Takayasu arteritis

Takayasu arteritis affects medium-sized and large arteries, specifically the aorta and the supraaortic branches. The disease is usually not seen in intracranial vessels nor in the temporal artery. Although for a long time DSA was accepted as a diagnostic... 

Lhermitte F, Gautier JC, Derouesne C (1970). Nature of occlusions of the middle cerebral artery. Neurology 20 82-88 Liang P and Hoffmann GS (2005). Advances in the medical and surgical treatment of Takayasu arteritis. Current Opinions in Rheumatology 17 16-24 Lim W, Crowther MA, Eikelboom JW (2006). Management of antiphospholipid antibody syndrome a systematic review. Journal of the American Medical Association 295 1050-1057... 

American Medical Association 193 711-719 Schulz UGR, Rothwell PM (2003). Differences in vascular risk factors between aetiological subtypes of ischemic stroke in population-based incidence studies. Stroke 34 2050-2059 Seko Y (2007). Giant cell and Takayasu arteritis. 

Ringleb PA, Strittmatter El, Loewer M, Hartmann M, Fiebach JB, Lichy C, Weber R, Jacobi C, Amendt K, Schwaninger M Cerebrovascular manifestations of takayasu arteritis in europe. Rheumatology (Oxford) 2005 44 pp. 1012-1015. 

Pfefferkorn T, Bitterling H, Htifner K, Opherk C, Schewe S, Pfister HW, Straube A, Dichgans M Malignant hemispheric infarction in takayasu arteritis. J Neurol 2008 255 pp. 1425-1426. 

Chua et al. (C6) reported markedly, but transiently, elevated levels of proMMP-9 and TIMP-1 in the plasma of patients with Kawasaki disease (an acute, self-limiting vasculitis) this data is consistent with MMP-9 involvement in vascular remodeling and an inflammatory response to a microbial agent. Matsuyama et al. (M9) reported that circulating levels of MMPs can be useful in the diagnosis of Takayasu arteritis. 

M9. Matsuyama, A., Sakai, N., Ishigami, M., et at. Matrix metalloproteinases as novel disease markers in Takayasu arteritis. Circulation 108, 1469-1473 (2003). 

Renal arteries are more commonly investigated by MRI rather than by CT. However, CTA in combination with oblique MIP or VRT is helpful in the detection of different pathologies of the renal arteries, such as atherosclerotic stenosis, fibromuscular dysplasia or Takayasu arteritis. Post-processing of the renal arteries also allows measurement of the degree of stenosis prior to intervention, or as followup control (Sabharwal et al. 2006). 

Wintersperger B, Jakobs T, Herzog P, Schaller S, Nikolaou K, Suess C, Weber C, Reiser M, Becker C (2005) Aorto-iliac multidetector-row CT angiography with low kV settings improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol 15 334-341 Yamada I, Nakagawa T, Himeno Y, Numano F, Shibuya H (1998) Takayasu arteritis evaluation of the thoracic aorta with CT angiography. Radiology 209 103-109... 

Kreidstein SH, L3dwyn A, Keystone EC. Takayasu arteritis with acute interstitial pneumonia and coronary vascuhtis expanding the spectrum. Arthritis Rheum 1993 36(8) 1175-1178. 

In a prospective open-label study on 15 Takayasu arteritis patients with active disease, patients received leflunomide (20mg/day) for at least 6 months. During follow-up (mean of 9.1 months) three patients (20%) experienced mild adverse events, while 33% of patients showed elevation of liver enzymes two times above the upper limit [74 ]. 

A 43-year-old female on corticosteroids for Takayasu arteritis, INH for suspicious positive tuberculin skin test for past three months and escistalopram 20 mg/day for past month, developed acute onset of fever and confusion. Neurological examination revealed fever, rigidity, clonus, bilateral positive Babinsky and Hoffman signs... 

A 52-year-old woman with Takayasu arteritis and a history of multiple sclerosis treated with IFN 3-la experienced a severe worsening of the arteritis after the reintroduction of the previously withdrawn IFN therapy. Symptoms included fever, weakness, increased inflammation and claudication in the left arm where no blood pressure or radial-ulnar pulse was measurable due to severe stenosis of the left axillary artery. Withdrawal of IFN 3-la resulted in prompt improvement of the vasculitis [56 ]. 

EHamantopoulas AP, Hetland H, Hansen AE, Myklebust G. Severe deterioration of newly diagnosed Takayasu arteritis in a patient re-treated with interferon beta-la for concomitant longstanding multiple sclerosis. Med Rheumatol 2012 22(3) 474-8. 

Horai Y, Satoru O, Lapalme-Remis S, Sumiyoshi R, Nakashima Y, Suzuki T, et al. Takayasu arteritis developing during treatment of ulcerative colitis with infliximab. Mod Rheumatol 2013 23(3) 572-6. 

Andrews J, Al Nahhas A, Pennell DJ et al. (2004) Non-invasive imaging in the diagnosis and management of Takayasu s arteritis. Ann Rheum Dis 63 995-1000... 

Tenderness of the branches of the external carotid artery (occipital, facial, superficial temporal) points towards giant cell arteritis. Tenderness of the common carotid artery in the neck can occur in acute carotid occlusion but is more Ukely to be a sign of dissection, or arteritis. Absence of several neck and arm pulses in a young person occurs in Takayasu s arteritis (Ch. 6). Delayed or absent leg pulses suggest coarctation of the aorta or, much more commonly, peripheral vascular disease. Other causes of widespread disease of the aortic arch are atheroma, giant cell arteritis, syphihs, subintimal fibrosis, arterial dissection and trauma. 

Other situations Situations such as a pheochro-mocytomaand coronary arteritis secondary to systemic diseases, as Takayasu s disease, Kawasaki s disease, Churg-Strauss syndrome, etc., may generate myocardial ischaemia, ACS and even a myocardial infarction. This is also the case for patients with AIDS that often present diffuse and severe atherosclerotic lesions. 

Inflammatory conditions Primary angiitis Systemic lupus erythematosus Temporal arteritis Takayasu s arteritis... 

Giant cell arteritis carmot be differentiated from Takayasu s arteritis in morphological terms. Only the distribution of the lesions with predominance in supra-aortic vessels is indicative for this type of arteritis. 

Takayasu s arteritis can affect the whole aorta and its side branches. In the acute stage of the disease, CT and MRI show an inflammatory thickening of the aortic waU, with increased contrast enhancement. This enables the differentiation from atherosclerotic transformations of the aortic wall. In MRI, edema of the waU can additionally be detectable (Yamada et al. 1998). In chronic stages of the disease (weeks to months), long-segment stenosis of occlusion with the formation of collateral circulation, intraluminal thrombi, and calcifications of the aortic wall can be seen. The incidence of aortic aneurysms in Takayasu s arteritis lies between 30 and 50%... 

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