Ab1303 Does Combined Arteritis Damage Score (Cards) at the Diagnosis of Takayasu’ Arteritis Predict the Need for Biologic Therapy?

Background: Vasculitis activity score (VAS) and vasculitis damage index (VDI) components are limited for large vessel vasculitis compared to small vessel vasculitis, and more comprehensive and detailed information is needed in the evaluation of Takayasu' arteritis (TAK). Nakagomi et al. developed a combined arteritis damage score (CARDS) system evaluating 21 obligatory and 4 optional arterial regions and suggested a damage score using stenosis, occlusion, aneurysm and dilatation rather than wall thickness (WT) in differrentiation from giant cell arteritis [1]. Objectives: We aimed to investigate the relationship between patients' biological treatment need on follow-up and CARDS measurements at the diagnosis, and possible contribution of wall thickness at the same images. Methods: Before starting study, reader rheumatologist (RR) was trained by experienced reader interventional radiologist (RIR) with the CTA and MRA images of 10 TAK patients not included in study cohort. Blind evaluation of MRA/CTA at the time of diagnosis were done for all accessible patients' images. CARDS damage score was performed for 21 region (carotid, vertebral artery, brachiocephalic, subclavian, axillary artery, ascending aorta, aortic arch, descending aorta, abdominal aorta, celiac, superior mesenteric, renal, iliac, pulmonary artery bilaterally). Coronary arteries, stated as optional in the original study, were not scored. Treatment history was obtained from patients' records. Additionally, wall thickness was scored for all regions as present or absent. A modified CARDS (mCARDS) was calculated as the sum of CARDS and number of WT areas. Results: 25 TAK patients (Female/Male:21/4) with median age of 31 years (17-61) were included. The non-biologic treatment (nonBT) group included 11 TAK patients under only corticosteroids and conventional DMARDs during follow-up (F/M:9/2, median age 37 years (22-58)) and BT group included 14 TAK patients used at least one biologic treatment during follow-up (tocilizumab, adalimumab or infliximab) (F/M:12/2, median age 29.5 years (17-61)). Except for 1 patient with MRA, all patients were evaluated with CTA images. All scores were significantly higher in BT group compared to nonBT. Median scores of CARDS were 1,6 (0-7,2) vs 5 (0,6-19), p:0,005; WT 2 (0-8) vs 8 (1-21), p:0.0001; and mCARDS were 4,8 (0-14,2) vs 13,2 (1,6-40), p:0.0004, for nonBT and BT groups, respectively. Cohen's kappa coefficient between RR and RIR for WT was 1 with 100% aggrement, and CARDS was 0,98 with 99,6% aggrement. The AUC value of CARDS, WT, and mCARDS scores to predict biologic treatment need in follow up were 0.786, 0.840, and 0.871, respectively (Figure 1). The candidate cutt off values were given in Table 1. Conclusion: The prediction of course of TAK patients and biologic treatment need at the diagnosis can be a warning for closer follow-up, frequent imaging and use of earlier and increased use of immunnosuppressives to prevent permanent vascular damage and comorbidities. Combination of CARDS and WT as mCARDS reached highest sensitivity and spesificity, and all scores seems useful to predict prognosis. Replication of this findings in larger cohort is needed. REFERENCES: [1] Nakagomi D, et al. Development of a score for assessment of radiologic damage in large-vessel vasculitis (Combined Arteritis Damage Score, CARDS). Clin Exp Rheumatol. 2017. Acknowledgements: NIL. Disclosure of Interests: None declared.