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Background: Takayasu Arteritis (TAK) is a rare large vessel vasculitis requiring long term immunosuppressive therapy. Being a chronic disease, it is associated with frequent relapses while on or tapering of immunosuppression. We assessed relapses, their predictors, and prognosis in an inception cohort of TAK. Objectives: 1.To characterize the frequency of relapses and relapse-free survival. 2.To analyze the predictors of relapses. 3.To analyze the effect of relapses on mortality. Methods: From an inception cohort of TAK patients fulfilling the 2022 ACR/EULAR or 1990 ACR classification criteria, we analyzed the frequency of flares, relapse-free survival and its impact on mortality. We also analyzed predictors of flare from baseline demographic parameters and disease activity using univariable Cox proportional hazards regression models. Predictors of relapses based on clinical features or angiography were assessed using multivariable-adjusted Cox regression analyses (generated using parameters with pResults: From 125 patients with TAK in the cohort (124 of whom had attained remission), the 123 patients mean(±SD) age at disease onset 24.93(±9.81) years, age at diagnosis 28.18(±10.92) years, 82 females with follow-up data available after attaining remission were included for analysis. Forty-one patients had experienced 60 relapses (one relapse in 28 patients, two relapses in 11 patients, and one patient each with 3 and 7 relapses) over a mean(±SD) follow-up of 32.31(±21.68) months. Relapse free survival (with 95% confidence intervals) was 94.14 (87.36-97.33) % at 1 year, 85.14 (75.59-91.17) % at 2 years, 77.58 (66.45-85.41) % at 3 years, 68.09(55.26-77.96) % at 4 years, and 48.16(32.60-62.11%) at 5 years respectively. Active disease at baseline as per physician global assessment was associated with higher rate of relapse (Figure 1A). Higher baseline Indian TAK Clinical Disease Activity Score 2010 (HR 1.05, 1.00 – 1.09) or Disease Extent Index in TAK (HR 1.05, 1.00-1.10), younger age at disease onset (HR 0.96, 95%CI 0.93-0.99) and earlier diagnosis (HR 0.80, 0.69-0.93) associated with increased rate of relapses. Carotidynia (HR 3.34, 1.26-8.87), headache (HR 2.82, 1.32-6.07), limb claudication 3.25, 1.52-6.95), and descending thoracic aorta involvement (HR 2.37, 1.01-5.54) were associated with increased relapse rate (Table 1). Mortality was not significantly different between TAK with or without relapses (Figure 1B). Conclusion: Nearly a third of TAK relapsed on follow-up. Higher disease activity at baseline, younger age of onset, earlier time to diagnosis, carotidynia, headache, limb claudication, and descending thoracic aorta involvement were associated with higher relapse rates. Relapses in TAK did not adversely affect mortality.REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
Misra et al. (Sat,) studied this question.