Advertisement

Takayasu's Arteritis

  • Eamonn S. Molloy
  • John H. Stone
  • Carol A. Langford

Abstract

The aorta and its major branches are the prime disease targets in Takayasu's arteritis (TA). Clinical symptoms of vascular inflammation and vascular insufficiency are usually accompanied or preceded by a systemic inflammatory process. TA disease tends to affect women much more often than men (female:male ratio 9:1), and has a predilection for Asian women. However, the disease has been described in individuals of all racial and ethnic backgrounds. TA is associated with granulomatous inflammation within the blood vessel wall. The histopathologic features of the disease closely resemble those of giant cell arteritis. TA leads to vascular narrowing in most of the blood vessels it affects. However, in the aorta, the disease can cause aneurysms. These often lead to aortic regurgitation of the ascending aorta. A lesion of great concern in TA is renal artery stenosis, which can lead to a rennin-mediated hypertension. If the patient has narrowings in all of the blood vessels to the four extremities, then peripheral blood pressure measurements may not be accurate assessments of the true central aortic pressures. Catheterization may be required to determine the patient's blood pressure accurately. Eye lesions in TA are of two major types: hypertensive retinopathy (particularly in the setting of renal artery stenosis) and proliferative retinopathy (caused by extreme narrowing of the blood vessels supplying the head, which leads to neovascularization of the retinal vascular supply). Anterior ischemic optic neuropathy, the most common ocular lesion of giant cell arteritis, occurs very rarely in TA.

Keywords

Magnetic Resonance Angiography Aortic Regurgitation Renal Artery Stenosis Giant Cell Arteritis Anterior Ischemic Optic Neuropathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Aso T, Abe S, Yaguchi T. Clinical gynecologic features of pregnancy in Takayasu's arteritis. Heart Vessels. 1992;7:S125–132CrossRefGoogle Scholar
  2. Atalay M, Bluemke D. Magnetic resonance imaging of large vessel vas-culitis. Curr Opin Rheum. 2001;13:41–47CrossRefGoogle Scholar
  3. Flamm S, White R, Hoffman G. The clinical application of “edema-weighted” magnetic resonance imaging in Takayasu's arteritis. Int J Cardiol. 1998;66:151–9CrossRefGoogle Scholar
  4. Gotway MB, Araoz PA, Macedo TA, et al Imaging findings in Takayasu's arteritis. Am J Roentgenol. 2005;184:1945–50CrossRefGoogle Scholar
  5. Giordano J, Leavitt R, Hoffman G, et al Experience with surgical treatment for Takayasu's disease. Surgery 1991;109:252–8PubMedGoogle Scholar
  6. Hoffman G. Takayasu's arteritis: lessons from the American National Institutes of Health experience. Int J Cardiol. 1997;54:S99–102CrossRefGoogle Scholar
  7. Hoffman GS, Leavitt RY, Kerr GS, et al Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum. 1994;37:578–82PubMedCrossRefGoogle Scholar
  8. Hoffman GS, Merkel PA, Brasington RD, et al Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum. 2004b;50:2296–304CrossRefGoogle Scholar
  9. Kerr GS, Hallahan CW, Giordano J, et al Takayasu arteritis. Ann Intern Med. 1994;20:919–29CrossRefGoogle Scholar
  10. Lagneau P, Michel J-B, Vuong P. Surgical treatment of Takayasu's disease. Ann Surg. 1987;205:157–66PubMedCrossRefGoogle Scholar
  11. Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu's arteritis. Curr Opin Rheumatol. 2005;17:16–24PubMedCrossRefGoogle Scholar
  12. Maksimowicz-McKinnon K, Clark TM, Hoffman GS. Takayasu's arteritis: limitations of therapy and guarded prognosis in an American cohort. Arthritis Rheum. 2007;56:1000–9PubMedCrossRefGoogle Scholar
  13. Matsumura A, Moriwaki R, Numano F. Pregnancy in Takayasu arteritis from the view of internal medicine. Heart Vessels. 1992;7(S):120–4CrossRefGoogle Scholar
  14. Molloy ES, Langford CA, Clark TM, et al Durable remission in patients with refractory Takayasu's arteritis treated with infliximab and etan-ercept. Ann Rheum Dis. 2008;67:1567–9PubMedCrossRefGoogle Scholar
  15. Moreno D, Yuste JR, Rodriguez M, et al Positron emission tomography use in the diagnosis and follow up of Takayasu's arteritis. Ann Rheum Dis. 2005;64:1091–3PubMedCrossRefGoogle Scholar
  16. Pernicario C V, Winkelmann RK, Hunder GG. Cutaneous manifestations of Takayasu's arteritis. J Am Acad Dermatol. 1987;17:998–1005CrossRefGoogle Scholar
  17. Rojo-Leyva F, Ratliff N, Cosgrove D, et al Study of 52 patients with idiopathic aortitis from a cohort of 1,204 surgical cases. Arthritis Rheum. 2000;43:901–7PubMedCrossRefGoogle Scholar
  18. Satomi K, Yoh Z, Atsuhiro K, et al Inflammatory abdominal aortic aneurysm: close relationship to IgG4-related periaortitis. Am J Surg Pathol. 2008;32:197–204CrossRefGoogle Scholar
  19. Sharma B, Jain S, Vasishta K. Outcome of pregnancy in Takayasu arteritis. Int J Cardiol. 2000;75:S159–62PubMedCrossRefGoogle Scholar
  20. Stone JH, Khosroshahi A, Hilgenberg AD et al IgG4-related systemic disease and lymphoplasmacytic aortitis. Arthritis Rheum 2009 (in press)Google Scholar
  21. Terumi K, Atsutake O. IgG4-related sclerosing disease. World J Gastroenterol. 2008;14:3948–55CrossRefGoogle Scholar
  22. Tso E, Flamm SD, White RD, et al Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum. 2002;46:1634–42PubMedCrossRefGoogle Scholar
  23. Yoshida K, Toki F, Takeuchi T, et al Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40:1561–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Eamonn S. Molloy
    • 2
  • John H. Stone
    • 1
  • Carol A. Langford
    • 3
  1. 1.Clinical RheumatologyMassachusetts General HospitalBoston
  2. 2.Rheumatic and Immunologic DiseasesCleveland ClinicClevelandUSA
  3. 3.Department of Rheumatology & ImmunologyCleveland Clinic FoundationClevelandUSA

Personalised recommendations