High prevalent early damage independently predicts future mortality in an inception cohort of Takayasu arteritis.

Abstract

The objective of this study was to evaluate early damage, and its evolution and prognostic relevance in an inception cohort of patients with Takayasu arteritis (TAK) using the Large Vessel Vasculitis Index of Damage (LVVID). Baseline LVVID was scored in an inception cohort of TAK who were within 3 months of cohort entry, at 1 year, and at the last follow-up at or after 1 year. Levels of associations between initial LVVID scores and demographic characteristics, disease activity, and angiographic subtypes were evaluated. Hazard ratios (HRs) for mortality per point/quartile increase in baseline LVVID scores were calculated using Cox proportional hazards regression. Damage evolution from baseline to 1 year or last follow-up was assessed using the paired Student's t test. Pre-treatment predictors of progression were assessed using logistic regression. Of 199 patients (141 females; 54 paediatric-onset), 192/199 (96.5%) had damage (most often cardiovascular) as indicated by the LVVID at presentation, 112/114 (98.2%) at 1 year, and 126/130 (96.9%) at last follow-up. Initial LVVID was greater with active disease, Hata's type V, or Goel's cluster 1 angiographic subtypes. Higher baseline LVVID was consistently associated with increased mortality [crude HR per point increase 1.49 (95% CI 1.24-1.81) or per quartile increase in LVVID 1.92 (1.21-3.05)], despite adjustment for disease activity or angiographic subtype. Significant progression of LVVID was observed at 1 year (3.49 ± 2.01 vs 3.27 ± 1.86, P < 0.001) or at the last follow-up (3.73 ± 2.18 vs 3.28 ± 1.88 P < 0.001), and was predicted by active disease at presentation [ odds ratio (OR) 2.89] and glucocorticoid (OR 3.53) or immunosuppressant use (OR 3.52). Most patients with TAK had recordable early damage, which was associated with future mortality.