Long-Term Outcomes and Prognostic Factors of Complications in Takayasu's Arteritis: A Multicenter Study of 318 Patients
Background—Due to the wide variation in the course of Takayasu arteritis (TA), predicting outcome is challenging. We assess long term outcome and prognosis factors for vascular complications in patients with TA.
Methods—Retrospective multicenter study of characteristics and outcomes of 318 TA patients fulfilling American College of Rheumatology and/or Ishikawa criteria were analyzed. Factors associated with event-free survival (EFS), relapse-free survival (RFS) and incidences of vascular complications were assessed. Risk factors for vascular complications were identified in a multivariable model.
Results—The median age at TA diagnosis was 36 [25-47] years and 276 patients (86.8%) were women. After a median follow-up of 6.1 years, relapses were observed in 43%, vascular complications in 38% and death in 5%. Progressive clinical course was observed in 45%, carotidodynia in 10% and retinopathy in 4%. The 5- and 10-year event-free survival (EFS), relapse-free survival (RFS) and complication-free survival were 48.2% (42.2; 54.9) and 36.4% (30.3; 43.9), 58.6% (52.7; 65.1) and 47.7% (41.2; 55.1), and 69.9% (64.3;76) and 53.7% (46.8;61.7), respectively. Progressive disease course (p=0.018) and carotidynia (p=0.036) were independently associated with EFS. Male sex (p=0.048), elevated C-reactive protein (p=0.013), and carotidynia (p=0.003) were associated with RFS. Progressive disease course (p=0.017), thoracic aorta involvement (p=0.009), and retinopathy (p=0.002) were associated with complication-free survival.
Conclusions—This nationwide study shows that 50% of TA patients will relapse and experience a vascular complication within 10 years from diagnosis. We identified specific characteristics that identified those at highest risk for subsequent vascular complications.
- Received December 23, 2016.
- Revision received June 1, 2017.
- Accepted June 23, 2017.