Takayasu Arteritis how to diagnose in adults
Takayasu arteritis is a rare, chronic inflammatory disease that primarily affects large arteries, particularly the aorta and its major branches. While it most commonly presents in young women, it can also occur in adults of any age. Diagnosing Takayasu arteritis in adults can be challenging due to its nonspecific symptoms and the slow progression of arterial damage. A comprehensive approach combining clinical evaluation, laboratory tests, and imaging studies is essential for accurate diagnosis.
Clinically, adults with Takayasu arteritis often present with systemic symptoms such as fatigue, fever, weight loss, and malaise. As the disease progresses, signs of arterial narrowing or occlusion become evident, including discrepancies in blood pressure between limbs, diminished or absent pulses (especially in the upper extremities), and bruits heard over affected arteries. Some patients develop ischemic symptoms related to impaired blood flow, such as claudication, dizziness, or visual disturbances.
Initial laboratory investigations are aimed at detecting inflammation and ruling out other causes. Elevated inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are common but nonspecific findings. These markers support the presence of active inflammation but do not confirm the diagnosis. Other blood tests may include a complete blood count, which might reveal anemia or leukocytosis, and tests to exclude infectious or autoimmune diseases.
Imaging studies are central to diagnosing Takayasu arteritis, especially in adults where clinical signs may be subtle. Non-invasive vascular imaging modalities like Doppler ultrasonography can identify vascular wall thickening, stenosis, or occlusion in accessible arteries. However, for a comprehensive assessment, advanced imaging techniques are preferred. Magnetic resonance angiography (MRA) and computed tomography angiography (CTA) provide detailed images of the arterial lumen and wall, revealing characteristic features such as concentric wall thickening, stenosis, or aneurysm formation. Conventional angiography remains the gold standard for detailed visualization of vascular architecture and is particularly useful when planning surgical or endovascular interventions.
The diagnosis of Takayasu arteritis is often based on established classification criteria, such as the American College of Rheumatology (ACR) criteria, which include age of onset under 40 years (although adults can still be diagnosed), claudication of extremities, decreased brachi
al pulse, blood pressure discrepancy, and arteriographic abnormalities. It is important to integrate clinical, laboratory, and imaging findings rather than relying on a single test.
In some cases, biopsy of affected arteries can provide definitive histopathological confirmation, showing granulomatous inflammation with giant cells. However, biopsy is often not feasible due to the deep location of affected arteries and the patchy nature of the disease.
Early diagnosis is critical to prevent irreversible vascular damage, organ ischemia, and complications. A multidisciplinary approach involving rheumatologists, radiologists, and vascular surgeons is essential for optimal management. Regular monitoring with imaging and inflammatory markers helps assess disease activity and guide treatment.
In summary, diagnosing Takayasu arteritis in adults involves a combination of clinical suspicion, assessment of systemic and vascular signs, laboratory tests indicating inflammation, and advanced imaging techniques. Recognizing the disease early can significantly improve outcomes and prevent severe vascular complications.
