Researchers Describe Clinical Features of TAK With PAI

Patients with takayasu arteritis (TAK) with pulmonary artery involvement (PAI) were more likely to have dyspnea, pulmonary arterial hypertension, ischemic heart disease, respiratory infection, and nontuberculous mycobacteria than TAK patients without PAI, according to a recent report.

The retrospective study collected data from 166 patients with TAK, 14% (24) of whom had PAI. Among these patients, the researchers found that they were significantly more likely than TAK patients without PAI to exhibit several conditions, including dyspnea (25% vs 8.6%)

“Our results indicated that TAK patients with PAI had dyspnea more frequently than those without PAI, consistent with the report by He et al., suggesting that PAI should be considered when TAK patients complain of dyspnea,” noted the researchers. “Further examination may find PAI sooner, potentially increasing the precautions taken for cardiovascular disease and respiratory infections, including NTM.”

Patients with both TAK and PAI were also significantly more likely to have pulmonary arterial hypertension (16.7% vs 0%), ischemic heart disease (29% vs 9.3%), respiratory infection (25% vs 6%), and nontuberculous mycobacteria (20.8% vs 0.8%). Notably, the researchers believe their study is the first to document an association between PAI and IHD.

Meanwhile, patients with TAK and PAI were significantly less likely to have renal artery stenosis (0% vs 17%).

In their sample, right PA lesions were more frequent than left PA lesions, and occlusion (54.25%), which was the most common type of PAI, followed by stenosis (33.3%) and dilation (12.5%), which the researchers noted is consistent with previous study findings.

“Our results suggest that the TAK subgroups have different vascular involvement preferences. For example, Types IIa and IIb were more frequent in patients with PAI than in those without, descending aorta involvement was less frequent in patients with PAI, and no PAI patient had Type IV TAK,” wrote the researchers. “Gribbons et al. reported that patients with TAK and giant cell arteritis could be divided into six clusters, one of which was more likely to have abdominal lesions and another to have bilateral subclavian and carotid artery lesions.”

The majority of patients, regardless of PAI status, received glucocorticoids. Treatment decisions like maximum glucocorticoid dose, immunosuppressant administration, biologics administration, a combination of immunosuppressants and biologics, antiplatelet therapy, cardiovascular surgery, and catheter treatment did not differ between the 2 groups.

Reference

Mukoyama H, Shirakashi M, Tanaka N, et al. The clinical features of pulmonary artery involvement in Takayasu arteritis and its relationship with ischemic heart diseases and infection. Arthritis Res Ther. Published online December 3, 2021. doi: 10.1186/s13075-021-02675-9