Takayasu’s arteritis

Diagnosis

Takayasu’s arteritis is diagnosed by a healthcare professional based on a number of factors, such as:

• Physical examination: The healthcare provider will inquire about the signs and symptoms, perform a physical examination, and inquire about medical background. Through their stethoscope, healthcare provider might hear a bruit, which is an odd sound. Blood flow may be difficult if the patient has many narrowed blood vessels. 
• Blood tests: Inflammation–related signs and anemia can be checked for using these tests. 
• Angiography: An 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 the arteries or veins, X–rays are then taken. 

The generated images enable healthcare providers to determine if blood flow is normal or whether it is slowed down or interrupted because of blood vessel stenosis. Takayasu’s arteritis patients typically have stenosis in numerous places.

• Magnetic resonance angiography (MRA): With no need for X–rays or catheters, this less invasive type of angiography creates precise images of the blood vessels. Detailed images of tissue slices are created by a computer utilizing data produced by radio waves in a strong magnetic field during MRA. Healthcare provider is assisted in seeing and examining the blood vessels more clearly during this test, a contrast dye is injected into an artery or vein. 
• Computerized tomography (CT) angiography: This is a different noninvasive type of angiography that combines computerized X–ray image processing with intravenous contrast dye to enable the healthcare provider to examine the structure of the aorta and its adjacent branches as well as to track blood flow. 
• Ultrasonography: Doppler ultrasonography, an advanced variant of standard ultrasound, has the capacity to generate extremely high–resolution images of the walls of specific arteries, including those in the neck and shoulder. Before other imaging methods, it could be able to spot minute changes in these arteries. 
• Positron emission tomography (PET): Magnetic resonance imaging or computed tomography are frequently used together with this imaging examination. The severity of blood vessel inflammation is measurable by PET. In order to help the healthcare provider more easily identify areas with reduced blood flow, a radioactive substance is injected into an artery or vein prior to the scan. 

Treatment

Takayasu’s arteritis can be challenging to treat because the condition may persist even after symptoms are better. It is also conceivable that irreversible harm may have already taken place prior to receiving a diagnosis.

Takayasu’s arteritis treatment focuses on reducing inflammation with medication and preventing future blood vessel damage. 

The patient may not require therapy or may be able to taper and discontinue treatment if the healthcare practitioner advises it if they do not have signs and symptoms or significant complications.

• Medications: Discuss with the healthcare provider about the available medicines or combination medications, and any potential negative effects. A healthcare professional might suggest: 
  • Corticosteroids to control inflammation: Typically, corticosteroids like prednisone are used as the first line of treatment. Even if the patient starts to feel better, they might need to keep taking the medication indefinitely. The dose may be gradually reduced by the healthcare provider after a few months until it is the lowest level required to control inflammation. In due course, your physician may advise you to completely discontinue the medication.

Bone thinning, an increased risk of infection, and weight gain are a few of the potential side effects of corticosteroids. The healthcare provider can suggest taking calcium supplements and vitamin D to assist prevent bone loss. 

• Medications to regulate the immune system: Although further study is required, a healthcare provider may prescribe biologic medicines to address immune system disorders if a patient does not react to conventional therapy. Etanercept, infliximab, and tocilizumab are a few examples of biologics. An increased risk of infection is one of these medications’ most frequent side effects.
• Other drugs that suppress the immune system: A healthcare provider may administer medications including methotrexate, azathioprine and leflunomide if the condition does not react well to corticosteroids or the patient experiences problems as their medication dose is dropped. Mycophenolate mofetil (CellCept), a drug created for patients getting organ transplants, has a positive response in certain patients. An increased risk of infection is the most frequent adverse effect.

• Surgery: Surgery may be required to unblock or bypass the severely narrowed or blocked arteries in order to maintain the blood flow. Symptoms like elevated blood pressure and chest pain are frequently alleviated by doing this. However, occasionally the narrowing or blockage may return, requiring a second surgery. 

When artery inflammation has subsided, surgical options are best carried out. These include: 

• Bypass surgery: This surgery creates a bypass for blood to flow through by removing an artery or vein from another area of the body and attaching it to the blocked artery. When there is a considerable blood flow restriction or when the artery obstruction is permanent, bypass surgery is typically performed.
• Blood vessel widening (percutaneous angioplasty): In the event that the arteries are completely blocked, this treatment can be necessary. A small balloon is put into the damaged artery during percutaneous angioplasty and into a blood vessel. The balloon is inflated once it has been placed, expanded to clear the obstruction, then deflated and taken away.
• Aortic valve surgery: The aortic valve may require surgical repair or replacement if it is extensively leaking.