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)
- CRP
- computed tomography angiography (CTA)
- magnetic resonance angiography (MRA)
Investigations to consider
- Doppler ultrasound
- positron emission tomography with radiolabelled fluorodeoxyglucose (PET-FDG)
Treatment algorithm
all patients
Contributors
Authors
Kenneth J. Warrington, MD
Professor of Medicine
Mayo Clinic College of Medicine
Rochester
MN
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'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.
References
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 DifferentialsGuidelines
- 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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