Takayasu's arteritis differential diagnosis: Difference between revisions

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Revision as of 13:22, 24 May 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Takayasu's arteritis should be distinguished from other conditions that cause arthritis and rash. The differentials include other large and medium-vessel vasculitides such as giant cell arteritis, polyarteritis nodosa, other systemic ilnesses such as as systemic lupus erythematosus, rheumatoid arthritis, rhupus, mixed connective tissue disease, systemic sclerosis, Sjogren's syndrome, Bechet's disease, Kikuchi's disease, serum sickness, psoriatic arthritis and human papilloma B19 virus infection.

Differentiating Takayasu's arteritis from other diseases

Differentiating Takayasu's arteritis from other diseases that may cause arthritis and rash

Takayasu's arteritis should be distinguished from other conditions that cause arthritis and rash. The differentials include other large and medium-vessel vasculitides such as giant cell arteritis, polyarteritis nodosa, other systemic ilnesses such as as systemic lupus erythematosus, rheumatoid arthritis, rhupus, mixed connective tissue disease, systemic sclerosis, Sjogren's syndrome, Bechet's disease, Kikuchi's disease, serum sickness, psoriatic arthritis and human papilloma B19 virus infection. The following table differentiates between them:

Abbreviations: ANA: Antinuclear antibody, RF: Rheumatoid factor, Anti-CCp: Anti-cyclic citrullinated protein antibody, Anti U1RNP: Anti-U1 ribonucleoprotein antibodies , Anti Sm : Anti-Sm antibodies, Anti Ro: Anti Ro antibody also called anti-Sjögren's-syndrome-related antigen A antibody, Anti-dsDNA: Anti-double stranded DNA.

Disease		Arthritis					Auto-antibodies							Raynaud phenomenon	Rash pattern	Distinguishing/specific features
Disease		Polyarthritis	Tenderness	Edema	Deformity /Erosion	Pattern	ANA	RF	Anti-CCp	Anti U1RNP	Anti Sm	Anti Ro	Anti-dsDNA	Raynaud phenomenon	Rash pattern	Distinguishing/specific features
Vasculitis	Takayasu^[1]	-	+/-	+/-	-	Transient extremity	-	-	-	-	-	-	-		Erythema nodosum, pyoderma gangrenosum	Absent or weak peripheral pulse
	Giant cell^[2]	-	+	+	-	Distal extremity	-	-	-	-	-	-	-	-	Rare	Involvement of cranial branches of arteries, visual loss
	Poly-arteritis nodosa^[3]	-	+/-	-	-	General and mild	-	-	-	-	-	-	-	-	Tender erythematous nodules, purpura, livedo reticularis, bullous or vesicular eruption	Testicular pain or tenderness and neuropathies
Systemic lupus erythematosus^[4]		+	+	+	-	Small joints	↑	-	-	-	↑	↑	-	+	Malar rash and photosensitivity
Rheumatoid arthritis (RA)^[5]		+	+	+	+	Small and large joints	-	↑↑	↑↑	-	-	-	-	+	Subcutaneous nodules	Erosive arthropathy
Rhupus^[6]		+	+	+	+	Small and large joints	↑	↑	↑	↑	↑	-	↑	+	Malar rash and photosensitivity	Erosive arthropathy
Mixed connective tissue disease (MCTD)^[7]		-	-	-	+	Small and large joints	-	↑↑	↑	-	-	-	-	+	Cutaneous eruptions, gottron’s papules, photodistributed erythema, poikiloderma, and calcinosis cutis	Overlapping features of SLE, systemic sclerosis (SSc), and polymyositis (PM) that lead to more than one diagnosis
Undifferentiated connective tissue disease (UCTD)^[8]		+	-	-	-	Lower extremity	↑	↑	-	-	↑	-	-	+	Erythematous macules, patches, or papules with delicate scale	Multiple connective tissue diseases with no enough criteria for a single diagnosis
Systemic sclerosis (SSc)^[9]		+/-	+	+	+/-	Lower extremity	↑↑	-	-	-	↑	-	↑	+	Hyperkeratosis, edema, and erythema	Sclerodactyly, Telangiectasias, Calcinosis, Malignant hypertension, acute renal failure
Sjögren’s syndrome^[10]		+/-	+/-	-	-	Lower extremity, axiallary creases	↑	-	-	-	↑	↑	-	-	Xerosis, scaly skin, annular erythema	Keratoconjunctivitis sicca
Behçet’s syndrome^[11]		+/-	+/-	+/-	-	medium and large joints	-	-	-	-	-	-	-	-	Recurrent and usually painful mucocutaneous ulcers, acneiform lesions, papulo-vesiculo-pustular eruptions, superficial thrombophlebitis	Male dominancy
Kikuchi’s disease^[12]		-	+/-	-	-	medium and large joints	↑/↓	-	-	-	-	-	-	-	Transient skin rashes, malar rash, erythematous macules, patches, papules, or plaques	May be associated with SLE
Serum sickness^[13]		+	+	+/-	-	General	-	-	-	-	-	-	-	-	Pruritic rash, urticaria and/or serpiginous macular rash	Self-limited
Psoriatic arthritis^[14]		-	-	-	-	Small and large joints	-	-	-	-	-	-	-	-	Psoriasis and onychodystrophy	Dactylitis (sausage digits)
Human parvovirus B19 infection^[15]		+	+	-	-	Small joints	-	-	-	-	-	-	-	-	Erythematous rashes	Rare in adults, fifth's disease in children

References

↑ Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE (1977). "Takayasu's arteritis. Clinical study of 107 cases". Am. Heart J. 93 (1): 94–103. PMID 12655.
↑ Bablekos GD, Michaelides SA, Karachalios GN, Nicolaou IN, Batistatou AK, Charalabopoulos KA (2006). "Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review". Am. J. Med. Sci. 332 (4): 198–204. PMID 17031245.
↑ Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, Bienvenu B, Mouthon L, Guillevin L (2010). "Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database". Arthritis Rheum. 62 (2): 616–26. doi:10.1002/art.27240. PMID 20112401.
↑ Ehmke TA, Cherian JJ, Wu ES, Jauregui JJ, Banerjee S, Mont MA (2014). "Treatment of osteonecrosis in systemic lupus erythematosus: a review". Curr Rheumatol Rep. 16 (9): 441. doi:10.1007/s11926-014-0441-8. PMID 25074031.
↑ Lee DM, Weinblatt ME (2001). "Rheumatoid arthritis". Lancet. 358 (9285): 903–11. doi:10.1016/S0140-6736(01)06075-5. PMID 11567728.
↑ Panush RS, Edwards NL, Longley S, Webster E (1988). "'Rhupus' syndrome". Arch. Intern. Med. 148 (7): 1633–6. PMID 3382309.
↑ Cappelli S, Bellando Randone S, Martinović D, Tamas MM, Pasalić K, Allanore Y, Mosca M, Talarico R, Opris D, Kiss CG, Tausche AK, Cardarelli S, Riccieri V, Koneva O, Cuomo G, Becker MO, Sulli A, Guiducci S, Radić M, Bombardieri S, Aringer M, Cozzi F, Valesini G, Ananyeva L, Valentini G, Riemekasten G, Cutolo M, Ionescu R, Czirják L, Damjanov N, Rednic S, Matucci Cerinic M (2012). ""To be or not to be," ten years after: evidence for mixed connective tissue disease as a distinct entity". Semin. Arthritis Rheum. 41 (4): 589–98. doi:10.1016/j.semarthrit.2011.07.010. PMID 21959290.
↑ Alarcón GS, Williams GV, Singer JZ, Steen VD, Clegg DO, Paulus HE, Billingsley LM, Luggen ME, Polisson RP, Willkens RF (1991). "Early undifferentiated connective tissue disease. I. Early clinical manifestation in a large cohort of patients with undifferentiated connective tissue diseases compared with cohorts of well established connective tissue disease". J. Rheumatol. 18 (9): 1332–9. PMID 1757934.
↑ LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA, Rowell N, Wollheim F (1988). "Scleroderma (systemic sclerosis): classification, subsets and pathogenesis". J. Rheumatol. 15 (2): 202–5. PMID 3361530.
↑ Roguedas AM, Misery L, Sassolas B, Le Masson G, Pennec YL, Youinou P (2004). "Cutaneous manifestations of primary Sjögren's syndrome are underestimated". Clin. Exp. Rheumatol. 22 (5): 632–6. PMID 15485020.
↑ Tunç R, Uluhan A, Melikoğlu M, Ozyazgan Y, Ozdoğan H, Yazici H (2001). "A reassessment of the International Study Group criteria for the diagnosis (classification) of Behçet's syndrome". Clin. Exp. Rheumatol. 19 (5 Suppl 24): S45–7. PMID 11760398.
↑ Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M (2007). "Kikuchi-Fujimoto Disease: analysis of 244 cases". Clin. Rheumatol. 26 (1): 50–4. doi:10.1007/s10067-006-0230-5. PMID 16538388.
↑ Kunnamo I, Kallio P, Pelkonen P, Viander M (1986). "Serum-sickness-like disease is a common cause of acute arthritis in children". Acta Paediatr Scand. 75 (6): 964–9. PMID 3564980.
↑ Oriente P, Biondi-Oriente C, Scarpa R (1994). "Psoriatic arthritis. Clinical manifestations". Baillieres Clin Rheumatol. 8 (2): 277–94. PMID 8076388.
↑ Kaufmann J, Buccola JM, Stead W, Rowley C, Wong M, Bates CK (2007). "Secondary symptomatic parvovirus B19 infection in a healthy adult". J Gen Intern Med. 22 (6): 877–8. doi:10.1007/s11606-007-0173-9. PMC 2219874. PMID 17384979.

[pmid12655-1] Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE (1977). "Takayasu's arteritis. Clinical study of 107 cases". Am. Heart J. 93 (1): 94–103. PMID 12655.

[pmid17031245-2] Bablekos GD, Michaelides SA, Karachalios GN, Nicolaou IN, Batistatou AK, Charalabopoulos KA (2006). "Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review". Am. J. Med. Sci. 332 (4): 198–204. PMID 17031245.

[pmid20112401-3] Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, Bienvenu B, Mouthon L, Guillevin L (2010). "Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database". Arthritis Rheum. 62 (2): 616–26. doi:10.1002/art.27240. PMID 20112401.

[pmid25074031-4] Ehmke TA, Cherian JJ, Wu ES, Jauregui JJ, Banerjee S, Mont MA (2014). "Treatment of osteonecrosis in systemic lupus erythematosus: a review". Curr Rheumatol Rep. 16 (9): 441. doi:10.1007/s11926-014-0441-8. PMID 25074031.

[pmid11567728-5] Lee DM, Weinblatt ME (2001). "Rheumatoid arthritis". Lancet. 358 (9285): 903–11. doi:10.1016/S0140-6736(01)06075-5. PMID 11567728.

[pmid3382309-6] Panush RS, Edwards NL, Longley S, Webster E (1988). "'Rhupus' syndrome". Arch. Intern. Med. 148 (7): 1633–6. PMID 3382309.

[pmid21959290-7] Cappelli S, Bellando Randone S, Martinović D, Tamas MM, Pasalić K, Allanore Y, Mosca M, Talarico R, Opris D, Kiss CG, Tausche AK, Cardarelli S, Riccieri V, Koneva O, Cuomo G, Becker MO, Sulli A, Guiducci S, Radić M, Bombardieri S, Aringer M, Cozzi F, Valesini G, Ananyeva L, Valentini G, Riemekasten G, Cutolo M, Ionescu R, Czirják L, Damjanov N, Rednic S, Matucci Cerinic M (2012). ""To be or not to be," ten years after: evidence for mixed connective tissue disease as a distinct entity". Semin. Arthritis Rheum. 41 (4): 589–98. doi:10.1016/j.semarthrit.2011.07.010. PMID 21959290.

[pmid1757934-8] Alarcón GS, Williams GV, Singer JZ, Steen VD, Clegg DO, Paulus HE, Billingsley LM, Luggen ME, Polisson RP, Willkens RF (1991). "Early undifferentiated connective tissue disease. I. Early clinical manifestation in a large cohort of patients with undifferentiated connective tissue diseases compared with cohorts of well established connective tissue disease". J. Rheumatol. 18 (9): 1332–9. PMID 1757934.

[pmid3361530-9] LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA, Rowell N, Wollheim F (1988). "Scleroderma (systemic sclerosis): classification, subsets and pathogenesis". J. Rheumatol. 15 (2): 202–5. PMID 3361530.

[pmid15485020-10] Roguedas AM, Misery L, Sassolas B, Le Masson G, Pennec YL, Youinou P (2004). "Cutaneous manifestations of primary Sjögren's syndrome are underestimated". Clin. Exp. Rheumatol. 22 (5): 632–6. PMID 15485020.

[pmid11760398-11] Tunç R, Uluhan A, Melikoğlu M, Ozyazgan Y, Ozdoğan H, Yazici H (2001). "A reassessment of the International Study Group criteria for the diagnosis (classification) of Behçet's syndrome". Clin. Exp. Rheumatol. 19 (5 Suppl 24): S45–7. PMID 11760398.

[pmid16538388-12] Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M (2007). "Kikuchi-Fujimoto Disease: analysis of 244 cases". Clin. Rheumatol. 26 (1): 50–4. doi:10.1007/s10067-006-0230-5. PMID 16538388.

[pmid3564980-13] Kunnamo I, Kallio P, Pelkonen P, Viander M (1986). "Serum-sickness-like disease is a common cause of acute arthritis in children". Acta Paediatr Scand. 75 (6): 964–9. PMID 3564980.

[pmid8076388-14] Oriente P, Biondi-Oriente C, Scarpa R (1994). "Psoriatic arthritis. Clinical manifestations". Baillieres Clin Rheumatol. 8 (2): 277–94. PMID 8076388.

[pmid17384979-15] Kaufmann J, Buccola JM, Stead W, Rowley C, Wong M, Bates CK (2007). "Secondary symptomatic parvovirus B19 infection in a healthy adult". J Gen Intern Med. 22 (6): 877–8. doi:10.1007/s11606-007-0173-9. PMC 2219874. PMID 17384979.

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 {{CMG}}; {{AE}} {{MIR}}
 == Overview ==
-Takayasu's arteritis should be distinguished from other conditions that cause [[arthritis]] and [[rash]]. The differentials include other large and medium-vessel vasculitides such as [[giant cell arteritis]], [[polyarteritis nodosa]], other systemic ilnesses such as as [[systemic lupus erythematosus]], [[rheumatoid arthritis]], rhupus, [[mixed connective tissue disease]], [[systemic sclerosis]], [[Sjogren's syndrome]], [[Bechet's disease]], [[Kikuchi disease|Kikuchi's disease]], [[serum sickness]], [[psoriatic arthritis]] and human papilloma B`9 virus.
+Takayasu's arteritis should be distinguished from other conditions that cause [[arthritis]] and [[rash]]. The differentials include other large and medium-vessel vasculitides such as [[giant cell arteritis]], [[polyarteritis nodosa]], other systemic ilnesses such as as [[systemic lupus erythematosus]], [[rheumatoid arthritis]], rhupus, [[mixed connective tissue disease]], [[systemic sclerosis]], [[Sjogren's syndrome]], [[Bechet's disease]], [[Kikuchi disease|Kikuchi's disease]], [[serum sickness]], [[psoriatic arthritis]] and [[Parvovirus B19|human papilloma B19 virus]] infection.
 == Differentiating Takayasu's arteritis from other diseases ==
 ===== Differentiating Takayasu's arteritis from other diseases that may cause [[arthritis]] and [[rash]]=====
+Takayasu's arteritis should be distinguished from other conditions that cause [[arthritis]] and [[rash]]. The differentials include other large and medium-vessel vasculitides such as [[giant cell arteritis]], [[polyarteritis nodosa]], other systemic ilnesses such as as [[systemic lupus erythematosus]], [[rheumatoid arthritis]], rhupus, [[mixed connective tissue disease]], [[systemic sclerosis]], [[Sjogren's syndrome]], [[Bechet's disease]], [[Kikuchi disease|Kikuchi's disease]], [[serum sickness]], [[psoriatic arthritis]] and [[Parvovirus B19|human papilloma B19 virus]] infection. The following table differentiates between them:
 <span style="font-size:85%">'''Abbreviations:'''
 '''ANA:''' [[Anti-nuclear antibody|Antinuclear antibody]], '''RF:''' [[Rheumatoid factor]], '''Anti-CCp:''' [[Anti-citrullinated protein antibody|Anti-cyclic citrullinated protein antibody]], '''Anti U1RNP:''' Anti-U1 ribonucleoprotein antibodies , '''Anti Sm :''' Anti-Sm antibodies, '''Anti Ro:''' Anti Ro antibody also called anti-Sjögren's-syndrome-related antigen A antibody, '''Anti-dsDNA:''' [[Anti-dsDNA antbodies|Anti-double stranded DNA]].