Takayasu arteriti hastalarında spondiloartropati sıklığı

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Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi University, Tıp Fakültesi, Dahili Tıp Bilimleri, Turkey

Approval Date: 2018

Thesis Language: Turkish

Student: SAKİNE GÜZEL ESEN

Supervisor: ABDURRAHMAN TUFAN

Open Archive Collection: AVESIS Open Access Collection

Abstract:

Takayasu arteritis (TA) is characterized by inflammation of large arteries causing stenosis, occlusion, dilatation and/or aneurysm of affected vessels. TA most commonly seen in younger women between 20-30 ages. Etiopathogenesis of TA is largely unknown although evidence suggest complex interplay between environmental and genetic factors such as HLA (human leukocyte antigen) groups. The coexistence of TA with spondyloarthropathies (SpA) has been reported in limited case series, raising hypotheses about shared pathogenetic mechanisms. The aim was to determine the prevalence of spondyloarthropathy in patients with TA. Detailed clinical and demographic features of TA patients were recorded and all were screened for the presence of SpA following recommendations of ASAS. Patients were questioned for inflammatory back pain, enthesitis, uveitis, inflammatory bowel disease, peripheral arthritis, and investigated accordingly with HLA-B27, plain X-rays of pelvis and sacroiliac magnetic resonance imaging. Radiographic spondyloarthritis was reported in case of bilateral grade ≥2 or unilateral grade ≥3 sacroiliitis. There were 69 patients (65 female, 4 male) in the cohort. Mean age was 43.4 ±13.3 years and age at the diagnosis of TA was 36±13.5 years. Three out of fourteen TA + SpA patients had inadequate response to conventional drugs. Seven patients with TA + SpA treated with infliximab, 2 patients with etanercept, 2 patients with tocilizumab, 3 patients with adalimumab, 2 patients with sertolizumab,1 patient with golimumab, 1 patient with ustekizumab and 1 patient with rituximab. Inflammatory bowel disease, psoriasis and psoriatic arthritis were observed in four, three and one patients, respectively. Chronic axial pain was reported by 28 (39.4%) patients but inflammatory back pain was evident in 17 (23.9%) patients. Chronic arthritis was observed in 5 patients. HLA-B27 was positive in two patients. Four patients were diagnosed as AS, 2 were diagnosed as peripheral SpA, 1 patient was diagnosed as uSpA. In sum 14 patients were diagnosed as SpA (20.3%) according to ASAS criteria. Our study demonstrated that SpA is common in patients with Takayasu arteritis suggesting shared pathogenetic mechanisms.