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Takayasu’s arteritis is a rare form of vasculitis, a group of disorders that cause inflammation of the blood vessels. It is sometimes referred to as Takayasu disease, pulseless disease, or TAK. Takayasu’s arteritis causes inflammation and damage to the aorta, a major artery that delivers blood from the heart to the rest of the body.
The condition can cause arterial walls to become weaker and tear or bulge (aneurysm). It can also cause arteries to become narrower or blocked. The arteries that supply blood to the arms and flow through the neck to supply blood to the brain are among those that are affected. Additionally, it may cause chest discomfort, arm pain, high blood pressure, and heart failure or a stroke.
While it is possible for asymptomatic patients to forego treatment, the majority of individuals diagnosed with the condition usually require medication to address artery inflammation and prevent potential complications. It should be noted that even with treatment, relapses are common, and symptoms may vary over time.
Symptoms
While some TAK patients may not exhibit any symptoms, the majority of TAK patients will experience a generalized disease. Takayasu’s arteritis signs and symptoms frequently occur in two stages.
- Early stage: Early stage or the first stage signs and symptoms may include:
- Fatigue
- Unexplained weight loss
- Loss of appetite
- Muscle and joint pain
- Fever or night sweats
These early warning signs and symptoms are not always present. Inflammation may harm the arteries for years before anyone notice anything is seriously wrong.
- Later stage: Also referred as the second stage. As a result of the later stage’s inflammation, tissues and organs in the body receive less blood, oxygen, and nutrients. Signs and symptoms includes:
- Weakness or pain in the limbs.
- A weak pulse, trouble measuring blood pressure, or a difference in the arm’s blood pressure.
- Lightheaded, dizziness,or fainting
- Headaches
- Visual changes
- Memory issues or difficulty thinking
- Chest pain or difficulty in breathing
- High blood pressure
- Diarrhea or blood in the stool
- Anemia (low red blood cell)
Shortness of breath, arm or chest pain, as well as symptoms of a stroke such facial drooping, arm paralysis, or trouble speaking, should all be treated immediately.
Make an appointment with your doctor if you have other signs or symptoms that worry you. Effective treatment for Takayasu’s arteritis depends on early detection.
If Takayasu’s arteritis was the patient’s diagnosis, keep in mind that even with successful treatment, the symptoms could come and go. Pay attention to recurring symptoms as well as any new ones, and be sure to notify the healthcare provider once there are anything changes.
Causes
Takayasu’s arteritis may be an autoimmune illness, which implies that the immune system is attacking healthy tissue by mistake. A virus or another infection may cause a disease.
Some cases of Takayasu’s arteritis, according to researchers, may be caused by a gene that is inherited from both parents. Due to just carrying one copy of the gene, they may not exhibit any symptoms. They are susceptible to developing the disorder and its symptoms when they receive that particular gene from both parents.
Takayasu’s arteritis can cause inflammation in the aorta and other major arteries, including those that provide blood to the kidneys and the head. These arteries experience thickening, constriction, and scarring as a result of the inflammation over time.
Risk factors
The following factors increase the risk in developing takayasu’s arteritis.
- Age: TAK often affects between the ages of 20 and 40. People with Takayasu’s arteritis are frequently between 15 and 35 years old when they receive a diagnosis.
- Gender: Female are more prone in developing the condition than men. Between 80% and 90% of those with this disease were given the gender of a female.
- Race: Though it occurs everywhere, Asia is where it is most prevalent.
Diagnosis
Takayasu’s arteritis is diagnosed by a healthcare professional based on a number of factors, such as:
- Physical examination: The healthcare provider will inquire about the signs and symptoms, perform a physical examination, and inquire about medical background. Through their stethoscope, healthcare provider might hear a bruit, which is an odd sound. Blood flow may be difficult if the patient has many narrowed blood vessels.
- Blood tests: Inflammation–related signs and anemia can be checked for using these tests.
- Angiography: An angiography involves inserting a long, flexible tube (catheter) into a significant vein or artery. The catheter is then filled with a particular contrast dye, which is inserted into it. As the dye fills the arteries or veins, X–rays are then taken.
The generated images enable healthcare providers to determine if blood flow is normal or whether it is slowed down or interrupted because of blood vessel stenosis. Takayasu’s arteritis patients typically have stenosis in numerous places.
- Magnetic resonance angiography (MRA): With no need for X–rays or catheters, this less invasive type of angiography creates precise images of the blood vessels. Detailed images of tissue slices are created by a computer utilizing data produced by radio waves in a strong magnetic field during MRA. Healthcare provider is assisted in seeing and examining the blood vessels more clearly during this test, a contrast dye is injected into an artery or vein.
- Computerized tomography (CT) angiography: This is a different noninvasive type of angiography that combines computerized X–ray image processing with intravenous contrast dye to enable the healthcare provider to examine the structure of the aorta and its adjacent branches as well as to track blood flow.
- Ultrasonography: Doppler ultrasonography, an advanced variant of standard ultrasound, has the capacity to generate extremely high–resolution images of the walls of specific arteries, including those in the neck and shoulder. Before other imaging methods, it could be able to spot minute changes in these arteries.
- Positron emission tomography (PET): Magnetic resonance imaging or computed tomography are frequently used together with this imaging examination. The severity of blood vessel inflammation is measurable by PET. In order to help the healthcare provider more easily identify areas with reduced blood flow, a radioactive substance is injected into an artery or vein prior to the scan.
Treatment
Takayasu’s arteritis can be challenging to treat because the condition may persist even after symptoms are better. It is also conceivable that irreversible harm may have already taken place prior to receiving a diagnosis.
Takayasu’s arteritis treatment focuses on reducing inflammation with medication and preventing future blood vessel damage.
The patient may not require therapy or may be able to taper and discontinue treatment if the healthcare practitioner advises it if they do not have signs and symptoms or significant complications.
- Medications: Discuss with the healthcare provider about the available medicines or combination medications, and any potential negative effects. A healthcare professional might suggest:
- Corticosteroids to control inflammation: Typically, corticosteroids like prednisone are used as the first line of treatment. Even if the patient starts to feel better, they might need to keep taking the medication indefinitely. The dose may be gradually reduced by the healthcare provider after a few months until it is the lowest level required to control inflammation. In due course, your physician may advise you to completely discontinue the medication.
Bone thinning, an increased risk of infection, and weight gain are a few of the potential side effects of corticosteroids. The healthcare provider can suggest taking calcium supplements and vitamin D to assist prevent bone loss.
- Medications to regulate the immune system: Although further study is required, a healthcare provider may prescribe biologic medicines to address immune system disorders if a patient does not react to conventional therapy. Etanercept, infliximab, and tocilizumab are a few examples of biologics. An increased risk of infection is one of these medications’ most frequent side effects.
- Other drugs that suppress the immune system: A healthcare provider may administer medications including methotrexate, azathioprine and leflunomide if the condition does not react well to corticosteroids or the patient experiences problems as their medication dose is dropped. Mycophenolate mofetil (CellCept), a drug created for patients getting organ transplants, has a positive response in certain patients. An increased risk of infection is the most frequent adverse effect.
- Surgery: Surgery may be required to unblock or bypass the severely narrowed or blocked arteries in order to maintain the blood flow. Symptoms like elevated blood pressure and chest pain are frequently alleviated by doing this. However, occasionally the narrowing or blockage may return, requiring a second surgery.
When artery inflammation has subsided, surgical options are best carried out. These include:
- Bypass surgery: This surgery creates a bypass for blood to flow through by removing an artery or vein from another area of the body and attaching it to the blocked artery. When there is a considerable blood flow restriction or when the artery obstruction is permanent, bypass surgery is typically performed.
- Blood vessel widening (percutaneous angioplasty): In the event that the arteries are completely blocked, this treatment can be necessary. A small balloon is put into the damaged artery during percutaneous angioplasty and into a blood vessel. The balloon is inflated once it has been placed, expanded to clear the obstruction, then deflated and taken away.
- Aortic valve surgery: The aortic valve may require surgical repair or replacement if it is extensively leaking.
