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Open Access Rheumatol. 2017 May 5;9:91-99. doi: 10.2147/OARRR.S132080. eCollection 2017.

Variations in the clinical practice of physicians managing Takayasu arteritis: a nationwide survey.

Author information

1
Division of Rheumatology, The University of Western Ontario, St Joseph's Health Care, London, Ontario.
2
Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec.
3
Division of Rheumatology, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta.
4
Division of Rheumatology, BC Children's Hospital, Vancouver, British Columbia.
5
Division of Rheumatology, South Health Campus, University of Calgary, Calgary, Alberta.
6
Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa.
7
Division of Rheumatology, University of Alberta, Edmonton, Alberta.
8
Department of Rheumatology, Mount Sinai Hospital, Toronto, University of Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

Takayasu arteritis (TAK) is a large vessel vasculitis that predominately affects young women and can cause severe ischemic complications. Given the rarity of TAK, the management of this condition is challenging. We aim to describe current rheumatologist practices for the management of TAK and identify discrepancies and gaps in knowledge.

METHODS:

An online survey (developed by the Canadian Vasculitis Network and approved by the Canadian Rheumatology Association) containing 48 questions with regard to the diagnosis, monitoring and treatment of TAK was distributed to 495 Canadian adult and pediatric rheu-matologists by email.

RESULTS:

Sixty-six rheumatologists completed the survey (13% response rate): the majority (73%) were from academic centers and ≤25% reported managing more than ten patients in their career. For establishing the diagnosis of TAK, they relied on a combination of signs and symptoms of ischemia, elevations of inflammatory markers and vascular imaging (typically computed tomography and magnetic resonance angiography). The frequency of monitoring for disease activity and the methods employed (clinical, laboratory or imaging) were variable. All physicians used corticosteroids for the treatment of TAK, but 42% would treat for at least 6-12 months, 26% for 12-24 months and 23% would never stop corticosteroids. Fifty-three percent would always use an immunosuppressant (most commonly methotrexate or azathioprine) in addition to corticosteroids and the remainder would only start an immunosuppressant in patients with refractory or relapsing disease.

CONCLUSION:

Physician practices for the management of TAK are variable, suggesting that there are knowledge gaps, which may impact outcomes in patients with TAK.

KEYWORDS:

Takayasu arteritis; aortitis; large vessel vasculitis; physician practice patterns; practice guidelines

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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