Polachek Ari, Pauzner Rachel, Levartovsky David, Rosen Galia, Nesher Gideon, Breuer Gabriel, Anouk Marina, Arad Uri, Sarvagyl-Maman Hagit, Kaufman Ilana, Caspi Dan, Elkayam Ori
Department of Rheumatology, Tel Aviv Sourasky Medical Center, 6 Weizman st, Tel Aviv, 64239, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel,
Clin Rheumatol. 2015 Apr;34(4):721-7. doi: 10.1007/s10067-014-2813-x. Epub 2014 Nov 23.
The objective of this study is to describe a series of patients above the age of 50 years with large vessel arteritis and vascular involvement typical of TAK. A retrospective review of 18 patients (median age 64 years) with emphasis on clinical characteristics, laboratory values, and vascular involvement by CT, MRI, or planar angiography. Five patients fulfilled the ACR criteria for GCA, five for TAK, three both GCA and TAK, while five patients did not fulfill the criteria for either disease. The dominant presenting symptoms were constitutional, while only a few patients had cranial or peripheral symptoms. Sixty-one percent had physical signs of vascular compromise. Temporal artery biopsy showed giant cell arteritis in six out of nine biopsies. Arterial involvement: 78 % had either involvement of the ascending aorta, the aortic arch, descending or/and abdominal aorta, 9 carotid, 12 subclavian, 5 axillary, 3 renal, 7 iliac, and 2 femoral arteries; 7 mesenteric or celiac trunk. All the patients were treated with prednisone and 50 % with steroid-sparing drug. Nine out of 15 patients (60 %) achieved remission after 1 year of follow-up. No substantial differences in the distribution of vascular involvement, type of treatment, or outcome measures were observed between patients fulfilling criteria for GCA or TAK. Vascular involvement typical of TAK in patients above the age of 50 years with large vessel arteritis seems to be more frequent than previously assumed. Our findings support the assumption that TAK and GCA represent a spectrum of the same disease.
本研究的目的是描述一系列年龄在50岁以上、患有大血管动脉炎且有典型大动脉炎（TAK）血管受累情况的患者。对18例患者（中位年龄64岁）进行回顾性研究，重点关注临床特征、实验室检查值以及通过CT、MRI或平面血管造影显示的血管受累情况。5例患者符合美国风湿病学会（ACR）巨细胞动脉炎（GCA）标准，5例符合TAK标准，3例同时符合GCA和TAK标准，而5例患者不符合这两种疾病的标准。主要的首发症状为全身性症状，只有少数患者有头颅或外周症状。61%的患者有血管受损的体征。颞动脉活检显示，9例活检中有6例存在巨细胞动脉炎。动脉受累情况：78%的患者有升主动脉、主动脉弓、降主动脉或/和腹主动脉受累，9例有颈动脉受累，12例有锁骨下动脉受累，5例有腋动脉受累，3例有肾动脉受累，7例有髂动脉受累，2例有股动脉受累；7例有肠系膜或腹腔干受累。所有患者均接受泼尼松治疗，50%的患者同时使用了激素节省药物。15例患者中有9例（60%）在随访1年后病情缓解。在符合GCA或TAK标准的患者之间，未观察到血管受累分布、治疗类型或预后指标方面的显著差异。50岁以上患有大血管动脉炎的患者中，典型TAK血管受累情况似乎比之前认为的更为常见。我们的研究结果支持TAK和GCA代表同一种疾病谱的假设。
