Letter to the Editor
Similarities Between Takayasu Arteritis and Giant Cell Arteritis
Similitudes entre la arteritis de Takayasu y la arteritis de células gigantes
Maria Noelia Antoniol, Carlos Edgardo Perandones
Corresponding author
Sección Reumatología, Departamento de Medicina Interna, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
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Martín Guillén, Álvarez de Cienfuegos and Hurtado García.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The case they mention brought us to make certain reflections. Our patient is a 59-year-old woman at the onset of the disease, with occipital headaches accompanied by an increase in levels of acute-phase reactants. Physical examination revealed asymmetric peripheral pulses and the same was observed in temporal pulses.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Both Takayasu arteritis (TA) and giant cell arteritis (GCA) are vasculitides that predominantly affect large-sized vessels.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There are significant differences between these 2 disorders. Takayasu arteritis is generally found in patients under 40 years of age. It mostly involves the aorta and its major branches, whereas GCA mainly affects patients over 50 years of age, and is detected in branches of the external carotid artery. Both diseases predominantly affect women, they share pathogenic mechanisms and pathological findings, and have a similar response to treatment.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The typical symptoms of GCA are headache, loss of vision, jaw claudication and symptoms of polymyalgia. However, approximately 40% of the patients have manifestations considered atypical. Within this group, clinical involvement of the aorta and its major branches is found in 10%–15% of the patients as an initial manifestation.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> A study performed by Ostberg in autopsies of patients with GCA revealed the involvement of the aorta in 12 of 13 cases.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> In their cohort of 168 patients with GCA, Nuenninghoff et al. found that 27% had complications affecting the large vessels. In all, 18% had aortic aneurysm/dissection and 13% had stenosis.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> The majority of the cases are asymptomatic and it is underdiagnosed and, thus, its true prevalence is unknown. Patients with stenosis of the large vessels generally have fewer cranial symptoms, are found to have fewer changes in the temporal arteries on biopsies and a less marked increase in the levels of acute-phase reactants.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The detection of the involvement of the aorta its branches increases notably when ancillary tests like ultrasound, computed tomography angiography, positron emission tomography with <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose (FDG-PET) or angiography are utilized.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,6–8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The study evaluated 35 GCA patients who had not been treated with corticosteroids because of FDG-PET and found that 83% had increased FDG uptake in the large arteries. The involvement of the subclavian artery and aorta was observed in 74% and 54% of the cases, respectively. The uptake of FDG had increased after 3 months of treatment with corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> In another study, computed tomography angiography showed involvement of the large vessels in 67.5% of 40 patients with GCA. Those most widely affected were the aorta (65%), brachiocephalic trunk (47.5%), carotid arteries (35%) and subclavian arteries (42.5%).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In short, their patient, at the age of 64 years, has headaches but no Doppler evidence or temporal artery biopsy, and the predominating signs are arterial stenoses. She may have TA, as was suggested, or could have GCA, with stenoses involving the large vessels.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Antoniol MN, Perandones CE. Similitudes entre la arteritis de Takayasu y la arteritis de células gigantes. Reumatol Clin. 2017;13:122.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuevos fármacos en la arteritis de Takayasu, papel del tocilizumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Martín Guillén" 1 => "A. Álvarez de Cienfuegos" 2 => "R. 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| 2020 August | 28 | 33 | 61 |
| 2020 July | 17 | 13 | 30 |
| 2020 June | 41 | 21 | 62 |
| 2020 May | 22 | 25 | 47 |
| 2020 April | 14 | 16 | 30 |
| 2020 March | 20 | 9 | 29 |
| 2020 February | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 44 | 24 | 68 |
| 2018 March | 46 | 24 | 70 |
| 2018 February | 48 | 9 | 57 |
| 2018 January | 23 | 6 | 29 |
| 2017 December | 46 | 15 | 61 |
| 2017 November | 21 | 10 | 31 |
| 2017 October | 26 | 15 | 41 |
| 2017 September | 22 | 19 | 41 |
| 2017 August | 16 | 12 | 28 |
| 2017 July | 19 | 27 | 46 |
| 2017 June | 33 | 13 | 46 |
| 2017 May | 44 | 18 | 62 |
| 2017 April | 45 | 34 | 79 |
| 2017 March | 38 | 35 | 73 |
| 2017 February | 1 | 6 | 7 |
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