Takayasu's arteritis overview: Difference between revisions
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===History and Symptoms=== | ===History and Symptoms=== | ||
Common symptoms of Takayasu's arteritis include [[headache]], [[malaise]], [[Arthralgia|arthralgias]], [[bruit]], [[claudication]], [[hypertension]], [[visual disturbance]]. Less common symptoms of Takayasu's arteritis include [[fever]], weight loss, carotodynia or vessel tenderness, [[Raynaud's Syndrome|raynaud]] syndrome, [[stroke]], [[Transient ischemic attack|transient ischemic attacks]], [[Seizure|seizures]], [[erythema nodosum]]. | Common [[Symptom|symptoms]] of Takayasu's arteritis include [[headache]], [[malaise]], [[Arthralgia|arthralgias]], [[bruit]], [[claudication]], [[hypertension]], [[visual disturbance]]. Less common symptoms of Takayasu's arteritis include [[fever]], weight loss, carotodynia or vessel tenderness, [[Raynaud's Syndrome|raynaud]] syndrome, [[stroke]], [[Transient ischemic attack|transient ischemic attacks]], [[Seizure|seizures]], [[erythema nodosum]]. | ||
===Physical Examination=== | ===Physical Examination=== | ||
A thorough physical examination is essential, with particular attention to peripheral pulses, blood pressure in all 4 extremities, ophthalmologic examination. The most common finding is a systolic blood pressure difference (>10 mm Hg) between arms. Hypertension due to [[renal artery]] involvement is found in approximately 50% of patients. Absent or diminished pulses are the clinical hallmark of Takayasu arteritis, but pulses are normal in many patients and upper limbs are affected more often Than lower limbs. [[Ophthalmology|Ophthalmologic]] examination may show [[retinal ischemia]], | A thorough [[physical examination]] is essential, with particular attention to peripheral [[Pulse|pulses]], [[blood pressure]] in all 4 extremities, [[Ophthalmology|ophthalmologic]] examination. The most common finding is a systolic [[blood pressure]] difference (>10 mm Hg) between arms. [[Hypertension]] due to [[renal artery]] involvement is found in approximately 50% of patients. Absent or diminished [[Pulse|pulses]] are the clinical hallmark of Takayasu arteritis, but [[Pulse|pulses]] are normal in many patients and upper limbs are affected more often Than lower limbs. [[Ophthalmology|Ophthalmologic]] examination may show [[retinal ischemia]], [[Retinal]] [[hemorrhage]]<nowiki/>s, [[Cotton-wool spot|cotton-wool]] [[Exudate|exudates]], venous dilatation and beading, [[Aneurysm|microaneurysms]] of peripheral [[retina]], [[optic atrophy]], [[vitreous hemorrhage]], wreathlike peripapillary [[arteriovenous anastomoses]]. | ||
===X Ray=== | ===X Ray=== | ||
Revision as of 16:06, 27 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
In 1830, Rokushu Yamamoto, who practised Japanese oriental medicine described the first case of Takayasu’s arteritis. In 1905, Mikito Takayasu repoted a case of a 21 year old woman with characteristic fundal arteriovenous anastamoses as “a case of peculiar changes in the central retinal vessels.” In 1905, Onishi and Kagosha reported cases associated with absent radial pulses.
Classification
Takayasu arteritis may be classified according to angiographic findings into 6 subtypes. These systems are useful in that they allow a comparison of patient characteristics according to the vessels involved and are helpful in planning surgery, but they offer little by way of prognosis. The most commonly involved vessels include the left subclavian artery (50%), left common carotid artery (20%), brachiocephalic trunk, renal arteries, celiac trunk, superior mesenteric artery, and pulmonary arteries (50%). Infrequently, the axillary, brachial, vertebral, coronary, and iliac arteries are involved.
Pathophysiology
The pathogenesis of Takayasu's arteritis is poorly understood. Takayasu's arteritis characterized by segmental and patchy granulomatous inflammation of the aorta and its major derivative branches.This inflammation leads to arterial stenosis, thrombosis, and aneurysms. Three factors that have been suggested to have association with susceptibility, development and progression of Takayasu's arteritis are genetic influences, immunologic mechanisms and relationship to tuberculosis.
Causes
The cause of Takayasu's arteritis is idiopathic but genetic, immunologic and infectious factors play important role in the development of Takayasu's arteritis.
Differentiating Rheumatoid Arthritis from other Diseases
Takayasu's arteritis should be distinguished from other conditions that cause arthritis and rash.
Epidemiology and Demographics
Takayasu arteritis has a worldwide distribution, it is observed more frequently in Asian countries such as Japan, Korea, China, India, Thailand, and Singapore. The incidence of Takayasu arteritis is approximately 0.26 per 100,000 individuals worldwide. Female are more commonly affected by Takayasu arteritis than male. Mean age of onset of Takayasu arteritis is approximately 30 years.
Risk Factors
Common risk factors in the development of Takayasu's arteritis include genetic predisposition, female sex, age <40, asian ethnicity.
Natural History, Complications and Prognosis
The symptoms of Takayasu's arteritis typically develop between 15 and 30 years of age. Common complications of Takayasu's arteritis include hardening and narrowing of blood vessels, High blood pressure, Heart failure, Stroke, Transient ischemic attack. The five year survival rate in Takayasu arteritis is over 90%.
Diagnosis
History and Symptoms
Common symptoms of Takayasu's arteritis include headache, malaise, arthralgias, bruit, claudication, hypertension, visual disturbance. Less common symptoms of Takayasu's arteritis include fever, weight loss, carotodynia or vessel tenderness, raynaud syndrome, stroke, transient ischemic attacks, seizures, erythema nodosum.
Physical Examination
A thorough physical examination is essential, with particular attention to peripheral pulses, blood pressure in all 4 extremities, ophthalmologic examination. The most common finding is a systolic blood pressure difference (>10 mm Hg) between arms. Hypertension due to renal artery involvement is found in approximately 50% of patients. Absent or diminished pulses are the clinical hallmark of Takayasu arteritis, but pulses are normal in many patients and upper limbs are affected more often Than lower limbs. Ophthalmologic examination may show retinal ischemia, Retinal hemorrhages, cotton-wool exudates, venous dilatation and beading, microaneurysms of peripheral retina, optic atrophy, vitreous hemorrhage, wreathlike peripapillary arteriovenous anastomoses.
X Ray
Chest radiographs may reveal widening of the ascending aorta, irregular descending aorta, aortic calcifications, and rib notching (late findings).
CT
CT scan manifestations in Takayasu arteritis include mural thickening (typical manifestation), calcification in the thickened wall and double ring enhancement pattern.
Treatment
Medical Therapy
Most people with Takayasu’s arteritis respond to steroids such as prednisone. The usual starting dose is approximately 1 milligram per kilogram of body weight per day (for most people, this is approximately 60 milligrams a day). The two most important aspects of treatment: are controlling the inflammatory process and controlling hypertension.
Prevention
There are no established measures for the primary prevention of Takayasu's arteritis. Diet modification is necessary to manage hypertension or renal failure in Takayasu's arteritis. Any activity limitations depend on the severity of the disease and complication.