Takayasu’s Arteritis

Diagnosis

Diagnosing Takayasu arteritis involves a review of symptoms, a physical exam and an evaluation of your medical history. Your healthcare professional may also use specific tests to confirm the diagnosis and rule out other conditions with similar symptoms. Many of these tests are also helpful for monitoring how the condition responds to treatment.

Tests and procedures that may be used include:

• Blood tests to look for signs of inflammation and to check for anemia.

• X-rays of the blood vessels, also called angiography, to see how blood flows through the arteries and whether any areas are narrowed or blocked.

• MRA, a less invasive form of angiography that uses radio waves, strong magnetic fields and contrast dye to create detailed images of the blood vessels.

• CT angiography, which combines X-ray images and contrast dye to assess the aorta and its branches and to watch how blood moves through them.

• Ultrasonography, especially Doppler ultrasound, to detect early changes in the walls of certain arteries such as those in the neck and shoulder.

• Positron emission tomography, often combined with CT or MRI, to show how much inflammation is present in the blood vessels. A radioactive medicine helps highlight areas with reduced blood flow.

Treatment

Treatment for Takayasu arteritis focuses on controlling inflammation and preventing further damage to the blood vessels. The condition may be challenging to manage because inflammation can remain active even when symptoms improve. Some people may not need treatment if they do not have symptoms or complications, while others may taper off treatment over time under medical guidance.

Medicines play a major role in managing the condition. Corticosteroids such as prednisone are often the first treatment used to reduce inflammation. Even after symptoms improve, long-term use may be needed. Over time, the dose may be slowly lowered to the minimum required. Possible side effects include weight gain, bone loss and a higher risk of infection, so supplements such as calcium and vitamin D may be recommended.

If corticosteroids are not effective or if dose reduction causes symptoms to worsen, other medicines that suppress the immune system may be used. These may include methotrexate, azathioprine and leflunomide. Some people may respond well to medicines used for organ transplant patients, such as mycophenolate. Medicines called biologics, including etanercept, infliximab and tocilizumab, may be considered when standard treatments do not work. These medicines regulate immune system activity but also increase the risk of infection.

Surgery may be needed for severe narrowing of the arteries. Procedures can help improve blood flow and relieve symptoms such as chest pain and high blood pressure. In some cases, narrowing may return and require further treatment. Surgery may also prevent large aneurysms from tearing. It is usually recommended once inflammation has decreased.

Surgical options include:

• Bypass surgery, which uses a blood vessel from another part of the body to create a new pathway for blood flow around a blockage.

• Blood vessel widening, known as percutaneous angioplasty, in which a surgeon uses a tiny balloon to expand the narrowed area of an artery.

• Aortic valve surgery to repair or replace a severely leaking aortic valve.

These approaches help reduce complications and improve long-term outcomes in people with Takayasu arteritis.