Clinical spectrum and outcome of Takayasu's arteritis in children - 01/10/24

Doi : 10.1016/j.jbspin.2024.105735

Nolan Hassold ^a,^⁎ , Perrine Dusser ^a, Audrey Laurent ^b, Irene Lemelle ^c, Pascal Pillet ^d, Cloé Comarmond ^e, Arsene Mekinian ^f, Marc Lambert ^g, Tristan Mirault ^h, Ygal Benhamou ⁱ, Alexandre Belot ^b, Eric Jeziorski ^j, Héloïse Reumaux ^k, Jean Sibilia ^l, Alexandra Desdoits ^m, Olivier Espitia ⁿ, Albert Faye ^o, Pierre Quartier ^p, David Saadoun ^q, Isabelle Koné-Paut ^a
^a Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP–HP, université de Paris Saclay, Kremlin-Bicêtre, France
^b Department of paediatric rheumatology, Femme–Mère–Enfant Hospital, HCL, Lyon, France
^c Department of paediatric oncology, Hôpitaux de Brabois, CHU, Nancy, France
^d Department of paediatrics, Pellegrin Hospital, CHU, Bordeaux, France
^e Department of internal medicine, Lariboisière Hospital, AP–HP, Paris, France
^f Department of internal medicine, Saint-Antoine Hospital, AP–HP, Sorbonne université, Paris, France
^g Department of internal medicine, Claude-Huriez Hospital, CHU, Lille, France
^h Department of vascular medicine, George-Pompidou Hospital, AP–HP, Paris, France
ⁱ Department of internal medicine, Charles-Nicolle Hospital, CHU, Rouen, France
^j Department of paediatrics, Arnaud-de-Villeneuve Hospital, CHU, Montpellier, France
^k Department of paediatrics, Jeanne-de-Flandre Hospital, CHRU, Lille, France
^l Department of rheumatology, Arlin d’Alsace Hospital, CHU, Strasbourg, France
^m Department of paediatrics, Hôpital de la Côte-de-Nacre, CHU, Caen, France
ⁿ Nantes Université, CHU Nantes, Department of internal and vascular medicine, 44000 Nantes, France
^o Department of general paediatrics, infectious diseases and internal medecine, Robert-Debré Hospital, AP–HP, Université Paris Cité, Paris, France
^p Department of paediatric rheumatology, Necker Hospital, AP–HP, Paris, France
^q Department of internal medicine, La Pitié-Salpétrière Hospital, AP–HP, Sorbonne université, Paris, France

^⁎Corresponding author. Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP–HP, université de Paris Saclay, 78, rue du Général Leclerc, 94270 Kremlin-Bicêtre, France.Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP–HP, université de Paris Saclay78, rue du Général LeclercKremlin-Bicêtre94270France

Highlights

•	Paediatric TAK are more severe with more inflammation and kidney damages.
•	Prognosis is worse with more relapses and death.
•	Rapid initiation of biotherapy might be a key to avoid those complications.

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Abstract

Objectives

We aimed to compare clinical spectrum and outcome between adults and children with Takayasu's arteritis (TAK) in a European population.

Methods

We made a nationwide retrospective observational study between 1988 and 2019. All adult patients met the ACR diagnostic criteria for TAK and all children met the EULAR/PRINTO/PRES criteria for paediatric TAK.

Results

We identified 46 children and 389 adults with TAK. The male to female ratio was 34/46 (0.74) in the paediatric group compared to 241/274 (0.88) in the adult group (P<0.05). Children presented with significantly more systemic symptoms; i.e., fever (P<0.05), fatigue (P<0.001), weight loss (P<0.001), abdominal pain (P<0.05), and myalgia (P<0.05) while adults had more upper limb claudication (P<0.01). Topography of the lesions differed significantly between the two groups: adults had more damage at the cerebral vasculature (P<0.01), upper and lower limbs (P<0.001) while children had more kidney lesions (P<0.05). Children TAK had more frequent (P<0.01) and higher (P<0.001) biological inflammation than adults. Children received higher dose-weight of corticosteroids (P=0.001) and less biotherapy (P<0.010) at diagnosis. Relapses (P<0.05) and death (8.6% vs 4.9%) were more frequent in children TAK than in adults.

Conclusion

Paediatric TAK seems more severe than adult TAK. Therefore, paediatrics patients may require closer monitoring and systemic use of biological treatment.

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Keywords : Takayasu's arteritis, Children, Prognosis, Biotherapy

Plan

Characteristics of paediatric TAK

Characteristics of adults TAK

Comparison between paediatric and adult groups

Discussion

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Vol 91 - N° 5

Article 105735- septembre 2024 Retour au numéro

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Clinical spectrum and outcome of Takayasu's arteritis in children - 01/10/24

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