Takayasu's arteritis

Takayasu's arteritis (TAK for short), or "tah-kah-YAH-sooz ahr-tuh-RIE-tis," is one of several diseases that cause inflammation of the blood vessels, which is called vasculitis. This particular form of vasculitis has the potential to damage the heart's largest artery: the aorta.

Definition & Facts

Takayasu's arteritis is a rare form of vasculitis, with individuals at the highest level of risk being women under the age of 50. 90 percent of all affected individuals are female. The youngest ever reported case was in a child six months of age. Often, symptoms first arise when the individual is in young adulthood.

Individuals of Asian descent are more likely to contract the disease than other ethnicities. Overall, individuals of Indian, East Asian or Latin American descent are thought to be more at risk. Of special note: for women with Takayasu's arteritis who are pregnant or want to become pregnant, special advance planning and/or monitoring throughout pregnancy may be necessary in order to ensure a healthy baby.

Symptoms & Complaints

• Headaches, trouble with concentration, and cognitive impairment
• Dizziness or fainting.
• A feeling of weakness/pain in limbs during use.
• Chest pain.
• High blood pressure.
• Changes in eyesight or breathing.
• Slow pulse.
• Blood pressure differs from arm to arm.
• Loss of pulse in arms.
• Anemia (a lack of red blood cells).
• Lightheadedness.
• Unexplained weight loss.
• General feeling of malaise or fatigue.
• Fever.
• Aches and pains all over the body.

Causes

To date, researchers are not yet sure what causes Takayasu's arteritis. It is currently thought to be a type of autoimmune disease, which means it is possible the body's own immune system mistakenly begins attacking the arteries in the body. 

Another theory is that Takayasu's arteritis may be caused by a virus attacking the body, or perhaps it may be passed on genetically. However, more research is needed before either of these theories can be confirmed.

Diagnosis & Tests

One of the first steps a physician will take in order to diagnose Takayasu's arteritis is listen to the heart with a stethoscope. If bruits which are abnormal arterial noises, can be heard over the sound of the heartbeat, this can indicate a case of Takayasu's arteritis.

The doctor will also take a thorough medical history and ask for a list of symptoms. From here, there is a range of tests that can be done to confirm the diagnosis, including these:

• Blood tests. There are several possible tests that may be ordered, including one to test for anemia, one to test for inflammation, one to test for a certain type of protein and one to test the erythrocyte sedimentation rate or 'sed' rate.
• X-rays. X-rays will focus on examining the blood vessels to see if narrowing (stenosis) is detected, which is considered a positive indication of Takayasu's arteritis.
• Magnetic Resonance Angiography (MRA): Angiography using magnetic resonance imaging (MRI) takes a more detailed look at the blood vessels.
• Angiography using computerized tomography (CT). This test looks at the structure of the aorta itself as well as surrounding blood vessels.
• Ultrasonography. A Doppler ultrasound may be taken which will examine the arterial walls up close.
• Positron emission tomography (PET) scan. This test looks for inflammation in the blood vessels and, if found, measures the levels.

Not all of these tests will typically be ordered, but each test can aid in the accuracy of diagnosing Takayasu's arteritis. One key is to rule out other possible causes for why narrowing of the arteries may be taking place.

Treatment & Therapy

Treatment approaches aim to reduce the inflammation in the blood vessels in order to minimize symptoms. Takayasu's arteritis can be a difficult disease to manage because some individuals may be asymptomatic yet still have internal damage occurring in their blood vessels. So it is important to perform sufficient diagnostic tests to know how to approach treatment.

Treatment often starts with medications to control the inflammation. Corticosteroids can work well, although they usually can only be administered in short courses so they continue to stay effective. For individuals who can't take corticosteroids or for whom these drugs do not work well, there are other autoimmune suppressing medications that can be prescribed. 

In more severe cases of Takayasu's arteritis, surgery may be required to re-open blocked arteries. Often medications are tried first, and surgery is considered a last resort for treating Takayasu's arteritis. The most common surgical procedures associated with Takayasu's arteritis treatment include the following:

• Bypass surgery. This surgery uses an artery from another location in the body in order to bypass the blocked artery.
• Valve replacement. This surgery may address a leaky aortic valve (aortic valve regurgitation) through an aortic valve replacement.
• Percutaneous angioplasty. This surgery aims to widen the blood vessels to prevent blockages from affecting blood flow.

Continual monitoring over time is a requirement, since the disease can appear to go dormant only to resurface with more severe symptoms.

Prevention & Prophylaxis