View source for Takayasu arteritis

==Background==
*Large-vessel [[vasculitis]], leads to fibrosis and narrowing of the vessels <ref>Hellmann, DB et al. Chapter 31. Takayasu Arteritis. In: Imboden JB, Hellmann DB, Stone JH. eds. CURRENT Diagnosis & Treatment: Rheumatology, 3e New York, NY: McGraw-Hill; 2013.</ref>
*Most often affects women of Asian descent during reproductive age
*Diagnosis is often delayed due to the rarity of the disease and varied symptoms
*The disease process chronically improves and relapses<ref>Hellmann, DB et al. Rheumatologic, Immunologic, & Allergic Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. Current Medical Diagnosis & Treatment 2017 New York, NY: McGraw-Hill</ref>

{{Primary Vasculitis DDX}}

==Clinical Features==
*[[Hypertension]]
*[[Congestive Heart Failure]]
*[[CVA]]
*[[Dizziness]]
*Pulselessness
*Claudication
*Bruits
*[[Visual disturbances]]
*[[Arthralgia]]s/[[Myalgia]]s
*[[Aortic Regurgitation]]
*Weight Loss
*Arterial Aneurysm

==Differential Diagnosis==
*[[Systemic lupus erythematosus]]
*[[Syphilis]] 
*[[Rheumatoid Arthritis]]
*[[Sarcoidosis]]

==Evaluation==
[[File:Takayasu_MRA.png|thumb|An MRA showing occlusion of the left subclavian artery and significant narrowing of the left common carotid artery]]
*Work up should be tailored to the patient's symptoms as this disease process affects multiple organ systems due to vascular damage
===Laboratory===
*ESR, CRP, WBC may or may not be elevated
*Anemia may be present
===Imaging===
*Angiography revealing narrowing/occlusion of large vessels (e.g. Aorta) is the gold standard <ref>Lin, PH et al. Arterial Disease. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e New York, NY: McGraw-Hill; 2015.</ref>
*MRA or CTA can be used as well to appreciate vascular stenoses

==Management==
*Oral [[Prednisone]] 1 mg/kg for the first month followed by a taper
**Taper to approximately 10 mg/day
*The addition of [[Methotrexate]] or [[Mycophenolate mofetil]] to [[Prednisone]] therapy may be more effective than monotherapy
*Additional processes (e.g. Hypertension or Congestive Heart Failure) will require disease specific treatments
*In advanced disease processes, Cardiac or Vascular Surgery or Interventional Radiology may be required for angioplasty, stenting, or valvular repair

==Disposition==
*Disposition dependent on presentation and disease severity
*Admit patients with severe [[aortic regurgitation]], large aortic aneurysm, or other concerning features

==References==
<references/>

[[Category:Rheumatology]] [[Category:Vascular]]