Makindo Medical Notes

⚠️ Takayasu’s arteritis = "Pulseless disease" → think of a young woman (<40), weight loss, malaise, absent pulses, and raised ESR. The hallmark is granulomatous inflammation of the aorta and its major branches, leading to stenosis, occlusion, or aneurysm formation.

📖 About

• Chronic inflammatory large-vessel vasculitis of unknown origin.
• Median age of onset = 29 years; women are affected 8× more than men.
• Highest prevalence in Asia & Africa, less common in Europe/North America.

🧬 Pathophysiology

• Active inflammatory phase: Granulomatous aortitis ± branch vessel involvement.
• Sclerotic phase: Intimal hyperplasia + medial degeneration → stenosis/occlusion.
• Lesions are usually stenotic, though aneurysms may occur.

🩸 Affected Vessels

• Mainly the aorta and primary branches.
• Common sites = aortic arch, subclavian, renal, and carotid arteries.
• Pulmonary artery may also be affected.

🧑‍⚕️ Clinical Features

• Constitutional: fatigue, fever, night sweats, weight loss, arthralgia, headache.
• Vascular insufficiency signs:
  • Upper/lower limb claudication
  • Absent pulses → “pulseless disease”
  • BP difference >10 mmHg between arms
  • Bruits over subclavian / abdominal aorta
• Complications:
  • Renal artery stenosis → hypertension
  • Aortic regurgitation → heart failure
  • Coronary involvement → angina/MI
  • Carotid disease → TIA/stroke
  • Mesenteric ischaemia → abdominal angina

🧪 Laboratory Findings

• ↑ ESR & CRP (active inflammation)
• Anaemia of chronic disease
• Mild leukocytosis
• Hypergammaglobulinaemia

📋 Diagnostic Criteria (Arend et al., 1990)

🔍 Diagnosis

Imaging is essential → demonstrates stenosis, occlusion, or aneurysm.

• Aortography
• CT Angiography
• MR Angiography (non-invasive, preferred for follow-up)

💊 Treatment

• Corticosteroids: Prednisone 60–100 mg/day in active phase.
• If steroid-refractory → immunosuppressants (e.g. Methotrexate, Azathioprine, Mycophenolate).
• Biologics: Tocilizumab (IL-6 inhibitor) effective in resistant disease.
• Intervention:
  • Balloon angioplasty → for short stenoses (high restenosis risk).
  • Surgical bypass/reconstruction → avoid during active inflammation.

📊 Prognosis

• ~50% relapse within 10 years.
• 15-year survival: ~85% overall, but ↓ to 65% if major vascular complications.
• Leading causes of death = stroke, MI, heart failure.