Analysis of predictive factors for treatment resistance and disease relapse in Takayasu's arteritis

作者：Sun, Ying; Ma, Lili; Chen, Huiyong; Kong, Xiufang; Lv, Peng; Dai, Xiaomin; Ji, Zongfei; Yang, Chengde; Dai, Shengming; Wu, Lijun; Zou, Yaohong; Lin, Jiang; Shi, Hongcheng; Yu, Qiang; Jiang, Lindi

来源：Clinical Rheumatology, 2018, 37(10): 2789-2795.

DOI：10.1007/s10067-018-4094-2

• Clinical remission
• Cyclophosphamide (CYC)
• Disease relapse
• Hydroxychloroquine (HCQ)
• Takayasu's arteritis (TA)
• Treatment resistance

The objective of the study was to investigate the long-term treatment effects and predictive factors for treatment response and disease relapse for Takayasu's arteritis (TA). Eighty-one patients were recruited from the Department of Rheumatology, Zhongshan Hospital, Fudan University, between January 2009 and January 2015. The follow-up duration ranged from 6 to 36 months. Patients were divided into three groups: clinical remission (CR; n = 59); treatment-resistant (TR; n = 11); and disease relapse (DR; n = 11). Signs/symptoms, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and imaging items were recorded at baseline and at each visit. Kerr's criteria, physician's global assessment, and Indian Takayasu Clinical Activity Score (ITAS2010) were used to evaluate disease activity. Incipient disease was more common in CR patients compared with DR cases (69.49 vs. 36.36%, p = 0.05). Fewer patients aged < 40 years were in the CR group in comparison with the DR group (57.63 vs. 90.91%, p = 0.04). In TR patients, high CRP levels (63.74 vs. 23.73%, p = 0.01) and aortic arch involvement (70.00 vs. 24.14%, p < 0.01) were more common in comparison with CR cases. Patients with high CRP levels (> 25 mg/L) (OR = 1.61, p = 0.03) carried a higher risk for treatment resistance. Age > 40 years (OR = - 2.82, p = 0.03), incipient disease (OR = - 2.47, p = 0.01), and treatment with cyclophosphamide (OR = - 2.07, p = 0.03) and hydroxychloroquine (OR = - 1.91, p = 0.05) could prevent disease relapse. Patients with high CRP levels carry a high risk of treatment resistance. In patients with incipient disease, aged > 40 years, treatment with cyclophosphamide and hydroxychloroquine protects against disease relapse.

• 出版日期2018-10
• 单位中国人民解放军第二军医大学; 复旦大学; 上海交通大学; 新疆维吾尔自治区人民医院; 上海市闵行区中心医院