Background: The frequency of pulmonary arterial involvement (PAI) in Takayasu arteritis (TAK) has been reported between 14.0-57.0% by various imaging methods across different populations [1, 2, 3]. Undetected PAI can result in pulmonary hypertension leading to right heart dysfunction, which may result in a worse prognosis in TAK patients. Therefore, early detection and treatment of PAI can lead to a better disease course.

Objectives: This study aimed to investigate the frequency of PAI with computed tomography pulmonary angiography (CTPA) in TAK patients, as well as to assess the clinical characteristics and long-term outcomes of TAK patients with PAI.

Methods: This cross-sectional study included 72 TAK patients (62 female/10 male) who underwent CTPA to investigate PAI between January 2021 and July 2023. An experienced radiologist reviewed CTPA images, and PAI is characterized by increased PA wall thickness, stenosis, and/or thrombosis. Demographic and disease characteristics, and the follow-up information of the patients were collected from patient files.

Results: The mean age of the patients was 46.4±13.0 years, and nine patients had active disease during CTPA evaluation. The median CRP and ESR values were 3.1 (3.7) mg/L and 14.5 (21.0) mm/hr. The treatments for TAK were immunosuppressives (IS) in 62 (86.1%), biological treatment in 25 (34.7%), glucocorticoids (GC) in 30 (41.7%), and acetylsalicylic acid (ASA) in 50 (69.4%) patients. Twenty-two (30.6%) patients had a pulmonary symptom, most commonly dyspnea, and chest pain when CTPA was performed. PAI was detected in 13 (18.1%) patients. Additionally, in 5(6.9%) patients PA thrombosis unrelated to vasculitis was present (Figure 1). Among 13 PAI patients, IS treatment was initiated or changed in 9 (69.2%), GC was started, or the dose was increased in 8 (61.5%), and anticoagulants were started in 7 (53.8%). The presence of pulmonary symptoms, CRP, and ESR values were significantly higher in patients with PAI (p<0.001, p=0.001, and p=0.008). In addition, PAI was significantly lower in patients using ASA (p=0.002). After 2-year follow-up, one patient with PAI had a relapse and 3 patients had chronic thromboembolic pulmonary hypertension.

Conclusion: In this study, PAI was present in 18.1% of TAK patients, and the presence of pulmonary symptoms, higher ESR and CRP values, and lower ASA use were significantly associated with PAI.

REFERENCES: [1] Sharma S. et al., The incidence and patterns of pulmonary artery involvement in Takayasu’s arteritis. Clin Radiol. 1990;42(3):177-81.

[2] Mekinian A. et al., Pulmonary perfusion scintigraphy: a tool to detect the presence of pulmonary artery involvement in Takayasu’s arteritis. Presse Med. 2012;41(2):e37-42.

[3] Bicakcigil M, et al., Takayasu’s arteritis in Turkey - clinical and angiographic features of 248 patients. Clin Exp Rheumatol. 2009;27(1 Suppl 52):S59-64.

Figure 1.

The distribution of CT angiography findings according to the presence of symptoms and high acute phase reactants

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.