Rheumatology Division, Universidade Federal de São Paulo-UNIFESP, Rua Botucatu, 740, Third Floor, São Paulo, SP 04023-900, Brazil.
Rheumatol Int. 2012 Mar;32(3):703-9. doi: 10.1007/s00296-010-1694-9. Epub 2010 Dec 9.
In this retrospective longitudinal cohort study we included 52 patients with Takayasu arteritis (TA) who were on regular follow-up at the Vasculitis Unit of Universidade Federal de São Paulo between 2003 and 2009. The mean age at study was 38 years and the mean age at diagnosis was 29 years. Patients were followed for a mean 74.3 months. A relapse-remitting course was observed in 41 patients (78.8%) whereas 9 (17.3%) had a monophasic course and only 2 (3.8%) patients were chronic-active. Disease remission was achieved in 50 patients (96.2%). Angiographic type V was observed in 42.3% of TA patients at diagnosis and in 61.5% during follow-up. The most affected arteries were the abdominal aorta (63.5%) and left subclavian (60.6%). Prednisone was used by 94% of TA patients and immunosuppressive agents were prescribed for 51 (98%) patients. Methotrexate was used by 82.7%, followed by cyclophosphamide (26.9%), azathioprine (25.0%), anti-TNFα agents (5.8%) and leflunomide (5.8%). Although, forty patients (76.9%) used prednisone and methotrexate as initial treatment, 75% of them developed new vascular lesions along follow-up. Eighteen TA patients (34.6%) needed to change immunosuppressive therapy due to failure or toxicity, among them 83.3% presented new lesions. Surgical treatment was performed in 34.6% of patients and restenosis was observed in 13.5% in a median time of 11 months after surgery. In conclusion besides prednisone and methotrexate is largely used in TA, the majority of patients still develop new arterial lesions along time.
在这项回顾性纵向队列研究中，我们纳入了 52 例在 2003 年至 2009 年期间于巴西圣保罗联邦大学血管炎科接受常规随访的 Takayasu 动脉炎（TA）患者。研究时的平均年龄为 38 岁，诊断时的平均年龄为 29 岁。患者的平均随访时间为 74.3 个月。41 例（78.8%）患者表现为复发缓解型病程，9 例（17.3%）为单相病程，仅 2 例（3.8%）为慢性活动型。50 例（96.2%）患者达到疾病缓解。52 例患者中有 42.3%在诊断时和 61.5%在随访期间出现血管造影 V 型病变。最常受累的动脉为腹主动脉（63.5%）和左锁骨下动脉（60.6%）。94%的 TA 患者使用泼尼松，51 例（98%）患者使用免疫抑制剂。82.7%的患者使用甲氨蝶呤，其次是环磷酰胺（26.9%）、硫唑嘌呤（25.0%）、抗 TNFα 药物（5.8%）和来氟米特（5.8%）。虽然 40 例（76.9%）患者最初接受泼尼松和甲氨蝶呤治疗，但在随访期间，75%的患者出现新的血管病变。18 例 TA 患者（34.6%）因治疗失败或毒性需要更换免疫抑制剂治疗，其中 83.3%的患者出现新病变。34.6%的患者接受了手术治疗，中位时间为 11 个月后发生再狭窄，发生率为 13.5%。总之，除了泼尼松和甲氨蝶呤广泛用于 TA 治疗外，大多数患者在随访过程中仍会出现新的动脉病变。
