Abstract
BackgroundTakayasu Arteritis is an idiopathic, chronic, large vessel vasculitis involving the aorta and its primary branches. Few studies have been done in pediatric patients to date with the largest case series of US patients published in 2003 consisting of only 6 patients.MethodsA retrospective chart review was performed on all patients seen at Cleveland Clinic Children’s up until 2012 who met EULAR/PRINTO/PRES classification criteria for childhood Takayasu Arteritis.ResultsTwenty-one patients with a mean follow up of 2.3 years were studied. Weight loss, fatigue, and anorexia were the most common presenting complaints. 57.1% of patients were hypertensive at first visit. The most common examintation finding was diminished pulses (61.9%), followed by bruits, and then murmurs. Thoracic aorta stenosis was the most common vascular abnormality. Seven of twenty-one patients responded well to methotrexate and prednisone alone. Ten of twenty-one patients required an additional medication for symptom and disease control (infliximab most commonly). About two-thirds of patients required at least one anti-hypertensive medication. Eight of the twenty-one patients required surgical intervention for severe disease refractory to medications (renal artery stenosis being the most common indication). Almost all patients reported symptomatic improvement after surgical intervention. Two of the eight patients required a second surgery for return of symptoms. Disease sequelae included arterial aneurysms, resolved heart failure, and hypertensive emergencies.ConclusionOur study emphasizes that constitutional symptoms coupled with objective findings of diminished pulses, bruits, and hypertension should raise clinical suspicion for Takayasu Arteritis in pediatric patients. Pharmacologic therapy alone can be successful in controlling disease progression, however surgery was successful in minimizing symptoms when medical therapies failed.
Highlights
Takayasu Arteritis is an idiopathic, chronic, large vessel vasculitis involving the aorta and its primary branches
An article published by Brunner et al in 2010 summarized the pertinent findings from almost all studies in pediatric Takayasu Arteritis (TA) patients to date including 9 case series from medical centers in Turkey, Canada, USA, South Africa, Korea, India, and Mexico and 41 case reports representing a total of 241 patients
The primary aim of this study was to review the clinical presentation of TA in a contemporary cohort of United States children using recently validated European League Against Rheumatism (EULAR)/Pediatric Rheumatology International Trials Organization (PRINTO)/ Pediatric Rheumatology European Society (PRES) classification criteria, including the frequencies of anatomic arterial involvement
Summary
Takayasu Arteritis is an idiopathic, chronic, large vessel vasculitis involving the aorta and its primary branches. Few studies have been done in pediatric patients to date with the largest case series of US patients published in 2003 consisting of only 6 patients. Takayasu Arteritis (TA) is an idiopathic, chronic, large vessel arteritis involving the aorta and its primary branches [1]. An article published by Brunner et al in 2010 summarized the pertinent findings from almost all studies in pediatric TA patients to date including 9 case series from medical centers in Turkey, Canada, USA, South Africa, Korea, India, and Mexico and 41 case reports representing a total of 241 patients. One-third of children present after the acute phase and suffer effects of tissue ischemia with a median time from symptom onset to diagnosis of 19 months, close to four times longer than adults [3,6,7]
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