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Takayasu’s arteritis 

Takayasu’s arteritis
Chapter:
Takayasu’s arteritis
Author(s):

Yasushi Kobayashi

DOI:
10.1093/med/9780199204854.003.161404_update_001
Newer versions of this chapter are available. Next version Latest version
A more recent version of this content exists; this version was replaced on 27 Nov 2014. The version that replaced it can be found here.

May 31, 2012: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

18F-FDG CT-PET is increasingly used in the diagnosis of Takayasu arteritis in its early pre-stenotic stage and in the evaluation of disease activity during treatment.

Updated on 25 May 2011. The previous version of this content can be found here.
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date: 14 December 2017

Takayasu’s arteritis is a chronic granulomatous vasculitis of unknown cause characterized by stenosis, occlusion, and aneurysm of large elastic arteries, mainly the aorta and its branches. It mainly affects young women, predominantly in Asian, Middle Eastern, and South American countries.

Clinical presentation—symptoms in the acute stage are nonspecific, such as general fatigue and fever, which can persist for months to years. Symptoms in the chronic stage depend on the anatomical location of the vascular lesions, with typical complaints relating to ischaemia of the brain, eyes, or arms. The commonest finding on physical examination is a weak or absent pulse in one or both brachial, radial, and/or ulnar arteries. Bruits can often be heard over affected arteries. Hypertension and aortic insufficiency are strongly associated with poor prognosis.

Diagnosis—comprehensive angiographic imaging is required for diagnosis, evaluation of the extent of disease, and to guide therapy. American College of Rheumatology diagnostic criteria require the presence of three out of the following six to diagnose Takayasu’s arteritis: (1) age of onset less than 40 years; (2) claudication of a limb; (3) decreased brachial artery pulse; (4) systolic pressure difference between two limbs greater than 10 mmHg; (5) bruit over aorta or subclavian arteries; and (6) angiographic narrowing/occlusion of aorta, its primary branches, or large arteries in proximal arms or legs.

Treatment—is with prednisolone and antiplatelet agents, with other immunosuppressants added if necessary. Surgical bypass graft procedures are often required.

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