Takayasu’s arteritis a large vessel vasculitis of unknown etiology that typically affects

the aorta and its branches. Clinical manifestations relate to vascular insufficiency from

narrowing, thrombus, or aneurysm of affected arteries. Gross pathology typically reveals thickened arterial walls with vessel

narrowing and compensatory collateralization. More severe damage consists of aneurysm formation, particularly of the proximal aorta.

Koopman’s Arthritis and allied condition, 5th edition

Takayasu’s arteritis The prepulseless phase of nonspecific constitutional symptoms is

followed by a pulseless phase where vascular involvement is clinically and radiographically apparent.

Upper extremities are more frequently affected. Lab: elevated ESR, elevated CRP, thrombocytosis, and normocytic,

normochromic anemia Long, stenotic lesions are the most characteristic finding on

angiography, with poststenotic dilations and aneurysm formation occurring in approximately one third of patients.

Koopman’s Arthritis and allied condition, 5th edition

Primer on Rheumatic disease, 13th edition

Takayasu’s arteritis: MRI Its advantages over angiography are that it is noninvasive, directly vi

sualize the arterial wall for signs of inflammation, and does not use ionizing radiation.

In early disease, MRI may detect subtle mural wall abnormalities that precede detectable stenotic lesions seen on angiography.

Findings include increased wall thickness of vessels in a concentric pattern, aneurysm formation, and stenotic lesions.

Koopman’s Arthritis and allied condition, 5th edition

Takayasu’s arteritis: MRI

Prospective investigations reveal that MRI abnormalities have a sensitivity of 88% to 94% in patients with clinically active disease.

It is unclear if MRI overestimates disease activity or if current laboratory and clinical assessments fall short of accurately determining ongoing inflammation.

Koopman’s Arthritis and allied condition, 5th edition

Takayasu’s arteritis

Koopman’s Arthritis and allied condition, 5th edition

Patients with at least three criteria have probable TA with a sensitivity of 90.5% and a specificity of 97.8%.

Takayasu’s arteritis: Rx

Glucocorticoids: initial regimen of prednisone is 1 mg/kg po OD = cornerstone of therapy.

60% of pt achieve initial remission with glucocorticoids alone but additional cytotoxic agents are frequently required to maintain remission or as a steroid-sparing agent such as cyclosporine, cyclophosphamide, MTX, MMF and leflunomide.

Koopman’s Arthritis and allied condition, 5th edition

Takayasu’s arteritis: Rx Severe ischemia, stroke, HT from renal

artery stenosis, or AR can require surgery or percutaneous intervention in order to control or alleviate symptoms.

Surgical or percutaneous intervention is typically recommended during disease inactivity because this may improve long-term outcomes .Koopman’s Arthritis and allied condition, 5th edition

Histological Diagnosis of Atypical Takayasu Arteritis Using Percutaneous Transluminal Atherectomy: case report

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Beschorner et al. Diagnosis of Atypical Takayasu Arteritis Using PercutaneousTransluminal Atherectomy. Journal of Endovascular Therapy. 2008. 1545-1550.15: 241-243