Takayasu arteritis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 13 Aug 2025

Last updated: 10 Jan 2025

Takayasu arteritis is a vasculitis of large vessels that particularly affects the aorta and its primary branches.

Generally more common in women and typically presents before the age of 40 years.

Typical symptoms include limb claudication on exertion, chest pain, and systemic symptoms of weight loss, fatigue, low-grade fever, and myalgia.

On examination, vascular bruits may be audible over the carotids, abdominal aorta, or subclavian vessels. Unequal blood pressures may be recorded between sides, and a murmur of aortic regurgitation may be heard if there is aortic root dilation.

The diagnosis is usually made by vascular imaging.

Glucocorticoids are initial therapy, with additional use of corticosteroid-sparing immunosuppressants. Biologic agents are often used for refractory disease. Surgery may be required for established complications.

Long-term complications are due mainly to arterial occlusion and related damage, including limb ischemia and cardiac and neurologic manifestations.

Definition

Takayasu arteritis is a chronic granulomatous vasculitis affecting large arteries: primarily the aorta and its main branches. Vascular inflammation can cause stenosis, occlusion, and aneurysm formation. Symptoms from vascular ischemia include claudication and stroke. Diminished or absent pulses and hypertension are common. Constitutional symptoms, including fever and weight loss, are often accompanied by elevation of acute phase markers.[1][2][3][4]

History and exam

Key diagnostic factors

upper or lower limb claudication
absent pulse(s)
unequal blood pressures
vascular bruits
low-grade fever

Full details

Other diagnostic factors

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

Full details

Risk factors

genetic predisposition
female sex
age <40 years
Asian ethnicity

Full details

Diagnostic investigations

1st investigations to order

CRP
erythrocyte sedimentation rate (ESR)
computed tomography angiography (CTA)
magnetic resonance angiography (MRA)

Full details

Investigations to consider

Doppler ultrasound
positron emission tomography with radiolabeled fluorodeoxyglucose (PET-FDG)

Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Kenneth J. Warrington, MD

Professor of Medicine

Mayo Clinic College of Medicine

Rochester

Disclosures

KJW declares that he has received clinical trial support from Eli Lilly, BMS, and Kiniksa. He has received consulting fees and honoraria from Amgen and 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 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

Disclosures

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Weyand CM, Goronzy JJ. Medium- and large-vessel vasculitis. N Engl J Med. 2003 Jul 10;349(2):160-9. Abstract

Kerr GS. Takayasu's arteritis. Rheum Dis Clin North Am. 1995 Nov;21(4):1041-58. Abstract

Maz M, Chung SA, Abril A, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Rheumatol. 2021 Aug;73(8):1349-65.Full text Abstract

Pugh D, Karabayas M, Basu N, et al. Large-vessel vasculitis. Nat Rev Dis Primers. 2022 Jan 6;7(1):93.Full text Abstract

Isselbacher EM, Preventza O, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-393. Abstract

Grayson PC, Ponte C, Suppiah R, et al. 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis. 2022 Dec;81(12):1654-60.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Giant cell arteritis (GCA)
- Essential hypertension
- Syphilis
More Differentials
Guidelines
- 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis
- 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
More Guidelines
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Takayasu arteritis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

Kenneth J. Warrington, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Loic P. Guillevin, MD

Disclosures

Gene G. Hunder, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice