Last reviewed: 1 Nov 2021
Last updated: 08 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • upper or lower limb claudication
  • absent pulse(s)
  • unequal blood pressures
  • vascular bruits
  • low-grade fever

Other diagnostic factors

  • transient ischaemic attack (TIA)
  • myalgia
  • arthralgia
  • weight loss
  • fatigue
  • dizziness on upper-limb exertion
  • hypertension
  • stroke
  • chest pain
  • abdominal pain
  • diarrhoea
  • shortness of breath
  • haemoptysis
  • night sweats
  • vertigo
  • syncope
  • headache
  • heart murmur
  • visual symptoms
  • erythema nodosum
  • pyoderma gangrenosum

Risk factors

  • genetic predisposition
  • female sex
  • age <40 years
  • Asian ethnicity

Diagnostic investigations

1st investigations to order

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • computed tomography angiography (CTA)
  • magnetic resonance angiography (MRA)

Investigations to consider

  • catheter angiogram
  • Doppler ultrasound
  • positron emission tomography with radiolabelled fluorodeoxyglucose (PET-FDG)

Treatment algorithm

Contributors

Authors

Kenneth J. Warrington, MD
Kenneth J. Warrington

Professor of Medicine

Mayo Clinic College of Medicine

Rochester

MN

Disclosures

KJW's employer receives payments from Eli Lilly, Kiniksa, and GlaxoSmithKline for his role as investigator in giant cell arteritis clinical trials. KJW has conducted consulting work for Sanofi. KJW is an author of a number of references cited in this topic.

Acknowledgements

Dr Kenneth J. Warrington would like to gratefully acknowledge Dr Steven R. Ytterberg and Dr Eric L. Matteson, previous contributors to this topic.

Disclosures

SRY declares that he was a sub-awardee of a grant from the US Food and Drug Administration for a pilot study of abatacept, a treatment for Takayasu's arteritis. SRY is also a member of the steering committee at the Vasculitis Clinical Research Committee. ELM declares that he has no competing interests.

Peer reviewers

Loic P. Guillevin, MD

Internal Medicine

Hopital Cochin-Paris University

St-Jacques

Paris

France

Disclosures

LPG declares that he has no competing interests.

Gene G. Hunder, MD

Department of Medicine

Division of Rheumatology

Mayo Clinic

Rochester

MN

Disclosures

GGH is an author of a reference cited in this topic. GGH declares that he has no other competing interests.

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