Abstract
BackgroundsTakayasu arteritis (TAK) is a chronic, granulomatous vasculitis correlated with tuberculosis (TB). The two diseases share similar pathological characteristics and clinical manifestations which increase the difficulty to diagnose. Active tuberculosis (ATB) has implications for treatment strategies in TAK patients. Therefore, the investigation of clinical features and potential risk factors of ATB in TAK patients is vital.MethodsThe study reviewed hospitalized patients diagnosed with TAK in our hospital from 2008, to 2021. TAK patients with ATB were enrolled as the case group. The control group was randomly selected in a 3:1 ratio. The clinical characteristics of TAK patients with and without ATB were compared. Multivariate logistic regression analysis was performed to determine risk factors for ATB in TAK patients.ResultsWe reviewed 1,789 patients and ultimately identified 30 (1.7%) ATB cases. TAK patients with ATB were more prone to develop symptoms including fever (p=0.001), fatigue (p=0.003), cough (p=0.037), expectoration (p<0.001), weight loss (p=0.003), and night sweating (p<0.001). Increased level of hypersensitive C reactive protein (hsCRP, p=0.001), decreased level of albumin (p=0.031), and higher positive rate of T-SPOT.TB test (p<0.001) were observed in the case group. Multivariate logistic regression analysis revealed that hsCRP >8 mg/L (OR 9.108; 95% CI, 1.096–75.711; p=0.041) and positive T-SPOT.TB result (OR 68.669; 95% CI, 7.291–646.738; p<0.001) were risk factors for ATB in TAK patients. The proportion of patients undergoing subsequent surgery for Takayasu arteritis was lower in patients with ATB (p<0.001).ConclusionOur study suggested that the diagnosis of ATB should be considered when TAK patients experienced symptoms including fever, fatigue, weight loss, etc. hsCRP >8 mg/L and positive T-SPOT.TB result were identified as independent risk factors for ATB in TAK patients.
Highlights
Takayasu arteritis (TAK) is a chronic, granulomatous, largevessel vasculitis involving the aorta and its major branches
The studies with appreciable sample size focused on clinical characteristics in patients with TAK with and without TB infection, which did not distinguish active tuberculosis (ATB) from other states of TB infection: latent tuberculosis infection (LTBI) or previous tuberculosis (PTB) [10, 11]
Thirty (25.0%) of included patients were confirmed with the diagnosis of ATB during the disease course of TAK, while the remaining 90 patients (75.0%) without ATB were categorized into the control group with a median follow-up period of 21.3 (5.8, 42.7) months
Summary
Takayasu arteritis (TAK) is a chronic, granulomatous, largevessel vasculitis involving the aorta and its major branches. It has been reported that TAK is correlated with tuberculosis (TB), which is a considerable disease burden worldwide [4]. Pathological characteristics of both diseases are granulomas and caseous necrosis, and their constitutional symptoms overlap [5]. TAK patients with major blood vessel involvement may require surgical intervention, while ATB is an absolute contraindication for surgery. The studies with appreciable sample size focused on clinical characteristics in patients with TAK with and without TB infection, which did not distinguish ATB from other states of TB infection: latent tuberculosis infection (LTBI) or previous tuberculosis (PTB) [10, 11]
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