Takayasu'S Arteritis

1 What is Takayasu's Arteritis?

Takayasu's arteritis is a rare form of vasculitis that involves inflammation of walls of aorta and its major branches. Inflammation of the wall of the artery may lead to aneurysms, stenosis, and blockages in blood vessels. 

It may also lead to stroke or heart failure. Actual cause of the inflammation is not known.  Autoimmune condition, in which immune system attacks body’s healthy tissues, is implied in the development of this condition. 

It is most commonly found in Asians, and females below 40 years of age. Diagnosis is based on physical examination, review of symptoms, and radiography. Treatment focuses on suppressing the inflammation in blood vessels.

2 Symptoms

Symptoms of Takayasu's arteritis are caused by inflammation of the wall of the arteries. The disease has two stages, each stage characterized by different symptoms. 

Systemic stage or stage 1 has symptoms that occur before the occlusion of blood vessels. Stage 2 or Occlusion stage has symptoms due to narrowing of the blood vessels and reduced flow of blood to organs and tissues. 

Symptoms of stage 1 include:

  • Fatigue
  • Weight loss
  • Body pain and aches
  • Mild fever
  • Tenderness above the affected arteries

Symptoms of stage 2

Symptoms in stage 2 depends on the location of occlusion in blood vessel. It includes:

Peripheral pulses are generally not palpable in this condition. Pressure difference of more than 10 mm HG between the two arms is a characteristic sign of the condition. Noise could be heard over the arteries while using stethoscope. 

3 Causes

Takayasu's arteritis is caused by the inflammation of the lining of aorta and its branches. But, the actual cause of inflammation is not known. 

Inflammation of wall lining leads to narrowing, thickening, and scarring of the blood vessels. Blood flow through the vessel is restricted, affecting the nutrient and oxygen supply to tissues and organs. 

Autoimmune condition, in which immune system attacks healthy cells and tissues of the body, is implied in the development of Takayasu's arteritis. Viral and other infections are also considered to increase the risk of this rare form of vasculitis

It is most commonly seen in girls and women, particularly those below 40 years of age. In some cases, the condition is found to run in families. It is more prevalent in Asian countries when compared to others.

4 Making a Diagnosis

Review of signs and symptoms, evaluation of medical history, and physical examination are the first steps in the diagnosis of Takayasu's arteritis. 

Other tests are used for confirmatory diagnosis and to rule out chances of other medical conditions that result in similar symptoms. 

Blood tests are used to measure levels of C-reactive protein and erythrocyte sedimentation rate, two features which remain high in inflammation. It also helps to look out for anemia, another common symptom. 

Angiography is a procedure in which a catheter is inserted into a large artery and a contrast dye injected into the blood vessels. As the dye fills the blood vessels, x-ray images are taken to obtain detailed view of the arteries and veins. 

The images show the flow of blood in the vessels and also stenosis, if any.

Magnetic resonance angiography (MRA) is a form of MRI in which a contrast medium is injected into the blood vessels before taking an MRI. 

A detailed view of the soft tissues is obtained, including narrowing and thickening of blood vessels. 

CT angiography uses a contrast dye to view the structure and functioning of blood vessels. The dye is injected into a major blood vessel and tracked using x-ray images. 

Ultrasonography produces high-resolution images of the arterial walls to locate and detect changes in structure of arteries.

Positron emission tomography or PET produces detailed images of blood vessels that enable to measure the extent of inflammation in the arterial walls. 

A radioactive tracer is injected into the blood vessel before taking the PET scan, so as to obtain a clearer picture of the arteries. 

5 Treatment

Controlling inflammation and damage to the blood vessel are the first steps in the treatment of Takayasu's arteritis.

Medications are used to reduce inflammation and to suppress the immune system. 

  • Corticosteroids are the most commonly used medications for controlling inflammation. This medication is usually continued for a long term, but the dosage is gradually reduced until the lowest dose needed to control symptoms is reached. Corticosteroids have a number of side effects like weight gain, increased chances of infections, and osteoporosis
  • Immunosuppressant medications are recommended if the person does not respond to corticosteroids. Methotrexate and azathioprine are commonly prescribed for suppressing immune system. 
  • Medications to control immune system are prescribed if the patient does not respond to any of the conventional treatments. Etanercept and infliximab are examples of medications that correct the abnormal functioning of immune system. 
  • Severe stenosis or thickening of arteries may require surgery to improve the flow of blood. Surgical procedures are performed after controlling the inflammation. In bypass surgery, artery or vein from a different part of the body is used to bypass the affected part of the blood vessel. 
  • In percutaneous angioplasty, a tiny balloon is guided to the region of stenosis using a catheter. The balloon is then inflated to widen the blood vessel. Once the artery is wide enough, the balloon is deflated and removed from the blood vessel. Aortic valve surgery is recommended if valve is leaking. 

6 Prevention

There are no standard preventive measures for Takayasu's arteritis, as the cause of the disease is not known.

7 Alternative and Homeopathic Remedies

Several alternative and homeopathic remedies exist for Takayasu's arteritis.

Aconitum, arnica, belladonna, natrum mur, spigelia and hypericum are commonly indicated in homeopathy for controlling the symptoms of Takayasu's arteritis. 

Anti-inflammatory diet is often suggested to control inflammation in the blood vessels. 

This includes: 

  • avoiding cow’s milk and its products
  • eliminating polyunsaturated vegetable oil
  • increasing intake of omega-3 fatty acids
  • having more of fruits and vegetables

Ginger and turmeric are the anti-inflammatory herbs suggested for controlling inflammation. Grape seed extract is also used for keeping the blood vessels healthy. 

Alternate remedies suggested for Takayasu's arteritis include:

8 Lifestyle and Coping

Coping with the side effects of medication is the major challenge with the treatment of Takayasu's arteritis.

Having a healthy diet with more of anti-inflammatory food, helps to prevent problems caused by inflammation and medications. 

Regular exercise prevent bone loss, reduce hypertension, and improve overall health.

Learn more about the condition and the treatment.

Joining a support group to discuss the experiences help to cope with the condition better.

9 Risks and Complications

Some of the complications associated with Takayasu's arteritis include:

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