Diagnosis

Your doctor will ask you about your signs and symptoms, conduct a physical exam, and take your medical history. He or she may also have you undergo some of the following tests and procedures to help rule out other conditions that resemble 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, such as a high level of C-reactive protein or a high erythrocyte sedimentation rate — commonly referred to as a sed rate. Your doctor may also check for anemia.
  • X-rays of your blood vessels (angiography). During an angiogram, a flexible catheter is inserted into a large artery or vein. A special dye (contrast medium) is then injected into the catheter, and X-rays are taken as the dye fills your arteries or veins. The resulting images allow your doctor to see if blood is flowing normally or if it's being slowed or interrupted due to narrowing (stenosis) of a blood vessel. A person with Takayasu's arteritis generally has several areas of stenosis.
  • Magnetic resonance angiography (MRA). This less invasive form of angiography produces detailed images of your blood vessels without the use of catheters or X-rays, although an intravenous contrast medium generally is used. MRA works by using radio waves in a strong magnetic field to produce data that a computer turns into detailed images of tissue slices.
  • Computerized tomography (CT) angiography. This is another noninvasive form of angiography combining computerized analysis of X-ray images with the use of intravenous contrast dye to allow your doctor to check the structure of your aorta and its nearby branches and to monitor blood flow.
  • Ultrasonography. Doppler ultrasound, a more sophisticated version of the common ultrasound, has the ability to produce very high-resolution images of the walls of certain arteries, such as those in the neck (carotid arteries) and those in the shoulder (subclavian arteries). It may be able to detect subtle changes in these arteries before other imaging techniques can.
  • Positron emission tomography (PET). This imaging is able to measure the intensity of inflammation in blood vessels. Before the scan, you are given a radioactive drug (tracer).

Unlike other types of vasculitis, Takayasu's arteritis is not usually diagnosed by the removal and analysis of tissue (biopsy).

Treatment

Treatment of Takayasu's arteritis focuses on controlling the inflammation with medications and preventing further damage to your blood vessels. The disease can sometimes be difficult to treat because even if you appear to be in remission the disease might still be active. In addition, by the time some people are diagnosed, it's possible that irreversible damage has already occurred.

On the other hand, if you don't have a lot of signs and symptoms or serious complications, you may not need treatment at all.

Medications

Talk with your doctor about the drug or drug combinations that are options for you and what the possible side effects are. Your doctor may prescribe:

  • Corticosteroids to control inflammation. The first line of treatment is usually with a corticosteroid, such as prednisone. Even if you soon start feeling better, you may need to continue taking the drug long term. After the first month, your doctor may gradually begin to lower the dose until you reach the lowest dose you need to control inflammation. Some of your symptoms may return during this tapering period.

    Possible side effects of corticosteroids include weight gain, increased risk of infections, bone thinning (osteoporosis) and menstrual irregularities.

  • Other drugs that suppress the immune system. If your condition doesn't respond well to corticosteroids or you have trouble tapering off the medication, your doctor may prescribe immunosuppressant drugs. Examples are methotrexate (Trexall) and azathioprine (Azasan, Imuran). Some people respond well to medications that were developed for people receiving organ transplants. These drugs, including mycophenolate mofetil (CellCept), work by suppressing the immune system, and there is some evidence that they may be helpful with corticosteroids in effectively reducing blood vessel inflammation in people with Takayasu's arteritis. The most common side effect is an increased risk of infection.
  • Medications to regulate the immune system. If you don't respond to standard treatments, your doctor may suggest drugs that correct abnormalities in the immune system (biologics). Examples are etanercept (Enbrel) and infliximab (Remicade). Small studies have found these medications effective at controlling signs and symptoms, as well as at reducing the need for corticosteroid treatments. In addition, tocilizumab (Actemra) has been reported to be beneficial in treating Takayasu's arteritis. More research is needed. The most common side effect with these drugs an increased risk of infection.

Surgery

If your arteries become severely narrowed or blocked, you may need surgery to open or bypass these arteries to allow an uninterrupted flow of blood. Often this helps to improve certain symptoms, such as high blood pressure and chest pain. In some cases, though, narrowing or blockage may recur, requiring a second procedure. Also, if you develop large aneurysms, surgery may be needed to prevent them from rupturing. Your doctor may suggest holding off surgery until your condition is in remission.

Surgical options, which are best performed when inflammation of the arteries has been reduced, include:

  • Bypass surgery. In this procedure, an artery or a vein is removed from a different part of your body and attached to the blocked artery, providing a bypass for blood to flow through.
  • Blood vessel widening (percutaneous angioplasty). During this procedure, a tiny balloon is threaded through a blood vessel and into the affected artery. Once in place, the balloon is expanded to widen the blocked area, then it's deflated and removed.
  • Aortic valve surgery. Surgical repair or replacement of the aortic valve may be needed if the valve is leaking significantly (aortic valve regurgitation).

Coping and support

One of the greatest challenges of living with Takayasu's arteritis may be coping with side effects of your medication. The following suggestions may help:

  • Understand your condition. Learn everything you can about Takayasu's arteritis and its treatment. Know the possible side effects of the drugs you take, and tell your doctor about any changes in your health. Ask your doctor about the benefit of taking low-dose aspirin regularly.
  • Eat a healthy diet. Eating well can help prevent potential problems that can result from your condition and medications, such as high blood pressure, thinning bones and diabetes. Emphasize fresh fruits and vegetables, whole grains, and lean meats and fish, while limiting salt, sugar and alcohol.

    If you're taking a corticosteroid drug, ask your doctor if you need to take a vitamin D or calcium supplement.

  • Exercise regularly. Regular aerobic exercise, such as walking, can help prevent bone loss, high blood pressure and diabetes. It also benefits your heart and lungs. In addition, many people find that exercise improves their mood and overall sense of well-being.
  • Avoid all tobacco products. It's important to stop using all forms of tobacco to reduce the risk of injuring your blood vessels and tissues even more.

Preparing for your appointment

If your primary care doctor suspects 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's arteritis is a rare disorder that can be difficult to diagnose and treat.

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

Because appointments can be brief and because there's often a lot of ground to cover, it's a good idea to be prepared. Here's some information to help you get ready for your appointment.

What you can do

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

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

  • What's the most likely cause of my symptoms?
  • What are other possible causes for my symptoms?
  • What tests do I need? Do they require any special preparation?
  • Is my condition temporary or long lasting?
  • What are my treatment options, and which do you recommend?
  • I have another medical condition. How can I best manage these conditions together?
  • Do I need to change my diet or restrict 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 websites do you recommend?

What to expect from your doctor

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

  • When did you first start having symptoms?
  • Do you have your symptoms all the time, or do they come and go?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to worsen your symptoms?