Takayasu's Arteritis: Causes, Symptoms, Diagnosis, Treatment and Complications

Takayasu's arteritis is an uncommon form of vasculitis, a group of illnesses that cause inflammation of the blood vessels. Takayasu's arteritis causes inflammation that damages the aorta, a large artery that links your heart to the rest of your body, as well as its major branches.

Arteries may develop blockages or restrictions as a result of the illness, or their walls may weaken and tear or bulge (aneurysm). It could also result in chest pain, arm pain, excessive blood pressure, and finally heart failure or a stroke.

If you don't have any symptoms, therapy might not be necessary. The majority of patients with the illness, however, need medications to manage arterial inflammation and prevent issues. Even with treatment, relapses are common, and your symptoms might change.

Causes Of Takayasu's Arteritis

Takayasu's arteritis' initial inflammation has an unknown origin. Most likely, you have an autoimmune illness where your body mistakenly targets your own arteries. A virus or another infection may cause the sickness.

Symptoms Of  Takayasu's Arteritis

Takayasu's arteritis signs and symptoms frequently come in two stages.

Stage 1- During the first stage, you may experience:

• Fatigue
• Unwanted loss of weight
• Pains in joints and muscles
• Mild fever, occasionally with nocturnal sweats

These early warning signs and symptoms are not always present. Inflammation may harm your arteries for years before you notice anything is amiss.

Stage 2-  As a result of the second stage's inflammation, your organs and tissues receive less blood, oxygen, and nutrients.

Stage 2 warning signs and symptoms could include:

• Weakness or discomfort in your limbs after use.
• A weak pulse, trouble taking your blood pressure, or a variation in your arm's blood pressure.
• Feeling faint, woozy, or lightheaded.
• Migraines or changes in vision.
• Memory issues or difficulty thinking.
• Shortness of breath.
• High blood pressure.
• The aorta and other significant arteries, such as the ones to your head and kidneys, might become inflamed as a result of Takayasu's arteritis. These arteries undergo changes over time as a result of the inflammation, including thickening, constriction, and scarring.

Diagnosis Of Takayasu's arteritis

Your doctor will ask you about your signs and symptoms, do a physical exam, and take your medical history. In order to help rule out other disorders that mimic Takayasu's arteritis and to solidify the diagnosis, he or she could also ask you to go through some of the following tests and treatments. Some of these tests could also be performed to monitor your treatment progress.

• Blood test. You can use these tests to check for inflammation-related symptoms. Anaemia may also be examined by your doctor.
• Angiography. Angiography involves inserting a long, flexible tube (catheter) into a significant vein or artery. The catheter is then filled with a particular contrast dye, which is inserted into it. As the dye fills your arteries or veins, X-rays are then taken.

Your doctor can determine from the generated images if blood is flowing normally or if a blood vessel's stenosis is causing it to slow down or stop. Typically, Takayasu's arteritis patients have many stenosis-prone regions.

• MRA, or magnetic resonance angiography. Without the use of catheters or X-rays, this less intrusive type of angiography creates comprehensive images of your blood vessels. Using radio waves and a strong magnetic field, magnetic resonance angiography (MRA) generates data that a computer then uses to create precise pictures of tissue slices. A contrast dye is injected into an artery or vein during this test to help your doctor view and study the blood vessels more clearly.
• Angiography on a computerized tomography (CT) scan. This is yet another noninvasive kind of angiography that combines intravenous contrast dye with computerized image processing of X-rays to enable your doctor to examine the structure of your aorta and its adjacent branches as well as to track blood flow.
• Ultrasonography. The walls of some arteries, including those in the neck and shoulder, can be seen in incredibly high resolution using Doppler ultrasound, a more advanced variation of conventional ultrasound. It could be able to identify minute alterations in these arteries before other imaging methods.
• PET, or positron emission tomography. This imaging technique is frequently combined with magnetic resonance imaging or computerized tomography. Blood vascular inflammation can be quantified using positron emission tomography (PET). A radioactive substance is injected into an artery or vein prior to the scan to help your doctor more easily identify areas with reduced blood flow.

Treatment Of Takayasu's Arteritis

Takayasu's arteritis treatment focuses on reducing inflammation with medication and preventing future blood vessel damage. Because Takayasu's arteritis may still be active even after your symptoms become better, it can be challenging to treat. It's also possible that by the time you receive a diagnosis, irreparable harm has already been done.

On the other hand, if you don't have any symptoms, you might not need treatment or, if your doctor advises it, you might be able to taper and cease medication.

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Medications

Discuss the medication(s) or medication combinations that you have available to you, as well as any potential adverse effects, with your doctor. Your physician might advise:

Corticosteroids are used to manage inflammation. A corticosteroid like prednisone (Prednisone Intensol, Rayos) is typically the first course of treatment for such conditions. You might need to take the medication for a long time even if you start to feel better. When you achieve the lowest amount required to reduce inflammation, your doctor may start progressively lowering the dose. Your doctor might eventually advise you to stop using the drug altogether.

Weight gain, an increased risk of infection, and thinning bones are all potential side effects of corticosteroids. Your physician could advise taking a calcium supplement and taking vitamin D to help prevent bone loss.

Other medicines that weaken the immune system. Your doctor may prescribe medications like methotrexate (Trexall, Xatmep, among others), azathioprine (Azasan, Imuran), and leflunomide (Arava) if your illness doesn't react well to corticosteroids or if you experience problems as the dose of your medicine is dropped. Mycophenolate mofetil (CellCept), a drug designed for organ transplant recipients, has a positive response in certain patients. An elevated risk of infection is the most frequent adverse effect.

Immune system-regulating drugs. Your doctor might recommend medications that address immune system abnormalities (biologics) if you don't react to conventional treatments, but more study is required. Etanercept (Enbrel), infliximab (Remicade), and tocilizumab (Actemra) are some examples of biologics. 

An increased risk of infection is one of these medications' most frequent side effects.

Surgery 

You may require surgery to open or bypass any significantly restricted or clogged arteries in order to maintain a continuous blood flow. This frequently helps to alleviate specific symptoms like chest pain and high blood pressure. But occasionally, the narrowing or blockage may return, necessitating a second surgery.

Additionally, surgery can be required if you develop large aneurysms in order to stop them from rupturing. They consist of:

• Bypass surgery. In this surgery, a vein or artery is taken from another area of your body and joined to the blocked artery to provide a bypass for blood flow. When there is a considerable blood flow restriction or when artery constriction is irreparable, bypass surgery is typically undertaken.
• Vascular dilation (percutaneous angioplasty). If the arteries are significantly clogged, this operation might be necessary. A small balloon is inserted into the damaged artery during percutaneous angioplasty by passing it via a blood vessel. The balloon is first inflated to broaden the obstructed region before being removed.
• Operation on the aortic valve. If the aortic valve is significantly leaking, surgical repair or replacement may be necessary.

Complications Of  Takayasu's arteritis

Cycles of inflammation and healing in the arteries may cause one or more of the problems mentioned below in people with Takayasu's arteritis:

• Narrowing and hardening of blood arteries, which may result in less blood reaching tissues and organs.
• High blood pressure, is frequently as a result of impaired kidney blood flow.
• Heart inflammation, which may impact the heart valves or the heart muscle.
• Aortic valve disease that enables blood to leak back into your heart, excessive blood pressure, heart inflammation, or a combination of these can all cause heart failure.
• Stroke, which happens when the blood flow to your brain's arteries is impeded or blocked.
• TIA, or transient ischemic attack, is another name for a ministroke. The symptoms of a transient ischemic attack (TIA), which resemble those of a stroke but do not result in lasting damage, serve as a warning indicator.
• An aortic aneurysm develops when the blood vessel's walls weaken and strain, creating a bulge that could eventually burst.
• A heart attack could happen as a result of inadequate blood supply to the heart.

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