[Takayasu's arteritis and atherosclerosis]

Mechanisms and Screening for Atherosclerosis in Adults With Vasculitis

Vascular inflammation is a hallmark of both primary systemic vasculitis and atherosclerosis. As such, cardiovascular events are common in patients with vasculitis and likely due to both direct vascular inflammation and accelerated atherosclerosis. Direct cardiac involvement is possible in all vasculitides, though more commonly described in Takayasu arteritis, polyarteritis nodosa, and eosinophilic granulomatosis with polyangiitis. Accelerated atherosclerosis has been described in Takayasu arteritis and antineutrophil cytoplasmic antibody-associated vasculitis, though there remains a paucity of data in other forms of vasculitis. Multiple screening and management approaches for cardiovascular risk in people with vasculitis have been proposed, though evidence-based guidelines are lacking. In this review, we discuss the latest evidence in epidemiology, mechanisms, and screening for atherosclerosis in patients with primary systemic vasculitides.

Coronary artery lesions in Takayasu arteritis

Introduction

Takayasu arteritis (TAK) is a granulomatous inflammation of vessels of large diameter, mainly affecting the aorta and its proximal branches, which is more common in young women. The incidence of coronary artery disease in TAK is unknown and not sufficiently studied.

Material and methods

A literature review was performed for the period 2003 to 2023 using a search of the PubMed and Scopus scientific databases. We used the following key words to search the academic journal databases: "Takayasu arteritis", "coronary angiography", "myocardial revascularization", "coronary artery disease", "angina pectoris", and "myocardial infarction".

Results

The analysis of studies showed that coronary artery lesions (CAL) in TAK are not uncommon, being identified particularly in children and young individuals. Pathology of the coronary arteries increases the morbidity and mortality of TAK patients. In TAK, the ostia and proximal segments of the coronary arteries are more frequently affected, presenting as stenosis or occlusion with the development of stable coronary artery disease, unstable coronary artery disease, acute myocardial infarction, and sudden death. The diagnosis of TAK and coronary artery pathology is often complicated due to nonspecific manifestations and frequently the absence of symptoms. The treatment of patients with TAK with CAL is challenging and requires both pharmacological therapy and interventional or surgical methods of myocardial revascularization.

Conclusions

Takayasu arteritis is a more prevalent cause of CAL development, especially in young patients, than previously believed, and cardiovascular death due to CAL is not rare. Early diagnosis of TAK with CAL, particularly occlusion or hemodynamically significant stenosis, and the prompt initiation of appropriate treatment prevent dangerous complications, reduce mortality, and improve prognosis.

[Takayasu's disease: an underdiagnosed entity in Sub-Saharan Africa. Report of five Gabonese cases]

Background

Takayasu's disease (TM) is a vasculitis of the aorta and its main branches, Infectious diseases, especially Mycobacterium tuberculosis, can be a trigger for the development of TM by a hypersensitivity reaction, but paradoxically very few cases of the disease are reported in the literature review.

Materials and methods

Through a retrospective study carried out in the departments of internal medicine and cardiology of the Centre hospitalier universitaire de Libreville (CHUL) in Gabon, we identified all the observations of TM diagnosed in the said departments from 03/2014 to 05/2022, and rediscussed them on the basis of the criteria of Sharma et al. of 1996.

Results

Five patients (3 men, 2 women), with an average age of 38.4 years were found. 2/5 patients reported a history of pulmonary tuberculosis. There was a change in general condition (n=4), fever (n=2), arterial hypertension (n=4), a decrease in the radial pulse (n=2), rheumatological manifestations (n=3), involvement of the serous membranes (n=3). CRP was positive (n=4), and HIV1,2 serology negative (n=5). Echocardiography found pulmonary arterial hypertension (n=1), constrictive pericarditis (n=1) and valvular involvement (minimal aortic insufficiency) (n=1), and typing of aortic involvement by computed tomography or CT angiography staged Takayasu's disease as type IIa (n=2), IIb (n=2) and IV (n=1). The patients were treated with oral corticosteroid therapy (n=5) combined with methotrexate (n=4) and azathioprine (n=1).

Discussion

The criteria of Sharma et al. from 1996, suggest a high probability of TM with a sensitivity of 92.5% and a specificity of 95%. In sub-Saharan Africa, TM requires the elimination of certain differential diagnoses, particularly syphillis, tuberculosis, salmonellosis, and atherosclerosis. Corticosteroid therapy (coupled with immunosuppressive treatment) remains effective, allowing significant remission of the disease, but comes up against the risk of opportunistic infections.

Conclusion

There is a contrast between the involvement of Mycobacterium tuberculosis in the etiopathogenesis of TM on the one hand and the endemic nature of tuberculosis on the African continent on the other hand; which contrasts with the few cases reported in sub-Saharan Africa.

[Takayusu Arteritis on the background of congenital vascular anomaly?]

The article described a female patient with high-grade arterial hypertension diagnosed at her young age. Congenital abdominal aortic hyperplasia and conformity with criteria for Takayasu arteritis were diagnosed at 10 years following the clinical manifestation.