AB0609 Gaps in the diagnosis of Takayasu Arteritis: a Romanian cohort

Abstract

BackgroundThe diagnosis of Takayasu arteritis still represents a big challenge, even though the disease was first described more than 100 years ago. Proof of that is the continuing effort to develop criteria with high specificity and sensitivity.1ObjectivesThe aim of the study was to describe the clinical and paraclinical aspects of the disease at the time of diagnosis. Additionally, we wanted to evaluate the damage score in view of the diagnosis delay.MethodsWe retrospectively studied the clinical chart of 17 consecutive patients admitted to the Rheumatology Clinic of Emergency County Hospital from Cluj-Napoca, Romania between 2003 and 2021.ResultsThere was just one man in the cohort (0.05%). The average age at the time of diagnosis was 37.5 years old. The average delay in the diagnosis was 33 months, while the biggest delay was of 240 months. The diagnosis was made by rheumatologists in 58% of the cases, while 29% by cardiologists and 11.7% by internal medicine specialists. The most frequent symptoms were limb claudication (64.7%), fatigue (52.9%) and headache (52.9%). Vascular bruits were found in most of the patients at the time of diagnosis (70.5%), as well as blood pressure and pulse difference between arms (52.9%). Unobtainable blood pressure was seen in 5 patients (29.4%). There was a discrepancy in 3 patients (17.6%) between inflammatory markers and inflammation in the vessels’ walls, as confirmed by imaging techniques (angioMRI or angioCT). Most of the patients were classified as type V arteritis (35%), followed by type IV (18%), type I (17%), type IIA, respectively type IIB (12% each) and type III (6%). Stenosis of the involved arteries occurred 4.3 times more than aneurysm formation. Eight patients required vascular interventions at the time of diagnosis – four were treated by balloon angioplasty and six by stent placing. The average TADS (Takayasu Arteritis Damage Score) was 1.5 and it was not associated with delay in diagnosis (p>0.05).ConclusionTakayasu arteritis is a disease with heterogenous and nonspecific symptoms. For those reasons the delay in diagnosis is usually long, the treatment is started late and damage appears early in the course of the disease. This is reflected by the high amounts of vascular procedures needed at the time of diagnosis. We need better diagnostic criteria and specific monitoring scores.