ANGIOGRAPHIC PROGRESSION OF DISEASE IN LARGE-VESSEL VASCULITIS

Background: Angiography is essential to detect vascular disease in patients with large-vessel vasculitis (LVV). Guidelines differ on the role of periodic angiography to monitor patients with LVV, in part because there is limited prospective data characterizing the natural history of angiographic disease. Development of new areas of arterial damage, even in periods of apparent clinical remission, has been reported in LVV; however, whether this is a common or rare phenomenon is unknown. Objectives: To characterize angiographic progression of disease over time in Takayasu’s arteritis (TAK) compared to giant cell arteritis (GCA). Methods: Patients with GCA or TAK were recruited into a prospective, observational cohort. Patients fulfilled the 1990 American College of Rheumatology (ACR) Classification Criteria for TAK or modified 1990 ACR Criteria for GCA. All patients underwent baseline magnetic resonance angiography (MRA) and a follow-up MRA at least one year after baseline per a standardized imaging protocol. The presence of angiographic lesions, defined as stenosis, occlusion, or aneurysm, was evaluated by visual inspection by a single reader who was blinded to clinical status. Angiographic lesions were evaluated in 4 segments of the aorta and in 13 branch arteries. On follow up angiography, the development of new lesions was recorded, and existing lesions were characterized as improved, worsened, or unchanged. Results: 782 arterial territories were evaluated from 46 patients with LVV (TAK=28; GCA=18). Baseline characteristics were as follows: Age [TAK=24.8 years (18.6-34.9), GCA=64.8 years (57.8-73.9)], Female gender [TAK=21 patients (78%), GCA=16 patients (84%)], Disease duration [TAK=2.3 years (0.6-4.9), GCA 1.2 years (0.4-2.9)], Active clinical disease [TAK=12 patients (44%), GCA 12 patients (63%)]. The median time from initial MRA to follow up MRA was 2.4 years (1.5-3.1) for GCA and 1.6 years (1.3-3.3) for TAK. There were 159 territories affected at the baseline visit in 41 patients [TAK: 108 territories in 26 patients, GCA: 51 territories in 15 patients]. The development of new territory involvement was infrequent and only occurred in patients with TAK (8 new lesions out of 352 baseline unaffected territories (2.3%) in 5 patients). At follow up, existing arterial lesions improved in 25 (15.7%) territories, worsened in 6 (3.8%) territories, and stayed the same in 128 (80.5%) territories. There were no significant differences in angiographic progression of disease between the two diseases: improved - TAK 19 (17.6%), GCA 6 (11.8%); worsened - TAK 5 (4.6%), GCA 1 (1.9%); unchanged - TAK 84 (77.8%), GCA 44 (86.3%). Change in the branch arteries was more dynamic than change in the aorta (Figure). Improvement in angiographic disease was observed in 8 (17%) patients (TAK=6, GCA=2). Worsening of disease was seen in 3 (7%) patients (TAK=2, GCA=1). In 5 (11%) patients (TAK=5, GCA=0), there were areas of improvement and other areas of worsening disease within the same patient. Conclusion: Dynamic change in arterial lesions is observed in patients with TAK and GCA. Improvement and worsening of arterial lesions can be observed over time, even within the same patient. This observation suggests that both local factors at the level of the artery and systemic factors (e.g. treatment response) are likely associated with angiographic progression. The development of new angiographic lesions was infrequent, and only occurred in patients with TAK. These data may inform future guideline recommendations for angiographic monitoring in LVV. REFERENCES: N/A Figure. Disclosure of Interests: None declared Citation: Ann Rheum Dis, volume 79, supplement 1, year 2020, page 1064Session: Vasculitis (Poster Presentations)