How often do relapse and vascular complications occur over time in Takayasu arteritis?

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Takayasu arteritis (TA) varies widely in its course, making outcomes difficult to predict. Researchers assessed long-term outcomes and prognostic factors for vascular complications in patients with TA.

This retrospective nationwide multicenter study analyzed the characteristics and outcomes of 318 patients with TA who fulfilled the American College of Rheumatology and Ishikawa criteria. The researchers assessed factors associated with event-free survival, relapse-free survival, and the incidence of vascular complications. They used a multivariable model to identify risk factors for vascular complications.

The median age at TA diagnosis was 36 [25–47] years, and 276 patients (86.8%) were women. After a median follow-up of 6.1 years, relapse was observed in 43%, vascular complications in 38%, and death in 5%. A progressive clinical course was observed in 45%, carotidodynia in 10%, and retinopathy in 4%.

At 5 and 10 years, respectively, event-free survival was 48.2% (42.2; 54.9) and 36.4% (30.3; 43.9); relapse-free survival was 58.6% (52.7; 65.1) and 47.7% (41.2; 55.1); and complication-free survival was 69.9% (64.3; 76.0) and 53.7% (46.8; 61.7).

A progressive disease course (P = 0.018) and carotidynia (P = 0.036) were independently associated with event-free survival. Male sex (P = 0.048), elevated C-reactive protein (P = 0.013), and carotidynia (P = 0.003) were associated with relapse-free survival. A progressive disease course (P = 0.017), thoracic aorta involvement (P = 0.009), and retinopathy (P = 0.002) were associated with complication-free survival.

The researchers concluded that 50% of patients with TA relapse and experience a vascular complication within 10 years of diagnosis. They identified specific characteristics associated with the highest risk of subsequent vascular complications.