musculoskeletal and connective tissue disorders
Takayasu Arteritis
Symptoms and Signs of Takayasu Arteritis
Most patients present with only focal symptoms that reflect hypoperfusion of the affected organ or limb. About 50% of patients report constitutional symptoms such as fever, malaise, night sweats, weight loss, fatigue, and/or arthralgias. Repetitive arm movements and sustained arm elevation may cause pain and fatigue. Arterial pulses in arms and legs may be diminished and asymmetric. Extremities may have findings of ischemia (eg, coolness, leg claudication). Bruits are often audible over the subclavian arteries (above the clavicle in the supraclavicular fossa), brachial arteries, carotid arteries, abdominal aorta, or femoral arteries. Reduced blood pressure in one or both arms is common. Involvement of the carotid and vertebral arteries results in reduced cerebral blood flow manifested by dizziness, syncope, orthostatic hypotension, headaches, transient visual disturbances, transient ischemic attacks, or strokes. Stenotic lesions in a subclavian artery near the origin of a patent vertebral artery can cause posterior circulation ischemic neurologic symptoms or syncope when the arm is used (called subclavian steal syndrome). The mechanisms are retrograde flow through the vertebral artery to supply the subclavian artery distal to the stenosis and vasodilation of the arterial bed in the upper limb during exercise. Angina pectoris or myocardial infarction may result from narrowing of the coronary artery orifice due to aortitis or coronary arteritis. Aortic regurgitation may occur if the ascending aorta is markedly dilated. Heart failure can develop. Obstruction of the descending thoracic aorta sometimes causes signs of aortic coarctation (eg, hypertension, headache, leg claudication). Renovascular hypertension may develop if the abdominal aorta or renal arteries are narrowed. Intermittent arm or leg claudication can develop. Pulmonary arteries are affected, sometimes causing pulmonary hypertension. Involvement of the medium-sized branches of the pulmonary arteries can cause pulmonary infarcts. Because Takayasu arteritis is chronic, collateral circulation can develop. Thus, ischemic ulcerations or gangrene due to obstruction of the arteries to the extremities is rare. 