Takayasu arteritis is an inflammation of large arteries such as the aorta and its major branches. The aorta is the artery that carries blood from the heart to the rest of the body.
The cause of Takayasu arteritis is unknown. The disease occurs mainly in children and women between the ages of 20 to 40. It is more common in people of East Asian, Indian or Mexican descent. However, it is now being seen more often in other parts of the world. Several genes that increase the chance of having this problem were recently found.
Takayasu arteritis appears to be an autoimmune condition. This means the body's immune system mistakenly attacks healthy tissue. The condition may also involve other organ systems. Takayasu arteritis has many features that are similar to giant cell arteritis or temporal arteritis in older people.
Symptoms may include:
- Arm weakness or pain with use
- Chest pain
- Muscle or joint pain
- Skin rash
- Night sweats
- Vision changes
- Weight loss
- Decreased radial pulses (at the wrist)
- Difference in blood pressure between the two arms
- High blood pressure (hypertension)
Exams and Tests
There is no blood test available to make a definite diagnosis. The diagnosis is made when a person has symptoms and imaging showing blood vessel narrowing suggesting inflammation.
Possible tests include:
- Complete blood count (CBC)
- C-reactive protein (CRP)
- Electrocardiogram (ECG)
- Erythrocyte sedimentation rate (ESR)
- Magnetic resonance angiography (MRA)
- Magnetic resonance imaging (MRI)
- Computed tomography (CT)
- X-ray of the chest
Treatment of Takayasu arteritis is difficult. However, people who have the right treatment can see improvement. It is important to identify the condition early.
Most people are first treated with high doses of steroids. Immunosuppressive drugs, such as azathioprine, mycophenolate, methotrexate, or leflunomide are often added.
Biologic agents including TNF inhibitors such as infliximab are recommended for people who do not improve with the previous treatment.
Other biologic agents that show promising benefits for treating Takayasu arteritis include tocilizumab, and rituximab.
Surgery or angioplasty may be used to open up narrowed arteries to supply blood or open up the constriction.
Aortic valve replacement may be needed in some cases.
This disease can be fatal without treatment. However, a combined treatment approach using medicines and surgery has lowered death rates. Adults have a better chance of survival than children.
Complications may include:
- Blood clot
- Heart attack
- Heart failure
- Aortic valve insufficiency
- Gastrointestinal bleeding or pain from blockage of bowel blood vessels
When to Contact a Medical Professional
Call your health care provider if you have symptoms of this condition. Weak pulse, chest pain, and breathing difficulty require immediate care.
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Mekinian A, Comarmond C, Resche-Rigon M, et al. Efficacy of biological-targeted treatments in Takayasu arteritis: multicenter, retrospective study of 49 patients. Circulation. 2015;132(18):1693-1700. PMID: 26354797 www.ncbi.nlm.nih.gov/pubmed/26354797.
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