Takayasu arteritis

Description

Takayasu arteritis (tah-kah-YAH-sooz ahr-tuh-RIE-tis) is a rare type of vasculitis, a group of disorders that cause inflammation of the blood vessels. In takayasu arteritis, the inflammation damages the large artery that carries blood from the heart to the rest of the body (aorta) and its major branches.

The disease can lead to a narrowing or blockage of the arteries, or the weakening of the walls of the arteries that may bulge (aneurysm) and wear and tear. It can also lead to arm or chest pain, high blood pressure, and, finally, heart failure or stroke.

If you don't have symptoms, you may not need treatment. But most people with the disease need medications to control the inflammation in the arteries and prevent complications. Even with treatment, relapses are common, and the symptoms may appear and disappear.

Symptoms

The signs and symptoms of takayasu's arteritis often occur in two stages.

Stage 1

In the first stage, it is likely that you feel is wrong with:

  • Fatigue
  • Unintentional weight loss
  • Muscle and joint aches and pains
  • Mild fever, sometimes accompanied by night sweats

Not everyone can have these early signs and symptoms. It is possible that the inflammation with damage to the arteries of years before you realize that something is wrong.

Stage 2

During the second stage, the inflammation causes the arteries to narrow, so less blood and oxygen and fewer nutrients reach the organs and tissues. Stage 2 signs and symptoms may include:

  • Pain or weakness in their extremities with the use
  • A weak pulse, difficulty to obtain a blood pressure, or a difference in blood pressure between his arms
  • Lightheadedness, dizziness, or fainting
  • Headaches or changes in vision
  • Memory problems or difficulty thinking
  • Chest pain or shortness of breath
  • High blood pressure
  • Diarrhea or blood in the stool
  • Too few red blood cells (anemia)

When to see a doctor

Seek immediate medical care for shortness of breath, chest or arm pain, or signs of a stroke, such as the face drooping, arm weakness, or have difficulty speaking.

Make an appointment with your doctor if you have other signs or symptoms that worry you. The early detection of takayasu's arteritis is the key to getting effective treatment.

If you've already been diagnosed with takayasu's arteritis, keep in mind that the symptoms may come and go, even with effective treatment. Pay attention to signs similar to those that were originally or new, and be sure to tell your doctor immediately about changes.

Causes

With Takayasu's arteritis, the aorta and other major arteries, including those that the head and the kidneys can become inflamed. With time, the inflammation causes changes in the arteries, including thickening, narrowing and scarring.

No one knows exactly what causes the initial inflammation in takayasu arteritis. The condition is likely to be an autoimmune disease in which your immune system attacks its own artery by mistake. The disease can be caused by a virus or other infection.

Risk factors

Takayasu arteritis primarily affects girls and women under the age of 40 years. The disorder occurs worldwide, but is most common in Asia. Sometimes, the condition runs in families. Researchers have identified some genes associated with takayasu arteritis.

Complications

With Takayasu's arteritis, cycles of inflammation and scarring in the arteries that can lead to one or more of the following complications:

  • The hardening and narrowing of the blood vessels, which can lead to a decrease in the flow of blood to the organs and tissues.
  • High blood pressure, usually as a result of the decrease in blood flow to the kidneys.
  • Inflammation of the heart, which can affect the heart muscle or heart valves.
  • Heart failure due to high blood pressure, inflammation of the heart, aortic valve that allows blood to leak back into your heart, or a combination of these.
  • Stroke, which occurs as a result of the reduction or blockage of blood flow in the arteries leading to the brain.
  • Transient ischemic attack (TIA), also called a mini-stroke. transient ischemic attack (TIA) serves as a warning signal, because it produces symptoms similar to those of a stroke, but does not cause permanent damage.
  • The aneurysm of the aorta, which occurs when the walls of the blood vessels weaken and stretch, forming a lump that has the potential to break.
  • Heart attack, which can occur as a result of the reduction of blood flow to the heart.

Pregnancy

A healthy pregnancy is possible for women with Takayasu's arteritis. But the disease and the drugs used for the treatment may affect your fertility and pregnancy. If you have takayasu Arteritis and are planning to become pregnant, talk with your doctor to develop a plan to limit the complications of pregnancy before you conceive. See your doctor regularly during pregnancy for check-ups.

Takayasu arteritis

Diagnosis

Your doctor will ask about your signs and symptoms, conduct a physical exam and your medical history. He or she may also have to undergo some of the following tests and procedures to help rule out other conditions that resemble those of takayasu's Arteritis and to confirm the diagnosis. Some of these tests may also be used to check on your progress during treatment.

  • Blood tests. These tests can be used to look for signs of inflammation. Your doctor may also check for anemia.
  • The X-ray of blood vessel (angiography).During an angiogram, a long, flexible tube (catheter) that is inserted in an artery or vein. A special dye is then injected into the catheter and X-rays are taken as the dye fills of the arteries or the veins. The resulting images allow your doctor to see if the blood is flowing normally or if it slows down or is interrupted due to a narrowing (stenosis) of a blood vessel. A person with takayasu's arteritis in general, have multiple areas of stenosis.
  • The magnetic resonance angiography (MRA). This least invasive form of angiography produces detailed images of blood vessels without the use of catheters or x-rays. the magnetic resonance angiography (MRA) works through the use of radio waves in a strong magnetic field to produce data that a computer makes detailed images of tissue slices. During this test, a dye is injected into a vein or artery, to help your doctor better see and examine the blood vessels.
  • The computed tomography (CT) angiography. This is another form of non-invasive angiography of the combination of computer analysis of X-ray images with the use of intravenous contrast medium to allow your doctor to check the structure of the aorta and its branches nearby and to control the flow of the blood.
  • Ultrasound. Doppler ultrasound, a more sophisticated version of the common ultrasound, has the capacity to produce high-resolution images of the walls of certain arteries, such as those in the neck and the shoulder. You may be able to detect subtle changes in these arteries before other imaging techniques, it can be.
  • Positron emission tomography (PET). This imaging test is often done in combination with computed tomography or magnetic resonance imaging. positron emission tomography (PET) can measure the intensity of the inflammation in the blood vessels. Before the scan, a radioactive drug is injected into a vein or an artery to make it easier for your doctor to see the areas of decreased blood flow.

The X-ray of blood vessel (angiography). During an angiogram, a long, flexible tube (catheter) that is inserted in an artery or vein. A special dye is then injected into the catheter and X-rays are taken as the dye fills of the arteries or the veins.

The resulting images allow your doctor to see if the blood is flowing normally or if it slows down or is interrupted due to a narrowing (stenosis) of a blood vessel. A person with takayasu's arteritis in general, have multiple areas of stenosis.

Treatment

The treatment of takayasu arteritis is focused on the control of inflammation with medications and prevent further damage to the blood vessels.

Takayasu's arteritis can be difficult to treat because the disease can remain active even if your symptoms improve. It is also possible that irreversible damage has already occurred at the time of diagnosis.

On the other hand, if you don't have signs and symptoms or serious complications, you may not need treatment, or you may be able to taper and discontinue treatment if recommended by your doctor.

Drugs

Talk with your doctor about medications or combinations of medications that are options for you, and its possible side effects. Your doctor may prescribe:

  • Corticosteroids to control the inflammation.The first line of treatment is usually a corticosteroid, such as prednisone (Prednisone Intensol, Rays). Even if you begin to feel better, you may need to continue taking the medication long-term. After a couple of months, your doctor may slowly begin to lower the dose until you reach the lowest dose that you need to control the inflammation. Finally, the doctor may tell you to stop taking the drug altogether. Possible side effects of corticosteroids include weight gain, increased risk of infection and thinning of the bones. To help prevent bone loss, your doctor may recommend a supplement of calcium and vitamin D.
  • Other medications that suppress the immune system. If your condition does not respond well to treatment with corticosteroids or has problems, as the dose of your medicine is low, the doctor may prescribe medications such as methotrexate (Trexall, Xatmep, others), azathioprine (Azasan, Imuran) and leflunomide (Arava). Some people respond well to drugs that have been developed for the people who receive organ transplants, such as mycophenolate mofetil (CellCept). The most common side effect is an increase in the risk of infection.
  • Drugs to regulate the immune system. If you do not respond to standard treatments, your doctor may suggest medicines to correct abnormalities in the immune system (biological), although more research is needed. Examples of biological products include etanercept (Enbrel), infliximab (Remicade) and tocilizumab (Actemra). The most common side effect with these drugs is an increased risk of infection.

Corticosteroids to control the inflammation. The first line of treatment is usually a corticosteroid, such as prednisone (Prednisone Intensol, Rays). Even if you begin to feel better, you may need to continue taking the medication long-term. After a couple of months, your doctor may slowly begin to lower the dose until you reach the lowest dose that you need to control the inflammation. Finally, the doctor may tell you to stop taking the drug altogether.

Possible side effects of corticosteroids include weight gain, increased risk of infection and thinning of the bones. To help prevent bone loss, your doctor may recommend a supplement of calcium and vitamin D.

Surgery

If the arteries become too narrow or blocked, you may need surgery to open or derivation of these arteries to allow an uninterrupted flow of blood. Often, this helps to improve some of the symptoms, such as high blood pressure and chest pain. In some cases, however, the narrowing or blockage may occur again, requiring a second procedure.

Also, if you develop large aneurysms, surgery may be needed to avoid breakage.

The surgical options are best performed when the inflammation of the arteries, has been reduced. They include:

  • The Bypass surgery. In this procedure, an artery or a vein is removed from a different part of your body and connect to the blocked artery, providing a bypass for blood to flow through. Bypass surgery is usually performed when the narrowing of the arteries is irreversible, or when there is significant obstruction to blood flow.
  • Blood vessel enlargement (percutaneous angioplasty). This procedure may be indicated if the arteries are severely blocked. During percutaneous angioplasty, a small balloon is inserted through a blood vessel in the affected artery. Once in place, the balloon is expanded to widen the blocked area, is then deflated and removed.
  • Aortic valve surgery. The surgery of repair or replacement of the aortic valve may be necessary if the valve is leaking significantly.

Coping and support

One of the biggest challenges of living with takayasu's arteritis can deal with the side effects of the medication. The following suggestions may help:

  • Understand your condition. Learn all you can about takayasu's arteritis and its treatment. Learn about the possible side effects of the medications you take, and tell your doctor about any changes in your health. Ask your doctor about the benefits of taking a daily low dose of aspirin on a regular basis.
  • Eat a healthy diet.Eating well can help prevent potential problems that may arise in your condition and medications, such as high blood pressure, weakening of the bones and diabetes. The emphasis on fresh fruits and vegetables, whole grains, and lean meats and fish, while limiting the salt, sugar, and alcohol. If you are taking a corticosteroid medicine, ask your doctor if you need to take a supplement of vitamin D or calcium supplement.
  • Exercise regularly. Regular aerobic exercise, such as walking, can help prevent bone loss, high blood pressure and diabetes. It is also beneficial for the heart and the lungs. In addition, many people find that exercise improves your mood and overall sense of well-being.
  • Avoid all tobacco products. It is important to stop using all forms of tobacco to reduce the risk of injury to the blood vessels and tissues even more.
  • Stay up to date with vaccines. The medicines can make it harder for your body to fight infection. Talk with your doctor about getting vaccinated against the flu, pneumonia, herpes, and other diseases.

Eat a healthy diet. Eating well can help prevent potential problems that may arise in your condition and medications, such as high blood pressure, weakening of the bones and diabetes. The emphasis on fresh fruits and vegetables, whole grains, and lean meats and fish, while limiting the salt, sugar, and alcohol.

If you are taking a corticosteroid medicine, ask your doctor if you need to take a supplement of vitamin D or calcium supplement.

Preparing for your appointment

If your doctor suspects that you have takayasu's arteritis, he or she may refer you to one or more specialists with experience in helping people with this condition. Takayasu arteritis is a rare disease that can be difficult to diagnose and to treat.

You may want to talk with your doctor about a referral to a medical center that specializes in the treatment of vasculitis.

Because appointments can be brief and there's often a lot of information to discuss, it is a good idea to be prepared. Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. At the time of making the appointment, ask if you need to do anything in advance, such as restrict your diet.
  • List of the symptoms that you are experiencing, including any that seem unrelated to the reason for which you scheduled the appointment.
  • The list of personal information, including major stresses and recent changes in life.
  • List of all the medicines, vitamins, and supplements you are taking, including dosage.
  • Ask a family member or friend to come with you. In addition to providing support, he or she may write the information from your doctor or other clinic staff during the appointment.
  • List of questions to ask your doctor. Prepare a list of questions can help you make the most of their time together.

Takayasu's arteritis, some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • What are other possible causes of the symptoms?
  • What tests do I need? Does not require special preparation?
  • Is my condition temporary or long-term?
  • What are my treatment options, and I recommend?
  • I have another medical condition. How can I best manage these conditions?
  • Do I have to change my diet or limit my activities in any way?
  • Is there a generic alternative to the medicine you're prescribing?
  • What if I can't or don't want to take steroids?
  • Do you have any brochures or other printed material that I can take with me? What sites do you recommend?

What to expect from your doctor

Your doctor will likely ask you a series of questions, such as:

  • When did you first start having symptoms?
  • Do you have symptoms all the time, or come and go?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of takayasu's arteritis