History and exam
Key diagnostic factors
common
upper or lower limb claudication
Progressive symptoms of claudication are more common than claudication as a presenting feature. A history of pain on exertion of the upper or lower limb may be given; upper limb claudication is more common.
absent pulse(s)
Often found to have unilateral absence of brachial, radial, or carotid pulse due to occlusive disease.
unequal blood pressures
A discrepancy of >10 mmHg between the 2 arms may be noted.
vascular bruits
Bruits may be heard over subclavian, carotid, or abdominal vessels due to eccentric flow.
low-grade fever
A systemic sign, often present during the acute phase of inflammation.
Other diagnostic factors
common
transient ischemic attack (TIA)
History of a previous TIA, or a TIA as a presenting complaint in a young patient, may indicate inflammation of the vertebral or carotid vessels.
myalgia
A systemic symptom, seen in the acute phase; may be accompanied by a rise in inflammatory markers.
arthralgia
A systemic symptom, seen in the acute phase; may be accompanied by a rise in inflammatory markers.
weight loss
A systemic symptom, seen in the acute phase; may be accompanied by a rise in inflammatory markers.
fatigue
A systemic symptom, seen in the acute phase; may be accompanied by a rise in inflammatory markers.
dizziness on upper-limb exertion
May result from subclavian steal syndrome due to a stenotic lesion developing proximal to the origin of the vertebral artery.
hypertension
May develop due to involvement and narrowing of the renal arteries. Can be falsely low if there is a narrowed segment proximally.
uncommon
stroke
Evidence of a previous stroke may be suggestive of central nervous system involvement and arteritis affecting the vertebral or carotid vessels.
chest pain
This can be a feature of Takayasu arteritis if the coronary vasculature is involved, causing coronary ischemia, or if pulmonary arteries are affected.
abdominal pain
May result from involvement of the mesenteric branches of the aorta.
diarrhea
May result from involvement of the mesenteric branches of the aorta.
shortness of breath
Due to pulmonary artery stenosis, coronary artery involvement, or aortic regurgitation.
hemoptysis
May result from pulmonary artery stenosis or heart failure due to aortic root dilation and aortic regurgitation.
night sweats
Constitutional symptom that may be reported during the acute phase.
vertigo
May result from cerebral ischemia.
syncope
May result from cerebral ischemia.
headache
May result from cerebral ischemia or hypertension.
heart murmur
Aortic regurgitation may result from aortic root dilation.
visual symptoms
Due to cerebral ischemia secondary to carotid and vertebral involvement. May include amaurosis fugax, scotoma, or diplopia. The retinopathy originally described by Mikoto Takayasu is rarely seen and is usually a late sign.
erythema nodosum
Uncommonly found on the arms or legs.
pyoderma gangrenosum
Uncommonly found on the legs.
Risk factors
strong
genetic predisposition
Takayasu arteritis is most prevalent in Japan, Southeast Asia, India, and Mexico.[1][2][11][13] Polymorphisms in interleukin genes have been demonstrated in a population of Turkish patients with Takayasu arteritis, and certain HLA antigens have been found in greater-than-expected frequency in some patient populations.[15][16]
Asian ethnicity
There are more reported cases in Asian populations compared with non-Asian, although the reasons for this are unclear, and there may be a genetic basis confounding this association.
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