Criteria
2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis[35]
The following criteria established by collaboration between the American College of Rheumatology and the (EULAR) are validated and intended for the purpose of classification of vasculitis and are not appropriate for use to establish a diagnosis of vasculitis. The aim of the classification criteria is to differentiate cases of TAK from similar types of vasculitis in research settings. The criteria should only be applied when a diagnosis of large- or medium vessel vasculitis has been made and all potential “vasculitis mimics” have been excluded. It was created by an international Steering Committee comprising clinician investigators with expertise in vasculitis, statisticians, and data managers to update the previous 1990 American College of Rheumatology (ACR) endorsed classification criteria for Takayasu arteritis. The final criteria include 10 clinical items that are routinely assessed during clinical evaluation of patients with Takayasu arteritis. The criteria highlight the importance of clinical symptoms, vascular physical exam, and vascular imaging as important disease classifiers.
Classification criteria for Takayasu arteritis:
Considerations when applying these criteria:
These classification criteria should be applied to classify the patient as having Takayasu arteritis when a diagnosis of medium vessel or large vessel vasculitis has been made
Alternate diagnoses mimicking vasculitis should be excluded prior to applying the criteria.
Absolute requirements:
Age ≤ 60 years at time of diagnosis
Evidence of vasculitis on imaging¹.
Additional clinical criteria:
Female sex +1
Angina or ischemic cardiac pain +2
Arm or leg claudication +2
Vascular bruit² +2
Reduced pulse in upper extremity³ +2
Carotid artery abnormality⁴ +2
Systolic blood pressure difference in arms ≥ 20 mmHg +1.
Additional imaging criteria:
Number of affected arterial territories (select one)⁵
One arterial territory +1
Two arterial territories +2
Three or more arterial territories +3
Symmetric involvement of paired arteries⁶ +1
Abdominal aorta involvement with renal or mesenteric involvement⁷ +3
Sum the scores for 10 items, if present. A score of ≥ 5 points is needed for the classification of Takayasu Arteritis.
Evidence of vasculitis in the aorta or branch arteries must be confirmed by vascular imaging (e.g., computed tomographic/catheter-based/magnetic resonance angiography, ultrasound, positron emission tomography).
Bruit detected by auscultation of a large artery, including the aorta, carotid, subclavian, axillary, brachial, renal, or iliofemoral arteries.
Reduction or absence of pulse by physical exam of the axillary, brachial, or radial arteries.
Reduction or absence of pulse of the carotid artery or tenderness of the carotid artery.
Number of arterial territories with luminal damage (e.g., stenosis, occlusion, or aneurysm) detected by angiography or ultrasonography from the following nine territories: thoracic aorta, abdominal aorta, mesenteric, left or right carotid, left or right subclavian, left or right renal arteries.
Bilateral luminal damage (stenosis, occlusion, aneurysm) detected by angiography or ultrasonography involving the abdominal aorta and either the renal or mesenteric arteries. [Figure caption and citation for the preceding image starts]: The final 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu arteritisGrayson et al. Arthritis Rheumatol 2022;74(12):1872-80; used with permission [Citation ends].
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