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Volume 35, Issue 1, March 2024



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Mediterr J Rheumatol 2023;34(4):427-35
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Pre-Pulseless Takayasu Arteritis is Associated with Distinct Clinical and Angiographic Features but Similar Outcomes – A Cohort Study
Durga Prasanna Misra1, Upendra Rathore1, Swapnil Jagtap1, Prabhaker Mishra2, Darpan R Thakare1, Kritika Singh1, Tooba Qamar1, Deeksha Singh1, Juhi Dixit1, Manas Ranjan Behera3, Neeraj Jain4, Manish Ora5, Dharmendra Singh Bhadauria3, Sanjay Gambhir5, Vikas Agarwal1, Sudeep Kumar6
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1Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

2Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

3Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

4Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

5Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

6Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

 

DP Misra, U Rathore, S Jagtap, P Mishra, DR Thakare, K Singh, T Qamar, D Singh, J Dixit, MR Behera, N Jain, M Ora, D Singh Bhadauria, S Gambhir, V Agarwal, S Kumar

Abstract

Objectives:   To compare the presentation, angiographic features, evolution, and prognosis of pre-pulseless Takayasu arteritis (TAK) with TAK with pulse loss. Methods: Pre-pulseless TAK (defined as without pulse loss in the upper limbs, lower limb, carotid, or subclavian arteries) were identified from a cohort of TAK. Demographic characteristics, clinical features, angiographic involvement, baseline and longitudinal patterns of disease activity, medication use, and mortality rates were compared between pre-pulseless TAK and TAK with pulse loss. Adjusted odds ratios (aOR, with 95%CI) for categorical variables between pre-pulseless TAK and TAK with pulse loss were computed using multivariable-adjusted logistic regression models. Time-to-event data was compared using hazard ratios (HR) with 95%CI. Results: Compared with TAK with pulse loss, pre-pulseless TAK (91/238, 38.24%) more frequently had deranged renal function (aOR 4.43, 95%CI 1.58-12.37) and Hata’s type IV disease (aOR 8.02, 95%CI 2.61-24.65), and less often had pulse or blood pressure asymmetry (aOR 0.34, 95%CI 0.18-0.63), limb claudication (aOR for upper limb 0.38, 95%CI 0.18-0.82, for lower limb 0.28, 95%CI 0.12-0.68), right subclavian (aOR 0.45, 95%CI 0.23-0.90) or left carotid artery involvement (aOR 0.42, 95%CI 0.21-0.84). Only two patients with pre-pulseless TAK developed pulse loss on follow-up. Despite fewer pre-pulseless TAK having active disease at presentation, similar proportions of patients in both groups had active disease on follow-up. Survival was similar in both groups (HR for mortality 0.41, 95%CI 0.09-1.90). Conclusion: Pulse loss on follow-up is uncommon in those with pre-pulseless TAK. Pre-pulseless TAK is associated with similar long-term outcomes to TAK with pulse loss.



Cite this article as: Misra DP, Rathore U, Jagtap S, Mishra P, Thakare DR, Singh K, Qamar T, Singh D, Dixit J, Behera MR, Jain N, Ora M, Bhadauria DS, Gambhir S, Agarwal V, Kumar S. Pre-Pulseless Takayasu Arteritis is Associated with Distinct Clinical and Angiographic Features but Similar Outcomes – A Cohort Study. Mediterr J Rheumatol 2023;34(4):427-35

 

Article Submitted: 29 Nov 2023; Revised Form: 06 Dec 2023; Article Accepted: 06 Dec 2023; Available Online: 30 Dec 2023

This work is licensed under a Creative Commons Attribution 4.0 International License.

©2023 The Author(s).

https://doi.org/10.31138/mjr.301223.ppt

Keywords: Takayasu arteritis, aortic arch syndromes, outcome assessment, pre-pulseless, systemic vasculitis