Clinical manifestations, course variants and complications of Takayasu arteritis in Kyrgyz patients

Abstract

Objective: to study clinical presentation, course variants and complications of Takayasu arteritis (AT) in Kyrgyz patients.Patients and methods. 75 Kyrgyz patients with a definite diagnosis of AT were included in the study, most of them were women (93.3%). The median age was 33 [23; 40] years, the median duration of the disease was 7 [3.0; 13.0] years. The anatomical type of vascular lesions was determined using the angiographic classification of R. Moriwaki et al., the AT activity – according to the BVAS index, the clinical stage of AT – using the R. Jefferson classification, the severity and prognosis of the disease – according to the K. Ishikawa classification. Highly sensitivity CRP (hsCRP) was assessed in 44 (58.67%) patients, interleukin 6 (IL6) – in 26 (34.7%). Instrumental procedures included duplex Doppler ultrasonography of peripheral arteries and contrast-enhanced computed pan aortography.Results and discussion. The mean age of AT onset was 24.4±9.4 years. The majority of patients had V anatomical type of vascular lesions (61.3%), vascular stage (89.3%), severe stenosis (54.7%) with predominant affection of the brachiocephalic trunk (68%), common carotid arteries (53.7 %) and renal (52%) arteries. Most patients (82.7%) at the time of inclusion in the study had a severe exacerbation of AT according to the BVAS index. An increase in hsCRP level was seen in 66% of cases, IL6 – in 31%. At the onset of AT, 20% of patients had fever, general weakness, weight loss, myalgia and/or arthralgia. 43% of patients had ≥2 complications. The clinical manifestations of AT were mainly characterized by cardiovascular pathology (77.3%) with the formation of relative aortic valve insufficiency (AVI) (93.1%) and kidney damage (57.3%) with the development of renovascular arterial hypertension (91%). At the first visit, more than one third of patients (37.3%) had irreversible damage, accompanied in half of them by AVI degree II or III.Conclusion. Young women predominated among Kyrgyz patients with AT. Most of the patients had anatomical type V AT (61.3%), vascular stage (89.3%), severe stenosis (54.7%), affection of the brachiocephalic trunk (68%), common carotid (57.3%) and renal (52%) arteries. Severe exacerbation of the disease was observed in 82.7% of patients. The presence of ≥2 complications worsened the prognosis of AT. The clinical manifestations of AT were characterized mainly by cardiovascular pathology (77.3%) and kidney damage (57.3%). In more than one third of patients (37.3%) AT was diagnosed late.