K Bates Gribbons1, Cristina Ponte2, Simon Carette3, Anthea Craven4, David Cuthbertson5, Gary S Hoffman6, Nader A Khalidi7, Curry L Koening8, Carol A Langford6, Kathleen Maksimowicz-McKinnon9, Carol A McAlear10, Paul A Monach11, Larry W Moreland12, Christian Pagnoux3, Kaitlin A Quinn13, Joanna C Robson14, Philip Seo15, Antoine G Sreih10, Ravi Suppiah16, Kenneth J Warrington17, Steven R Ytterberg17, Raashid Luqmani4, Richard Watts18, Peter A Merkel10, Peter C Grayson1. 1. National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland. 2. Hospital de Santa Maria, Lisbon, Portugal. 3. Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 4. University of Oxford, Oxford, UK. 5. University of South Florida, Tampa. 6. Cleveland Clinic Foundation, Cleveland, Ohio. 7. McMaster University, Hamilton, Ontario, Canada. 8. University of Utah, Salt Lake City. 9. Henry Ford Health System, Detroit, Michigan. 10. University of Pennsylvania, Philadelphia. 11. Veterans Affairs Boston Healthcare System, Boston, Massachusetts. 12. University of Pittsburgh, Pennsylvania. 13. National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland, and Georgetown University, Washington, DC. 14. University of the West of England, Bristol, UK. 15. Johns Hopkins University, Baltimore, Maryland. 16. Auckland District Health Board, Auckland, New Zealand. 17. Mayo Clinic, Rochester, Minnesota. 18. Norwich Medical School, University of East Anglia, Norwich, and University of Oxford, Oxford, UK.
Abstract
OBJECTIVE: To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). METHODS: Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort. RESULTS: A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage. CONCLUSION: Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
OBJECTIVE: To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). METHODS: Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort. RESULTS: A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage. CONCLUSION: Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
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