Background: Assessment of disease activity in patients with Takayasu’s arteritis(TA) is difficult due to absence of definitive tests. Presence of carotid intima-medial thickening has been suggested as a possible mark...Background: Assessment of disease activity in patients with Takayasu’s arteritis(TA) is difficult due to absence of definitive tests. Presence of carotid intima-medial thickening has been suggested as a possible marker of inflammation and disease activity. Methods: We evaluated common carotid artery carotid intima-medial thickness(CCA-IMT) in 56 common carotid arteries(CCAs) in 28 healthy controls and 74 CCAs in 37 patients of TA.We correlated these findings with the presence of activity as assessed by the National Institutes of Health(NIH) cri- teria. Results: CCA-IMT was increased(>0.8 mm) in 59% of the patients with TA. In patients with disease activity, the CCA-IMT was more than in those without activity(1.5± 0.16 vs. 0.9± 0.2 mm, P< 0.005). This is presumably because of ongoing inflammation causing abnormal thickening. Even among patients without active disease, CCA-IMT was more than in controls(0.9± 0.2 vs. 0.6± 0.1 mm, P< 0.05) possibly due to a milder degree of inflammation or healing with fibrosis. All patients with angiographic carotid obstruction had increased CCA-IMT irrespective of whether they were active or not. However, in patients with angiographically normal carotid arteries, CCA-IMT was increased only among the patients who were active(1.4± 0.2 vs. 0.7± 0.04, P< 0.05). Abnormal CCA-IMT as marker of disease activity had a sensitivity of 82% and specificity of 60% . On excluding patients with increased CCA-IMT who had angiographic carotid stenosis(because the increase in CCA-IMT cannot be attributed entirely to activity alone in these patients), the specificity increased to 70% . Conclusion: Increased CCA-IMT is a reliable marker of active disease, especially in the absence of angiographically visible carotid disease.展开更多
Takayasu’s arteritis could result in chronic ocular ischemia with a spectrum of changes that is referred to as Takayasu retinopathy. The role of an ophthalmologist includes photocoagulation, monitoring for complicati...Takayasu’s arteritis could result in chronic ocular ischemia with a spectrum of changes that is referred to as Takayasu retinopathy. The role of an ophthalmologist includes photocoagulation, monitoring for complications, and timely referral for intervention. This article illustrates one such case that was effectively managed.展开更多
Takayasu arteritis (TA) is a chronic inflammatory vasculitis of the aorta and its major branches with a very low incidence in Europe and North America. Our objective was to determine the elastic properties of the affe...Takayasu arteritis (TA) is a chronic inflammatory vasculitis of the aorta and its major branches with a very low incidence in Europe and North America. Our objective was to determine the elastic properties of the affected ascending and descending aortic walls non-invasively in a 14-year-old Iraqi girl with a 3-year history of fever, fatigue, malaise and diffuse pain. Ultrasound and magnetic resonance angiography showed marked thickening of the aorticwall, dilatation of the aortic arch, and decreased luminal diameters of the abdominal aorta and both subclavian arteries, consistent with TA. Ascending and descending aortic elastic properties such as distensibility and stiffness index were markedly reduced compared to a group of healthy controls (n=39): ascending aortic distensibility was 20 kPa-1× 10-3 versus 63± 23 kPa-1× 10-3 in controls, and the ascending aortic stiffness index 9.6 versus 3.5± 1.3 in controls. Although the patient’ s general condition improved rapidly on oral prednisolone and azathioprine and inflammatory parameters normalised within 3 weeks, the aortic elastic parameters did not change during the first 2 weeks of anti-inflammatory treatment. Unfortunately, no further follow-up was possible. Conclusion: In patients with Takayasu arteritis, non-invasive quantification of reduced aortic elastic properties can help to assess aortic involvement, and possibly to follow disease activity and vascular response to therapy.展开更多
Pyoderma gangrenosum(PG) is a neutrophilic dermatosis characterized by destructive,necrotizing and noninfective ulceration of the skin mostly on lower extremities PG is well known as a complication of Takayasus arte...Pyoderma gangrenosum(PG) is a neutrophilic dermatosis characterized by destructive,necrotizing and noninfective ulceration of the skin mostly on lower extremities PG is well known as a complication of Takayasus arteritis in Japan, However, this association is not commonly observed in North American and European patients We describe a case of PG that was associated with Takayasus arteritis who was successfully treated with systemic cyclosporin We have reviewed 35 well documented PG cases with Takayasus arteritis in comparison to 106 PG cases without Takayasus arteritis The results demonstrate that this association occurs pred ominantly in young females and that these cases exhibit more widespread PG展开更多
文摘Background: Assessment of disease activity in patients with Takayasu’s arteritis(TA) is difficult due to absence of definitive tests. Presence of carotid intima-medial thickening has been suggested as a possible marker of inflammation and disease activity. Methods: We evaluated common carotid artery carotid intima-medial thickness(CCA-IMT) in 56 common carotid arteries(CCAs) in 28 healthy controls and 74 CCAs in 37 patients of TA.We correlated these findings with the presence of activity as assessed by the National Institutes of Health(NIH) cri- teria. Results: CCA-IMT was increased(>0.8 mm) in 59% of the patients with TA. In patients with disease activity, the CCA-IMT was more than in those without activity(1.5± 0.16 vs. 0.9± 0.2 mm, P< 0.005). This is presumably because of ongoing inflammation causing abnormal thickening. Even among patients without active disease, CCA-IMT was more than in controls(0.9± 0.2 vs. 0.6± 0.1 mm, P< 0.05) possibly due to a milder degree of inflammation or healing with fibrosis. All patients with angiographic carotid obstruction had increased CCA-IMT irrespective of whether they were active or not. However, in patients with angiographically normal carotid arteries, CCA-IMT was increased only among the patients who were active(1.4± 0.2 vs. 0.7± 0.04, P< 0.05). Abnormal CCA-IMT as marker of disease activity had a sensitivity of 82% and specificity of 60% . On excluding patients with increased CCA-IMT who had angiographic carotid stenosis(because the increase in CCA-IMT cannot be attributed entirely to activity alone in these patients), the specificity increased to 70% . Conclusion: Increased CCA-IMT is a reliable marker of active disease, especially in the absence of angiographically visible carotid disease.
文摘Takayasu’s arteritis could result in chronic ocular ischemia with a spectrum of changes that is referred to as Takayasu retinopathy. The role of an ophthalmologist includes photocoagulation, monitoring for complications, and timely referral for intervention. This article illustrates one such case that was effectively managed.
文摘Takayasu arteritis (TA) is a chronic inflammatory vasculitis of the aorta and its major branches with a very low incidence in Europe and North America. Our objective was to determine the elastic properties of the affected ascending and descending aortic walls non-invasively in a 14-year-old Iraqi girl with a 3-year history of fever, fatigue, malaise and diffuse pain. Ultrasound and magnetic resonance angiography showed marked thickening of the aorticwall, dilatation of the aortic arch, and decreased luminal diameters of the abdominal aorta and both subclavian arteries, consistent with TA. Ascending and descending aortic elastic properties such as distensibility and stiffness index were markedly reduced compared to a group of healthy controls (n=39): ascending aortic distensibility was 20 kPa-1× 10-3 versus 63± 23 kPa-1× 10-3 in controls, and the ascending aortic stiffness index 9.6 versus 3.5± 1.3 in controls. Although the patient’ s general condition improved rapidly on oral prednisolone and azathioprine and inflammatory parameters normalised within 3 weeks, the aortic elastic parameters did not change during the first 2 weeks of anti-inflammatory treatment. Unfortunately, no further follow-up was possible. Conclusion: In patients with Takayasu arteritis, non-invasive quantification of reduced aortic elastic properties can help to assess aortic involvement, and possibly to follow disease activity and vascular response to therapy.
文摘Pyoderma gangrenosum(PG) is a neutrophilic dermatosis characterized by destructive,necrotizing and noninfective ulceration of the skin mostly on lower extremities PG is well known as a complication of Takayasus arteritis in Japan, However, this association is not commonly observed in North American and European patients We describe a case of PG that was associated with Takayasus arteritis who was successfully treated with systemic cyclosporin We have reviewed 35 well documented PG cases with Takayasus arteritis in comparison to 106 PG cases without Takayasus arteritis The results demonstrate that this association occurs pred ominantly in young females and that these cases exhibit more widespread PG
