Takayasu's arteritis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
In 1830, Rokushu Yamamoto, who practised Japanese oriental medicine described the first case of Takayasu’s arteritis. In 1905, Mikito Takayasu repoted a case of a 21 year old woman with characteristic fundal arteriovenous anastamoses as “a case of peculiar changes in the central retinal vessels.” In 1905, Onishi and Kagosha reported cases associated with absent radial pulses.
Classification
Takayasu arteritis may be classified according to angiographic findings into 6 subtypes. These systems are useful in that they allow a comparison of patient characteristics according to the vessels involved and are helpful in planning surgery, but they offer little by way of prognosis. The most commonly involved vessels include the left subclavian artery (50%), left common carotid artery (20%), brachiocephalic trunk, renal arteries, celiac trunk, superior mesenteric artery, and pulmonary arteries (50%). Infrequently, the axillary, brachial, vertebral, coronary, and iliac arteries are involved.
Pathophysiology
The pathogenesis of Takayasu's arteritis is poorly understood. Takayasu's arteritis characterized by segmental and patchy granulomatous inflammation of the aorta and its major derivative branches.This inflammation leads to arterial stenosis, thrombosis, and aneurysms. Three factors that have been suggested to have association with susceptibility, development and progression of Takayasu's arteritis are genetic influences, immunologic mechanisms and relationship to tuberculosis.
Causes
The cause of Takayasu's arteritis is idiopathic but genetic, immunologic and infectious factors play important role in the development of Takayasu's arteritis.
Differentiating Rheumatoid Arthritis from other Diseases
Takayasu's arteritis should be distinguished from other conditions that cause arthritis and rash.
Epidemiology and Demographics
Takayasu arteritis has a worldwide distribution, it is observed more frequently in Asian countries such as Japan, Korea, China, India, Thailand, and Singapore. The incidence of Takayasu arteritis is approximately 0.26 per 100,000 individuals worldwide. Female are more commonly affected by Takayasu arteritis than male. Mean age of onset of Takayasu arteritis is approximately 30 years.
Risk Factors
Common risk factors in the development of Takayasu's arteritis include genetic predisposition, female sex, age <40, asian ethnicity.
Natural History, Complications and Prognosis
The symptoms of Takayasu's arteritis typically develop between 15 and 30 years of age. Common complications of Takayasu's arteritis include hardening and narrowing of blood vessels, High blood pressure, Heart failure, Stroke, Transient ischemic attack. The five year survival rate in Takayasu arteritis is over 90%.