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• W2510080661 abstract "Dear Editor, We read the recent report by Yoshida et al.1 with great interest. They concluded that Takayasu arteritis (TAK) and giant cell arteritis (GCA) differ substantially, while many features are comparable between patients with early-onset TAK (≤ 40 years old) and patients with late-onset TAK (> 40 years old), including the distribution of arterial lesions. They used the criteria of the Japanese Circulation Society to diagnose TAK,2 because American College of Rheumatology (ACR) criteria of TAK involves the age criteria (< 40 years old). We would like to make some comments regarding the diagnosis of late-onset TAK. GCA patients who lack cranial symptoms but have aortic involvement, have recently been regarded as having a subtype of GCA called large-vessel GCA (LV-GCA). Such patients do not necessarily satisfy the ACR criteria3, 4 and the definition of LV-GCA varies among authors.3-5 According to the Japanese criteria, patients with LV-GCA can be diagnosed as having TAK, irrespective of their age. Yoshida et al. also acknowledged that their patients with late-onset TAK could be labeled as having LV-GCA. Thus, their study suggested that clinical characteristics and radiographic features were also comparable between early-onset TAK and LV-GCA. Although they concluded that TAK and GCA differ substantially, comparison of patients in the same age range is more effective for elucidating similarities/differences between two diseases. However, they did not compare late-onset TAK with GCA, probably due to the small number of patients with GCA in their series. Accordingly, we would like to report our findings regarding comparison between patients with GCA and those with late-onset TAK (Table 1). Patients > 50 years old with large-vessel vasculitis diagnosed at our institution from 1995 to 2014 were divided into two groups, namely patients with GCA who fulfilled the ACR criteria (n = 21) and patients who did not (n = 16). The latter group of patients fulfilled the Japanese TAK criteria used by Yoshida et al. and thus had late-onset TAK. Temporal artery biopsy was performed in 18 out of 21 GCA patients, showing evidence of vasculitis in 12 of them. None of the patients with late-onset TAK had headache, temporal artery abnormalities, jaw claudication, ischemic optic neuropathy, or polymyalgia rheumatica. As shown in Table 1, age was the only difference in the demographic and clinical profiles between patients with GCA and those with late-onset TAK. There was no difference in the frequency of aortic regurgitation or hypertension. Arteritis was diagnosed by contrast-enhanced computed tomography and/or gadolinium-enhanced magnetic resonance imaging.6 The frequency of involvement of the carotid artery, subclavian artery and descending aorta/abdominal aorta differed between the two groups of patients (Table 2). Thus, the differences between the two groups were age and the distribution of arterial involvement, while there was no difference in the frequency of aortic regurgitation. According to Yoshida et al., aortic regurgitation is the only difference between TAK and GCA apart from age. The younger age of patients with late-onset TAK relative to those with GCA resembles the findings of Western studies comparing LV-GCA with cranial GCA.3, 4 The high frequency of carotid and subclavian artery involvement in our patients with late-onset TAK was similar to the findings of Yoshida et al. and corresponds to the report that subclavian artery involvement is common in patients with LV-GCA.3 In contrast, the frequency of aortic involvement, especially involvement of the abdominal aorta, was higher than Yoshida et al. found. However, the frequency of aortic involvement is highly variable in Western patients with GCA (6–89%)3, 7-9 and there have been no reports about the frequency of aortic involvement in Asian GCA patients (including Japanese) because of the rarity of this disease in Asia. Ethnic differences should be considered when comparing arterial involvement since the distribution of arterial involvement in TAK differs among races.10 The Japanese diagnostic criteria for TAK include various clinical and laboratory features as well as radiological findings.2 The main purpose of these criteria is to identify patients who are eligible to receive financial aid from the government for their treatment. Thus, the criteria may not be adequate for research purposes since they describe the features of TAK, rather than being useful for classification. In fact, these criteria are not widely known and are rarely used outside Japan. Classic cranial GCA and TAK can easily be discriminated from each other, because these two diseases are quite different. The former affects very elderly people of European descent, while the latter is predominantly a disease of young Asian women. The problem is how to classify patients with large-vessel vasculitis aged from the 40s to 60s who do not have cranial features. Some authors have proposed that these patients may have a third form of large-vessel vasculitis that is clinically and genetically distinct from cranial GCA.3, 4 It is a matter of debate as to whether or not TAK and GCA are the same disease entity.7-9, 11 Based on our findings and those of Yoshida et al., we support the opinion that these two diseases may not be distinct entities and instead represent differing phenotypes within the spectrum of a single disorder.9, 11 A large-scale genetic study involving different races, rather than simple comparison of clinical phenotypes, would be needed to obtain a definitive answer.5, 12, 13" @default.
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• W2510080661 date "2016-08-12" @default.
• W2510080661 modified "2023-10-17" @default.
• W2510080661 title "Comment on: retrospective analysis of 95 patients with large vessel vasculitis: a single center experience" @default.
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• W2510080661 doi "https://doi.org/10.1111/1756-185x.12945" @default.
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