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TNF inhibitors appear to inhibit disease progression and improve outcome in Takayasu arteritis; an observational, population-based time trend study.

ABSTRACT: Magnetic resonance imaging (MRI) and computed tomography (CT) angiography have now largely replaced interventional angiography in the diagnoses and follow up of Takayasu arteritis (TAK) but data on the effects of this change of imaging method on diagnostic delay and vascular damage, and detailed data on the effect of different treatment regimens on the accumulation of vascular damage are missing. The aim of this study was to assess time trends in diagnostic delay, therapeutic approaches, arterial lesion accrual, persistent disease activity and remission rates in TAK.The study cohort included all 78 patients from the 1999?-?2012 population-based South-East Norway TAK cohort and 19 patients from a tertiary referral cohort. TAK was classified by the 1990 American College of Rheumatology criteria and/or the 1995 modified Ishikawa diagnostic criteria. Data were retrieved by review of electronic patient journals and imaging data analyses.Diagnostic delay fell significantly during the study period and the number of lesions at diagnoses fell from three to two. Patients diagnosed from 2000 onwards more often received up-front treatment with disease-modifying antirheumatic drugs (DMARDs) than those diagnosed before 2000 (51% vs 4%; p?

SUBMITTER: Gudbrandsson B

PROVIDER: S-EPMC5437509 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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TNF inhibitors appear to inhibit disease progression and improve outcome in Takayasu arteritis; an observational, population-based time trend study.

Gudbrandsson Birgir B Molberg Øyvind Ø Palm Øyvind Ø

Arthritis research & therapy 20170518 1

<h4>Background</h4>Magnetic resonance imaging (MRI) and computed tomography (CT) angiography have now largely replaced interventional angiography in the diagnoses and follow up of Takayasu arteritis (TAK) but data on the effects of this change of imaging method on diagnostic delay and vascular damage, and detailed data on the effect of different treatment regimens on the accumulation of vascular damage are missing. The aim of this study was to assess time trends in diagnostic delay, therapeutic ...[more]

PMID: 28521841

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Project description:IntroductionWe conducted a systematic review of patient-reported outcome measures (PROMs) regarding quality of life, disability, mood abnormalities (anxiety, depression), fatigue, illness perceptions and fibromyalgia in Takayasu arteritis (TAK). Wherever available, comparisons with healthy controls, disease controls or longitudinal changes in PROMs were noted.MethodsMEDLINE, EMBASE, Scopus, Web of Science and Pubmed Central databases, major recent international rheumatology conference abstracts, clinical trial databases and the Cochrane library were searched for relevant articles. Wherever possible, outcome measures across studies were pooled using the restricted maximum likelihood model. Inter-group differences were pooled and compared using standardized mean differences (SMD) with 95% confidence intervals (95% CI). Heterogeneity was assessed using the I2 statistic. Quality of randomized controlled trials was assessed using the Cochrane risk of bias tool. For cross-sectional and cohort studies, the Joana Briggs Institute checklist and Newcastle-Ottawa scale were used, respectively. GRADE methodology was used to determine the certainty of evidence for outcomes.ResultsTwenty-one studies (all but one observational) involving 1311 patients with TAK and 308 healthy controls were identified. Ten studies (559 TAK patients, 182 healthy controls were synthesized in a meta-analysis. Patients with TAK had worse quality of life (pooled SMD - 6.66, 95% CI - 10.08 to - 3.23 for individual domains; - 0.64, 95% CI - 1.19 to - 0.09 for pooled physical and mental component scores of 36-item Short Form Survey), depression (SMD 0.26, 95% 0.05-0.47) and anxiety (SMD 0.34, 95% CI - 0.06 to 0.75) scores and higher disability (SMD 0.64, 95% CI 0.43-0.84) than healthy controls. Patients with active TAK had worse quality of life, depression and work impairment when compared with those with inactive disease. Included studies were of moderate to high quality. Certainty of evidence for individual outcomes was low to very low.ConclusionLiterature on PROMs in TAK, albeit sparse, appears to indicate worse scores in patients with TAK compared to healthy individuals. These results, however, require cautious interpretation. Development of a TAK-specific PROM is an important focus of the research agenda.

Dataset Information

TNF inhibitors appear to inhibit disease progression and improve outcome in Takayasu arteritis; an observational, population-based time trend study.

Publications

TNF inhibitors appear to inhibit disease progression and improve outcome in Takayasu arteritis; an observational, population-based time trend study.

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