S-128
1
Division of Paediatric Rheumatology,
Dept. of Paediatrics, and
2
Dept. of Imaging
Diagnostic Universidade Federal de São Paulo;
3
Paediatric Rheumatology Unit of Children’s
Hospital, Universidade de São Paulo, Brazil;
4
Santa Casa de Misericórdia of São Paulo;
5
Faculdade de Medicina of Universidade de
São Paulo - Ribeirão Preto, Brazil;
6
Universidade Estadual of Rio de Janeiro;
7
Institute of Paediatrics Martagão Gesteira
of Universidade Federal do Rio de Janeiro;
8
Unit of Rheumatology of Universidade
Federal do Rio de Janeiro, Brazil;
9
Unit of Rheumatology of Universidade
Federal de Pernambuco, Recife, Brazil;
10
Universidade Federal da Bahia, Salvador;
11
Hospital Pequeno Príncipe, Curitiba, Brasil.
Gleice Clemente, MD
Maria Odete E. Hilário, MD
Henrique Lederman, MD
Clovis A. Silva, MD
Adriana M. Sallum, MD
Lúcia M. Campos, MD
Silvana Sacchetti, MD
Maria Carolina dos Santos, MD
Virgínia P. Ferriani, MD
Flávio Sztajnbok, MD
Rozana Gasparello, MD
Sheila Knupp Oliveira, MD
Marise Lessa, MD
Blanca Bica, MD
André Cavalcanti, MD
Teresa Robazzi, MD
Marcia Bandeira, MD
Maria Teresa Terreri, MD
Please address correspondence to:
Maria Teresa Terreri, MD,
Division of Paediatric Rheumatology,
Department of Paediatrics,
Universidade Federal de São Paulo,
Rua Ipê 112, ap111,
04022-005 São Paulo/SP, Brazil.
E-mail: teterreri@terra.com.br
Received on May 23, 2013; accepted in
revised form on September 13, 2013.
Clin Exp Rheumatol 2014; 32 (Suppl. 82):
S128-S133.
© Copyright CliniCal and
ExpErimEntal rhEumatology 2014.
Key words: Takayasu arteritis,
vasculitis, child, adolescent,
diagnosis, angiography
Competing interests: none declared.
ABSTRACT
Objective. To evaluate and compare
demographic, clinical, laboratory and
angiographic data of Brazilian chil-
dren and adolescents with Takayasu’s
arteritis.
Methods. In this Brazilian multicentre,
retrospective study which included 10
paediatric rheumatology centres, we
identiied 71 children and adolescents
with Takayasu’s arteritis which were di-
agnosed before their 19
th
birthday. The
patients’ demographic, clinical, labora-
torial and angiographic data were re-
corded. The participants were divided
into two groups: children, deined by
the WHO as younger than 10 years old
(group 1: 36 patients) and adolescents,
deined as individuals aged 10 to 19
years old (group 2: 35 patients). Fea-
tures of both groups concerning disease
manifestations were compared.
Results. A total of 21 (58.3%) patients
in group 1 and 30 (85.7%) patients in
group 2 were girls (p=0.01). The mean
age at disease onset, the mean time to
diagnosis, and the mean follow-up time
were 5.7 and 12.7, 1.8 and 0.7, 7.2 and
3.6 years, respectively, in groups 1 and
2 (p<0.001, 0.001 and <0.001). At ini-
tial evaluation, constitutional symptoms
(77.5%) were the most predominant
symptoms and decreased peripheral
pulses (85.9%) was the most predomi-
nant clinical sign without differences
between groups. The main laboratory
indings were increased erythrocyte
sedimentation rate followed by leuko-
cytosis. Anaemia, thrombocytosis and
higher platelet levels were signiicantly
more frequent in group 1 (p=0.031,
0.001 and 0.018). Angiographic data
were similar in both groups.
Conclusion. Children presented more
laboratory abnormalities but clinical
and angiographic characteristics were
similar to those presented by the ado-
lescents. Diagnosis delay is longer in
younger patients.
Introduction
Takayasu’s arteritis is a chronic vascu-
litis that affects the wall of large and
medium sized arteries, especially the
aorta, its primary branches and the pul-
monary artery. It was thought in the
past to be a disease predominately af-
fecting young Asian women but is cur-
rently known to affect both genders,
though most studies report a higher
frequency among females (1-7).
In the literature, an increasing number
of papers on vasculitis, and particularly
Takayasu’s arteritis, have been pub-
lished in the last years (8-10). It is the
third most frequent type of vasculitis
in childhood. However, because it is a
rare disease, there are few studies ad-
dressing its prevalence among this age
group. Some studies report a frequen-
cy between 20% and 32% of patients
younger than 20 years old (3, 11, 12).
Lupi-Herrera et al. observed that 77%
of the patients were aged between 10
and 20 years old (1).
Studies report differences in the clini-
cal presentation and prognosis of the
disease between children and adults, as
well as an important delay in the diag-
nosis among paediatric patients (1, 4,
6, 11). There are some studies address-
ing Takayasu’s arteritis in the paedi-
atric population, but all studies are
from speciic services, conducted with
a small number of patients who were
diagnosed according to adult criteria,
which hinders acquiring knowledge
concerning the disease during child-
hood (13-16). The characteristics of the
disease among different paediatric age
Paediatric rheumatology
Takayasu arteritis in a Brazilian multicentre study:
children with a longer diagnosis delay than adolescents
G. Clemente
1
, M.O.E. Hilário
1
, H. Lederman
2
, C.A. Silva
3
, A.M. Sallum
3
, L.M. Campos
3
,
S. Sacchetti
4
, M.C. dos Santos
4
, V.P. Ferriani
5
, F. Sztajnbok
6
, R. Gasparello
6
, S. Knupp
Oliveira
7
, M. Lessa
7
, B. Bica
8
, A. Cavalcanti
9
, T. Robazzi
10
, M. Bandeira
11
, M.T. Terreri
1