http://informahealthcare.com/mor ISSN 1439-7595 (print), 1439-7609 (online) Mod Rheumatol, 2014; 24(2): 372–373 © 2014 Japan College of Rheumatology DOI: 10.3109/14397595.2013.854045
LETTER
Ulcerative colitis is not a rare complication of Takayasu arteritis Ryu Watanabe, Tomonori Ishii, Kyohei Nakamura, Tsuyoshi Shirai, Hiroshi Fujii, Shinichiro Saito, and Hideo Harigae Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
Mod Rheumatol Downloaded from informahealthcare.com by Nyu Medical Center on 04/14/15 For personal use only.
Keywords Takayasu arteritis, Ulcerative colitis History Received 28 November 2012 Accepted 25 December 2012 Published online 18 January 2013
To the Editor, I read with interest the case report by Horai et al. [1] describing a 22-year-old patient who developed Takayasu arteritis (TAK) while undergoing infliximab therapy for ulcerative colitis (UC). On the basis of the case reports and registration in Japan, they estimated the complication rate for UC in patients with TAK to be 0.783 % [1, 2]. However, we believe the complication rate is much higher than this estimation. From 1990 to 2012, we treated 82 patients who were registered as having TAK. Among these patients, five were complicated with UC (Table 1); thus, the complication rate was 6.1 % (5/82), which was much higher than that reported in previous studies [1, 2]. This difference may be due to the estimation method employed in previous reports. Among 4,980 patients with TAK who were registered in Japan since 1996, 39 cases were reported to be complicated with UC at the time of previous reports. Thus, they estimated the complication rate was 0.783 % (39/4,980). However, not all the patients that developed both diseases were reported like our cases. Therefore, we are convinced that UC is not that rare in patients with TAK. Now, over 50 cases with UC and TAK have been reported worldwide, with most being from Japan and Southeast Asia [3, 4]. Furthermore, it has been suggested that human leukocyte antigens (HLA) such as A24 and B52 are involved in the association of TAK
Correspondence to: T. Ishii, Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi 980-8574, Japan Tel: +81-22-7177162. Fax: +81-22-7177497. E-mail: [email protected]
and UC [3, 4]. Because even an anti-tumor necrosis factor (antiTNF) agent might not be able to prevent the development of UC or TAK as suggested by Horai et al. [1], rheumatologists must carefully monitor extravascular manifestations in patients with TAK.
Conflict of interest None.
References 1. Horai Y, Satoru O, Lapalme-Remis S, Sumiyoshi R, Nakashima Y, Suzuki T, et al. Takayasu arteritis developing during treatment of ulcerative colitis with infliximab. Mod Rheumatol. 2012, Jun 21 [Epub ahead of print]. 2. Horai Y, Miyamura T, Shimada K, Takahama S, Minami R, Yamamoto M, et al. A case of Takayasu’s arteritis associated with human leukocyte antigen A24 and B52 following resolution of ulcerative colitis and subacute thyroiditis. Intern Med. 2011;50:151–4. 3. Masuda H, Ishii Y, Aoki N, Nakayama H, Sato F, Karube H, et al. Ulcerative colitis associated with Takayasu’s disease in two patients who received proctocolectomy. J Gastroenterol. 2002; 37:297–302. 4. Morita Y, Yamamura M, Suwaki K, Mima A, Ishizu T, Hirohata M, et al. Takayasu’s arteritis associated with ulcerative colitis; genetic factors in this association. Intern Med. 1996;35:574–8.
Letter
DOI 10.3109/14397595.2013.854045
373
Table 1. Clinical characteristics of five patients with UC and TAK Sex Family history UC Age of onset Type Severity Therapy Operation TAK Age of onset Main affected artery Therapy
Case 1 F None
Case 2 F None
Case 3 F None
Case 4 F None
Case 5 F None
34 Proctitis Mild DEXA suppository –
35 Pancolitis Severe PSL 60 mg SASRAZA Total colectomy
28 Pancolitis Moderate PSL 40 mg SASP, CYC –
18 Pancolitis Moderate Mesalazine –
58 Pancolitis Severe PSL 50 mg mesalazine Total colectomy
23 Bilateral carotid PSL30 mg MTX
43 Left carotid PSL 30 mg
34 Right subclavian PSL40 mg
19 Bilateral carotid PSL 40 mg CyA
22 Left subclavian PSL40 mg
Mod Rheumatol Downloaded from informahealthcare.com by Nyu Medical Center on 04/14/15 For personal use only.
AZA azathioprince, CyA cyclosporice, CYC cyclophosphamide, DEXA dexamethasone, MTX methotrexate, PSL prednisolone (mg/day), SASP salazosulfapyridine, TAX Takayasu arteritis, UC ulcerative colitis
LETTER
Ulcerative colitis is not a rare complication of Takayasu arteritis Ryu Watanabe, Tomonori Ishii, Kyohei Nakamura, Tsuyoshi Shirai, Hiroshi Fujii, Shinichiro Saito, and Hideo Harigae Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
Mod Rheumatol Downloaded from informahealthcare.com by Nyu Medical Center on 04/14/15 For personal use only.
Keywords Takayasu arteritis, Ulcerative colitis History Received 28 November 2012 Accepted 25 December 2012 Published online 18 January 2013
To the Editor, I read with interest the case report by Horai et al. [1] describing a 22-year-old patient who developed Takayasu arteritis (TAK) while undergoing infliximab therapy for ulcerative colitis (UC). On the basis of the case reports and registration in Japan, they estimated the complication rate for UC in patients with TAK to be 0.783 % [1, 2]. However, we believe the complication rate is much higher than this estimation. From 1990 to 2012, we treated 82 patients who were registered as having TAK. Among these patients, five were complicated with UC (Table 1); thus, the complication rate was 6.1 % (5/82), which was much higher than that reported in previous studies [1, 2]. This difference may be due to the estimation method employed in previous reports. Among 4,980 patients with TAK who were registered in Japan since 1996, 39 cases were reported to be complicated with UC at the time of previous reports. Thus, they estimated the complication rate was 0.783 % (39/4,980). However, not all the patients that developed both diseases were reported like our cases. Therefore, we are convinced that UC is not that rare in patients with TAK. Now, over 50 cases with UC and TAK have been reported worldwide, with most being from Japan and Southeast Asia [3, 4]. Furthermore, it has been suggested that human leukocyte antigens (HLA) such as A24 and B52 are involved in the association of TAK
Correspondence to: T. Ishii, Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi 980-8574, Japan Tel: +81-22-7177162. Fax: +81-22-7177497. E-mail: [email protected]
and UC [3, 4]. Because even an anti-tumor necrosis factor (antiTNF) agent might not be able to prevent the development of UC or TAK as suggested by Horai et al. [1], rheumatologists must carefully monitor extravascular manifestations in patients with TAK.
Conflict of interest None.
References 1. Horai Y, Satoru O, Lapalme-Remis S, Sumiyoshi R, Nakashima Y, Suzuki T, et al. Takayasu arteritis developing during treatment of ulcerative colitis with infliximab. Mod Rheumatol. 2012, Jun 21 [Epub ahead of print]. 2. Horai Y, Miyamura T, Shimada K, Takahama S, Minami R, Yamamoto M, et al. A case of Takayasu’s arteritis associated with human leukocyte antigen A24 and B52 following resolution of ulcerative colitis and subacute thyroiditis. Intern Med. 2011;50:151–4. 3. Masuda H, Ishii Y, Aoki N, Nakayama H, Sato F, Karube H, et al. Ulcerative colitis associated with Takayasu’s disease in two patients who received proctocolectomy. J Gastroenterol. 2002; 37:297–302. 4. Morita Y, Yamamura M, Suwaki K, Mima A, Ishizu T, Hirohata M, et al. Takayasu’s arteritis associated with ulcerative colitis; genetic factors in this association. Intern Med. 1996;35:574–8.
Letter
DOI 10.3109/14397595.2013.854045
373
Table 1. Clinical characteristics of five patients with UC and TAK Sex Family history UC Age of onset Type Severity Therapy Operation TAK Age of onset Main affected artery Therapy
Case 1 F None
Case 2 F None
Case 3 F None
Case 4 F None
Case 5 F None
34 Proctitis Mild DEXA suppository –
35 Pancolitis Severe PSL 60 mg SASRAZA Total colectomy
28 Pancolitis Moderate PSL 40 mg SASP, CYC –
18 Pancolitis Moderate Mesalazine –
58 Pancolitis Severe PSL 50 mg mesalazine Total colectomy
23 Bilateral carotid PSL30 mg MTX
43 Left carotid PSL 30 mg
34 Right subclavian PSL40 mg
19 Bilateral carotid PSL 40 mg CyA
22 Left subclavian PSL40 mg
Mod Rheumatol Downloaded from informahealthcare.com by Nyu Medical Center on 04/14/15 For personal use only.
AZA azathioprince, CyA cyclosporice, CYC cyclophosphamide, DEXA dexamethasone, MTX methotrexate, PSL prednisolone (mg/day), SASP salazosulfapyridine, TAX Takayasu arteritis, UC ulcerative colitis
