Furuta Shunsuke, Cousins Claire, Chaudhry Afzal, Jayne David
From the Lupus and Vasculitis Clinic, and the Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.S. Furuta, MD, PhD; A.N. Chaudhry, MD, PhD; D. Jayne, MD, FRCP, Director, Lupus and Vasculitis Clinic, Addenbrooke's Hospital; C. Cousins, MD, FRCP, Department of Radiology, Addenbrooke's Hospital.
J Rheumatol. 2015 Feb;42(2):300-8. doi: 10.3899/jrheum.140562. Epub 2014 Nov 15.
Takayasu arteritis (TAK) and giant cell arteritis (GCA) are 2 major variants of large vessel vasculitis (LVV). The frequent involvement of large vessels in GCA has raised the possibility that TAK and GCA should be regarded as 1 disease. By detailed phenotyping of a single-center cohort, we aimed to define the differences between TAK and GCA.
Forty-five patients (23 TAK, 22 GCA) were identified. Baseline characteristics, clinical symptoms, laboratory data, enhanced computed tomography/magnetic resonance imaging, treatments, and clinical courses were retrospectively assessed with descriptive statistics. In addition, latent class analysis of the 45 patients was performed to explore phenotypic differences.
Patients with GCA had more frequent headache (p < 0.01), higher C-reactive protein levels (p = 0.01), and higher erythrocyte sedimentation rates (p = 0.03) than did patients with TAK at diagnosis. With the exception of subdiaphragmatic lesions, the distributions of vessel lesions were not different between TAK and GCA. However, focusing on subclavian and carotid arteries, long tapered-type stenotic lesions were more frequent in GCA than in TAK (p < 0.01). The proportion of patients without relapse was higher in GCA (60%) than in TAK (22%, p = 0.01). Latent class analysis also divided patients with LVV into 2 separate groups consistent with TAK and GCA.
The differences observed in clinical symptoms, inflammatory markers, radiological findings, and clinical courses suggested that TAK and GCA were 2 different diseases. Latent class analysis supported these results. The shape of stenotic lesions in the subclavian and carotid arteries is a useful discriminator between TAK and GCA.
高安动脉炎（TAK）和巨细胞动脉炎（GCA）是大血管血管炎（LVV）的两种主要类型。GCA中大动脉频繁受累引发了一种可能性，即TAK和GCA应被视为同一种疾病。通过对单中心队列进行详细的表型分析，我们旨在明确TAK和GCA之间的差异。
确定了45例患者（23例TAK，22例GCA）。采用描述性统计方法对基线特征、临床症状、实验室数据、增强计算机断层扫描/磁共振成像、治疗方法及临床病程进行回顾性评估。此外，对这45例患者进行潜在类别分析以探索表型差异。
与TAK患者相比，GCA患者在诊断时头痛更为频繁（p < 0.01）、C反应蛋白水平更高（p = 0.01）、红细胞沉降率更高（p = 0.03）。除膈下病变外，TAK和GCA的血管病变分布无差异。然而，聚焦于锁骨下动脉和颈动脉，GCA中长锥形狭窄病变比TAK更常见（p < 0.01）。GCA中无复发患者的比例（60%）高于TAK（22%，p = 0.01）。潜在类别分析也将LVV患者分为与TAK和GCA一致的两个不同组。
在临床症状、炎症标志物、影像学表现及临床病程中观察到的差异表明TAK和GCA是两种不同的疾病。潜在类别分析支持了这些结果。锁骨下动脉和颈动脉狭窄病变的形态是区分TAK和GCA的有用指标。
