Takayasu Arteritis and Giant Cell Arteritis A Spectrum Within the Same Disease?
Takayasu Arteritis and Giant Cell Arteritis A Spectrum Within the Same Disease?
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DOI：
10.1097/md.0b013e3181af70c1
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发表时间：
2009-07-01
期刊：
影响因子：
1.6
通讯作者：
Hoffman, Gary S.
中科院分区：
文献类型：
--
作者：
Maksimowicz-McKinnon, Kathleen;Clark, Tiffany M.;Hoffman, Gary S.
巨细胞动脉炎（GCA）和高松动脉炎（TAK）根据其临床特征、发病年龄和种族分布被认为是不同的疾病。然而，仔细检查，这些疾病显得相似多于不同。这些疾病的动脉病变的组织病理学可能难以区分。影像学研究显示，至少60%的GCA患者存在大血管炎症。我们质疑这些疾病之间的区别是否在一定程度上是由于收集历史和物理数据的偏见而造成的。我们假设GCA和风湿性多肌痛的体征和症状发生在TAK患者中，但由于这种偏倚，报道不足。我们对75例TAK患者和69例GCA患者（按美国风湿病学会标准）进行了回顾性研究。使用标准化数据库记录诊断前后一年内可归因于疾病的体征和症状、治疗和介入结果以及死亡率。所有病例均由一名医生评估，对患有两种疾病的患者使用相同的病史和体格检查表。患者以女性为主（占91%）。GCA 82%)和白色（TAK 88%, GCA 95%）。新发头痛是52%的TAK患者和70%的GCA患者的主要症状。所有TAK患者均行血管影像学检查，发现有大血管异常。然而，只有一小部分GCA患者（43/69 62%）进行了类似的研究。在该组中，73%的GCA患者至少有一种动脉病变。在TAK和GCA中，最常见的受累部位是主动脉（TAK 77%, GCA 65%）和锁骨下动脉（TAK 65%, GCA 37%）。与TAK患者相比，GCA患者的下颌跛行（GCA 33%, TAK 5%），视力模糊（GCA 29%, TAK 8%），复视（GCA 9%, TAK 0%）和失明（GCA 14%, TAK 0%）的患病率更高。GCA或TAK特征性的症状、体征和影像学异常在这两种疾病中都经常出现，尽管频率不同。这些发现支持了这样一种假设，即这些疾病可能不是不同的实体，而是在单一疾病的频谱中代表扭曲的表型。表现频率的差异可能反映了每种疾病患者数据收集方式的显著偏差，以及血管和免疫衰老的影响。
Giant cell arteritis (GCA) and Takayasu arteritis (TAK) have been considered distinct disorders based on their clinical features, age of onset, and ethnic distribution. However, oil closer examination, these disorders appear more similar than different. The histopathology of arterial lesions in these diseases may be indistinguishable. Imaging studies have revealed large vessel inflammation in at least 60% of patients with GCA. We questioned whether the distinctions between these diseases might in part be all artifact due to bias in gathering historical and physical data. We postulated that signs and symptoms of GCA and polymyalgia rheumatica occur in patients with TAK but have been under-reported as a result of this bias.We performed a retrospective review of 75 patients with TAK and 69 patients with GCA (per American College of Rheumatology criteria). Signs and symptoms attributable to disease within the year before and following diagnosis, treatment and interventional outcomes, and mortality were recorded using a standardized database. All cases were evaluated by a single physician, using identical history and physical examination forms for patients with both diseases.Patients were predominantly female (TAK 91%. GCA 82%) and white (TAK 88%, GCA 95%). New headache was a presenting symptom in 52% of TAK and in 70% of GCA patients. All TAK patients underwent vascular imaging studies and were demonstrated to have large vessel abnormalities. However, only a subset of patients with GCA (43/69 62%) was similarly studied. Among this group, 73% of GCA patients had at least I arterial lesion identified. In both TAK and GCA, the most common sites of involvement were the aorta (TAK 77%, GCA 65%) and subclavian (TAK 65%, GCA 37%) arteries. Compared to patients with TAK, patients with GCA had a greater prevalence of jaw claudication (GCA 33%, TAK 5%), blurred vision (GCA 29%, TAK 8%), diplopia (GCA 9%, TAK 0%), and blindness (GCA 14%, TAK 0%).Symptoms, signs, and imaging abnormalities that are characteristic of GCA or TAK are often present, albeit in differing frequencies, in both disorders. These findings lend support to the hypothesis that these diseases may not be distinct entities, but represent skewed phenotypes within the spectrum of a single disorder. Differences in frequencies of manifestations may reflect a significant bias in how data are gathered for patients with each disease, as well as the influence of vascular and immunologic senescence.