000200006
Jornal Vascular Brasileiro
Original Article

Arterite de Takayasu: aspectos clínicos e terapêuticos em 36 pacientes

Takayasu's arteritis: clinical and therapeutic aspects in 36 patients

Marília Duarte Brandão Panico; Ethel Stambovsky Spichler; Leandro Cordeiro Dias Rodrigues; Fernando Oliveira; Daniel Buchatsky; Carmen Porto; Márcia Ribeiro Alves; David Spichler

http://dx.doi.org/10.1590/S1677-54492008000200006 J Vasc Bras, vol.7, n2, p.123-130, 2008
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Resumo

CONTEXTO: A arterite de Takayasu é uma vasculite crônica, geralmente com diagnóstico tardio devido à pouca especificidade dos sintomas durante a fase inicial do acometimento vascular. A terapêutica de eleição é o uso de imunossupressores. O procedimento cirúrgico, quando necessário, é sempre evitado na fase aguda. OBJETIVO: Descrever alterações clínicas, laboratoriais e vasculares de arterite de Takayasu no período de 1977 a 2006. MÉTODO: A amostra compreendeu 36 pacientes - 10 brancos, 35 mulheres, idade média de 31,7 anos (±13,7), com prevalência significante na quarta década (p < 0,005). Evolução de 3 anos e período até o diagnóstico de 7,9 anos. Velocidade de hemossedimentação (VHS) e proteína C reativa (PCR) avaliaram atividade da doença, e o duplex scan aferiu a espessura médio- intimal da artéria carótida. RESULTADOS: Hipertensão arterial sistêmica e claudicação de membros superiores e inferiores foram ressaltados em 85,2, 69,5 e 30,5%, respectivamente. O resultado da VHS foi > 60 mm em 50% da amostra (p < 0,005). PCR mg/dL foi realizado em 18, variando de 0,4-25 na admissão para 0,11-1,9 na evolução. Doença auto-imune, tuberculose e HIV correlacionaram-se em 19,4, 8,3 e 2,7%, respectivamente. Lesões aórticas foram significativas em 22% (quatro oclusões, dois aneurismas infra-renais, um torácico). Em 19,4%, foram acometidas artérias renais e subclávias uma oclusão bilateral de carótidas, e em 25% os membros inferiores. A espessura médio-intimal da carótida comum foi estratificada em: > 3 mm, < 3 e > 1,7, < 1,7 e > 1,2 e < 1,2 mm, representando 41,6, 19,4, 8,37 e 30,50%, respectivamente (p < 0,005). Glicocorticóides foram utilizados em 61,1%, azatioprina em 16.6%, e associada a ciclofosfamida em 8,3%. Procedimento cirúrgico ou endovascular foi realizado em 30,5% com dois óbitos por complicações cardiovasculares. CONCLUSÕES: A VHS, PCR, e a espessura médio-intimal nas carótidas são importantes marcadores de acompanhamento da arterite de Takayasu. O período entre os sintomas e o diagnóstico deve ser abreviado, com redução da morbimortalidade.

Palavras-chave

Arterite de Takayasu, diagnóstico por imagem, imagem por duplex scan, carótida, aorta, espessamento intimal, tratamento clínico, tratamento cirúrgico

Abstract

BACKGROUND: Takayasu arteritis is a chronic vasculitis often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. Treatment includes imunosuppression drugs. Surgical treatment, when necessary, should be avoided in the acute phase. OBJECTIVE: To describe clinical, laboratory and vascular findings in Takayasu's arteritis from 1977 through 2006. METHODS: The sample was comprised of 36 patients (10 Caucasians, 35 women), mean age of 31.7 (±13.7) years, and significant prevalence in the forth decade (p < 0.005). Disease course was 3 years and time until diagnosis was 7.9 years. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to assess disease activity, and duplex scan to measure carotid artery intima-media wall thickness. RESULTS: Hypertension was present in 85.2%, and upper and lower limb claudication in 69.5 and 30.5%, respectively. ESR was > 60 mm in 50% of the sample (p < 0.005). PCR mg/dL was performed in 18 cases, ranging from 0.4-25 on admission to 0.11-1.9 during disease course. Autoimmune diseases, tuberculosis and HIV correlated in 19.4, 8.3 and 2.7%, respectively. Major aortic lesions were detected in 22.2% (four occlusions, two infrarenal aneurysms, one thoracic aneurysm). Other arteries involved renal, subclavian and one carotid occlusion (19%), and some level of lower limb occlusion (25%). Intima-media thickness was stratified in > 3 mm (41.6%), < 3 and > 1.7 (19.4%), < 1.7 and > 1.2 (8.37%), and < 1.2 mm (30.50%) (p < 0.005). Glucocorticoids were used in 61%, azathioprine in 16.6%, and azathioprine combined with cyclophosphamide in 8.3%. Surgical and endovascular procedures were performed in 30.5%. Two patients died due to cardiovascular diseases. CONCLUSIONS: Carotid intima-media thickness, PCR, and ESR are important markers for the follow-up of Takayasu's arteritis. Delay in diagnosis is an important issue for Takayasu's progression, since it may reduce morbidity and mortality rates.

Keywords

Takayasu's arteritis, imaging diagnosis, duplex scan imaging, carotid, aorta, intimal thickening clinical treatment, surgical treatment

References

Martorell F, Fabré J. El sindrome de obliteración de los troncos supra aórticos. Med Clin (Barc). 1944;2:26-30.

Heberer G, Rau G, Löhr HH. Enfermedades de la aorta y de las grandes artérias. 1970.

Vidal-Barraquer F. Patologia vascular: fisiopatologia, clínica e tratamiento. 1973.

Cossermelli W. Vasculites. 2002.

Borelli FAO, Passareli Jr. O, Souza MG, Fagundes Jr. AAP, Pimenta E, Amoseo C. Arterite de Takayasu: conhecer para diagnosticar. J Bras Nefrol. 2005;27(4):215-9.

Kerr GS. Takayasu's arteritis. Rheum Dis Clin North Am. 1995;21:1041-58.

Seko Y. Takayasu's arteritis: insights into immunopathology. Jpn Heart J. 2000;41:15-26.

Sun Y, Yip PK, Jeng JS, Hwang BS, Lin WH. Ultrasonographic study and long term follow up of Takayasu's arteritis. Stroke. 1996;27:2178-82.

Andrews J, Mason JC. Takayasu's arteritis: recent advances in imaging offer promise. Rheumatology (Oxford). 2007;46:6-15.

Mayo J, Culham JA. Magnetic resonance imaging in pediatric vascular disease. Can Assoc Radiol J. 1987;38:165-9.

Baptista LPS. Contribuição da ressonância magnética na arterite de Takayasu. .

Heggtveit HA. Syphilitic aortitis, a clinipathologic autopsy study of 100 cases. Circulation. 1964;29:346-55.

Ishikawa K. Natural history and classification of occlusive thromboarthropathy. Circulation. 1978;57:27-55.

Watts RA, Carruthers DM, Scott DG. Epidemiology of systemic vasculitis: changing incidence or definition. Semin Arthritis Rheum. 1995;25:28-34.

Homme JL, Aubry MC, Edwards WD. Surgical pathology of the ascending aorta: a clinicopathologic study of 513 cases. Am J Surg Pathol. 2006;30:1159-68.

Moriwaki R, Noda M, Yajima M, Sharma BK, Numano F. Clinical manifestations of Takayasu arteritis in India and Japan: new classification of angiographic findings. Angiology. 1997;48:369-79.

Zheng D, Fan D, Liu L. Takayasu arteritis in China: a report of 530 cases. Heart Vessels. 1992;7(^sSuppl):32-6.

Kinare SG. Aortitis in early life in India and its association with tuberculosis. J Pathol. 1970;100:69-76.

Numano F. Differences in clinical presentation and outcome in different countries for Takayasu's arteritis. Curr Opin Rheumatol. 1997;9:12-5.

Numano F, Okawara M, Inomata H, Kobayashi Y. Takayasu's arteritis. Lancet. 2000;356:1023-5.

Chauhan SK, Tripathy NK, Nityanand S. Antigenic targets and pathogenicity of anti-aortic endothelial cell antibodies in Takayasu arteritis. Arthritis Rheum. 2006;54:2326-33.

Verma DK, Tripathy NK, Verma NS, Tiwari S. Interleukin 12 in Takayasu's arteritis: plasma concentrations and relationship with disease activity. J Rheumatol. 2005;32:2361-3.

Tripathy NK, Gupta PC, Nityanand S. High TNF-alpha and low IL-2 producing T cells characterize active disease in Takayasu's arteritis. Clin Immunol. 2006;118:154-8.

Numano F, Kobayashi S. Takayasu arteritis: beyond pulselessness. Intern Med. 1999;38:226-32.

Rodriguez-Pla A, Stone JH. Vasculitis and systemic infections. Curr Opin Rheumatol. 2006;18:39-47.

Perniciaro CV, Winkelmann RK, Hunder GG. Cutaneous manifestations of Takayasu's arteritis. J Am Acad Dermatol. 1987;17:998-1005.

Hall S, Barr W, Lie JT, Stanson AW, Kazmier FJ, Hunder GG. Takayasu arteritis: A study of 32 north american patients. Medicine (Baltimore). 1985;64:89-99.

Hall S, Buchbinder R. Takayasu's arteritis. Rheum Dis Clin North Am. 1990;16:411-22.

Jennette JC, Falk RJ, Andrassy K. Nomenclature of systemic vasculitis: proposal of an international consensus conference. Arthritis Rheum. 1994;37:187-92.

Hunder GG, Arend WP, Bloch DA. The American College of Rheumatology 1990 criteria for the classification of Takayasu's arteritis. Arthritis Rheum. 1990;33:1129-34.

Hata A, Numano F. Magnetic resonance imaging of vascular changes in Takayasu's arteritis. Int J Cardiol. 1995;52:31-7.

Hoffman GS. Takayasu arteritis: lessons from the American National Institutes of Health experience. Int J Cardiol. 1996;54(^sSuppl):S99-102.

Sano K, Aiba T. Pulseless disease: summary of our 62 cases. Jpn Circ J. 1966;30:63-7.

Sato EI, Sassaki Jr RH, Leão CS, Hatta FS, Nunes DS, Santo BE. Clinical and angiographic features of Takayasu's arteritis. Rev Bras Reumatol. 1998;38:9-14.

Salvarani C, Cantini F, Boiardi L, Hunder GG. Laboratory investigations useful in giant cell arteritis and Takayasu arteritis. Clin Exp Rheumatol. 2003;21:S23-8.

Kinare SG. Aortitis in early life in India and its association with tuberculosis. J Pathol. 1970;100(1):69-76.

Pantell RH, Goodman BW. Takayasu's arteritis: the relationship with tuberculosis. Pediatrics. 1981;67:84-8.

Shoenfeld Y, Isenberg DA. Mycobacteria and autoimmunity. Immunol Today. 1998;9:178-82.

Moraes MF, Ordway D, Oliveira L. Cellular immune responses to mycobacterium tuberculosis in a patient with Takayasu's arteritis. Rev Port Cardiol. 1999;18:359-67.

Cupps TR, Fauci AS. Takayasu's arteritis. The vasculitis: Major problems in internal medicine. 1981:107-12.

Morrison RCA, Milner LS, Jacobs D, Thomson PD, Franklin J, Ninin D. The role of mycobacteria in Takayasu's arteritis. Kidney Int. 1989;35:973.

Sheikhzadeh A, Tettenborn I, Noohi F, Eftekharzadeh M, Schnabel A. Occlusive thromboaortopathy (Takayasu disease): clinical and angiographic features and a brief review of literature. Angiology. 2002;53:29-40.

Schmidt WA, Nerenheim A, Seipelt E, Poehls C, Gromnica-Ihle E. Diagnosis of early Takayasu arteritis with sonography. Rheumatology (Oxford). 2002;41:496-502.

Sato EI, Lima DN, Espírito Santo B, Hata F. Takayasu arteritis: treatment and prognosis in a university center in Brazil. Int J Cardiol. 2000;75:S163-6.

Park SH, Chung JW, Lee JW, Han MH, Park JH. Carotid artery involvement in Takayasu's arteritis evaluation of the activity by ultrasonography. J Ultrasound Med. 2001;20:371-8.

Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol. 2005;17(1):16-24.

Souza AWS, Neves RMS, Oliveira KR, Sato EI. Tratamento da arterite de Takayasu. Rev Bras Reumatol. 2006;46:2-7.

Maksimowicz-Mckinnon K, Clark T, Hoffman G. Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients. Arthritis Rheum. 2007;56:1000-9.

Matsubara K, Matsumoto K, Kameyama K, Obara H, Kitajima M. Large renal artery aneurysm in Takayasu arteritis. J Vasc Surg. 2006;44:1107-9.

Robinson WP 3rd, Detterbeck FC, Hendren RL, Keagy BA. Fulminant development of mega aorta due to Takayasu arteritis: a case report and review of the literature. Vascular. 2005;13:178-83.

Regina G, Bortone A, Impedovo G, De Cillis E, Angiletta D, Marotta V. Endovascular repair of thoracic stent graft bulging rupture in a patient with multiple thoracic aneurysms due to Takayasu Arteritis disease. J Vasc Surg. 2007;45:391-4.

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