Takayasu's arteritis in Mexico: a clinical review of 44 consecutive cases.

OBJECTIVES

To review our experience in clinical diagnosis of the non-specific arteritis called Takayasu's arteritis (TA), and to assess its possible relationship with previous mycobacterial infections as judged by delayed hypersensitivity skin test.

METHODS

We examined 44 consecutive patients in Mexico City. All of them fulfilled the ACR criteria for the classification of TA and had a characteristic panaortogram in the absence of any other arterial or systemic disease.

RESULTS

Forty-three of our patients were Mexican mestizos; only one had a Caucasian appearance. 38 were women, and the age at diagnosis ranged from 15 to 64 years with a mean of 32 and a median of 35. Age at onset of the symptoms was under 30 years in most cases. Five patients had type I disease, and 4 had type II. Most had a diffuse arteritis (type III), and in seven cases involvement of the pulmonary artery (type IV) was recognized. All patients showed abnormal peripheral pulses and blood pressure differences, 35 had systemic arterial hypertension and 7 pulmonary hypertension. A noisy vascular auscultation was very common and cardiac ailments were also found in many cases. Systemic complaints such as fever, weight loss and malaise were present in the active stages of the disease. Arthritis did occur in a single case, arthralgia was frequent and inflammatory nodules involving the shin, perimalleolar area, and the antero-external surface of the distal leg were also common. Polyclonal hypergammaglobulinemia was a frequent finding in active and inactive cases; leukocytosis with neutrophilia, accelerated ESR and high fibrinogen, however, did occur when the disease was active. Eight of our patients had a previous diagnosis of tuberculosis, and 81% developed a delayed skin reactivity to PPD (2U old tuberculin). None had a bacteriologic diagnosis of tuberculosis or mycobacterial disease.

CONCLUSION

Non-specific arteritis, or Takayasu's disease, frequently affects young women of colored race in Mexico. Late diagnosis is common and cardiovascular features dominate the clinical picture. Arterial compromise is widespread and may involve the pulmonary artery and its branches. Most cases are inactive and morbidity results from systemic arterial hypertension and heart disease; active cases have systemic complaints and laboratory abnormalities suggestive of ongoing inflammation. The close relationship between Takayasu's arteritis and previous contact with Mycobacterium tuberculosis was again confirmed in our series, although further studies are necessary to clarify this probable relationship.