Takayasu Arteritis in Children: Features of the Clinical Course in the Onset

Study Objective: Determine the demographic factors, clinical manifestations and features of Takayasu arteritis (АТ) in children observed at the I.M. Sechenov University Children's Clinical Hospital.

Study Design: A non-randomized retrospective study.

Material and methods. 51 children with a reliable diagnosis of AT were observed. The data that we evaluated in all children included gender, age, duration of the disease before diagnosis and type of AT. In addition to this, we also evaluated the clinical manifestations (systemic and local), laboratory (hemoglobin, leukocytes, platelets, ESR, CRP), instrumental studies (DUS, CT-angiography, catheter angiography) and a modifying Indian Takayasu Activity Score (ITAS.A).

Study Results. There were no significant gender differences in the age groups up to 7 years (the ratio M:D 1 : 1.25, versus 1 : 7.4 in the group of patients older than 7 years), while the average duration of AT before diagnosis in this group was higher than in children older than 7 years (29.33 ± 28.66 months and 14.86 ± 11.95 months). The most frequent variants of AT were type 5 (70,6%), 4 (11,8%) and 1 (7.9%). At the time of the diagnosis, malaise (90%) and fever (67.5%) were the most common systemic symptoms, along with vascular pain (37.5%), claudication of extremities (35%) and pulse absence/weakening (35%). The delay of diagnosis in 12 patients (30%) with arterial hypertension was longer than in the general group (26 ± 11.67 months). This led to 9 children out of 12 to require surgical treatment. DUS was the first imaging in all 40 patients with AT, supplemented subsequently by CT-angiography in 30, and catheter angiography in 10 children. The common carotid arteries on the left (65%), the abdominal aorta (52.5) and the subclavian artery on the left (50%) were most often affected. At the time of diagnosis, the median ESR was 48 mm/h (min 28, max 74), median CRP was 33.5 mg/l (min 4, max 200), anemia and leukocytosis were observed in 80%, thrombocytosis in 42.5%, median ITAS.A activity index was 12.5 (min 7, max 20). Basic therapy was prescribed to all patients after confirmation of the diagnosis of AT.

Conclusion. In children with suspected AT, it is necessary to palpate the pulse on all available arteries, measure blood pressure on 4 limbs, auscultation of available vessels, in combination with DUS. The delay of the diagnosis leads to a higher risk of ischemic complications.

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