Takayasu's Arteritis
Takayasu's arteritis is a rare form of vasculitis, a series of conditions linked to inflamed blood vessels. In this particular form, the inflammation causes damage to the aorta, the artery that brings blood from the heart to the rest of the body, and the arteries leading to the head and kidneys. This disorder can lead to stenosis (abnormally narrowed or blocked arteries) or to aneurysm (abnormally distended arteries). Takayasu's arteritis can result in arm or chest pain and high blood pressure and carries the risk of causing heart failure or stroke. Takayasu's arteritis primarily affects females under the age of 40.
Causes of Takayasu's Arteritis
The cause of the disease has not yet been determined, but is considered to be an autoimmune disorder in which the patient's immune system attacks the patient's own arteries. Research indicates that this disorder may be triggered by a virus or other infection.
Symptoms of Takayasu's Arteritis
The symptoms of Takayasu's arteritis typically appear in two stages.
First Stage
During the first stage of Takayasu's arteritis, patients may feel general malaise, experiencing:
- Night sweats
- Fatigue
- Sudden, unintentional weight loss
- Muscle aches or joint pain
- Occasional low grade fever
Some patients never experience these early symptoms and are therefore not diagnosed until the disease has progressed to stage two.
Second Stage
By the time a patient is in the second stage of Takayasu's arteritis, some arteries have narrowed, reducing blood flow. This insufficient blood flow deprives tissues of needed oxygen and nourishment and may result in:
- Arm or leg weakness or pain
- Headaches, lightheadedness, or fainting
- Vision problems
- Abdominal or chest pain
- Anemia
- Cognitive difficulties
- Shortness of breath
During second stage Takayasu's arteritis, abnormalities in blood pressure are common, including high blood pressure, blood that differs from one arm to the other and a pulse that is difficult to locate, or even absent, in the wrists.
Treating Takayasu's arteritis at its earliest stages is most effective, though the disease can still be difficult to manage
Diagnosis of Takayasu's Arteritis
To diagnose Takayasu's arteritis, the doctor takes a comprehensive medical history and performs a complete physical examination. Additional testing is typically necessary to rule out other conditions, the symptoms of which may be similar to those of Takayasu's arteritis. These tests may include:
- Blood tests
- MRI or CT scan
- Angiography
- Magnetic resonance angiography
- Doppler ultrasound
Takayasu's arteritis tends to go into remission and then recur in flare-ups, so these tests may be used not only for diagnostic purposes, but for monitoring disease progression and efficacy of treatment. While a biopsy may be performed to diagnose other types of vasculitis, biopsies are not usually performed to diagnose Takayasu's arteritis.
Treatment of Takayasu's Arteritis
Depending on the severity of the individual case, Takayasu's arteritis may be treated with medication or surgery.
Medications
Treatment for Takayasu's arteritis is focused on managing inflammation and preventing additional blood vessel damage, while keeping medication side effects at bay. Medications for Takayasu's arteritis may include:
- Corticosteroids
- Immune-suppressing medications
- Drugs that regulate the immune system (biologics)
All of these medications can have serious side effects that must be managed. The most common side effect of all three types of medications is an increased risk of infection.
Surgery
In more serious cases of Takayasu's arteritis, surgery is necessary. Several types of surgery may be considered, including
For some patients, by the time the disease is diagnosed, irreversible damage may have already occurred and it may be too late for surgical repair.
- Percutaneous angioplasty to unblock arteries with a balloon
- Bypass surgery to circumvent blocked blood vessels
- Stenting to keep an artery open after an angioplasty
For patients whose disease is detected early, or in whom the disorder is not severe, it is possible that no treatment will be necessary, though such patients should be monitored to prevent complications should symptoms occur.