Takayasu Arteritis
2026/03/02
Takayasu arteritis is a rare autoimmune condition that usually occurs in young women under 40 years old, but can happen to anyone. It is a type of blood vessel inflammation (also known as vasculitis) that affects the large arteries in the body, mainly the aorta (the main artery that carries blood from the heart to the rest of the body) and its major branches.
This inflammation can lead to narrowing, blockage or abnormal widening (aneurysms) of the arteries, causing reduced blood flow to the various organs and limbs. Symptoms may vary depending on which artery is involved (see below). Common symptoms include fatigue, muscle and joint pain, dizziness and headaches. In severe cases, blood flow to the major organs (such as the heart and brain) can be compromised, leading to heart attack and stroke respectively. As Takayasu arteritis often develops slowly, it can be challenging to diagnose early but with the right treatment to control the inflammation, patients are often able to manage their symptoms and avoid major complications.
The exact cause is not fully understood, but it is thought to result from an autoimmune response, where the body’s immune system mistakenly attacks its own arteries. This can be contributed by a complex relationship between genetic and environmental factors.
• Genetic predisposition: Takayasu arteritis is more common in Asians, suggesting a possible genetic link.
• Environmental triggers: infections or other environmental exposures may trigger or worsen disease in those who are genetically predisposed.
Symptoms vary based on the affected arteries and the severity of involvement. Signs and symptoms often develop gradually but may come on suddenly. Common symptoms include:
• Fatigue
• Persistent fever
• Loss of appetite and/or weight
• Joint pain, stiffness and swelling
• Arm or leg pain during activity (limb claudication)
• Dizziness or fainting
• Signs and symptoms of stroke such as weakness and / or numbness affecting one side of the body, speech / swallowing impairment, double vision, unsteadiness
• Headache or vision problems
• Chest pain, palpitations or shortness of breath
Some features may be noted during clinical examination:
• Weak or absent pulses
• Blood pressure difference between the arms / legs
• High blood pressure (often difficult to control)
Not everyone will experience all of these symptoms. Early diagnosis and treatment can help prevent long-term complications.
Diagnosing Takayasu arteritis can be difficult because initial symptoms may be mild and seen in other medical conditions. Furthermore, there is no single test for diagnosing Takayasu arteritis.
Diagnosis usually involves a combination of:
• Detailed medical history and physical examination, including assessment of the pulses and blood pressure.
• Blood tests, including blood counts and markers of inflammation, such as the Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
• Imaging tests like CT, MRI and ultrasound scans to evaluate the vessels involved. PET-CT scan is another form of imaging which can be used to look for active vessel inflammation.
Takayasu arteritis is a chronic condition that can be managed effectively with medications. The goal of treatment is to reduce inflammation, prevent damage to blood vessels, and preserve blood flow to vital organs.
Steroids are immune suppression medications that work quickly to reduce inflammation, often started at high doses (intravenous injections through the veins or oral), then reduced over time.
Takayasu arteritis is a chronic condition that can be managed effectively with medications. The goal of treatment is to reduce inflammation, prevent damage to blood vessels, and preserve blood flow to vital organs.
Steroids are immune suppression medications that work quickly to reduce inflammation, often started at high doses (intravenous injections through the veins or oral), then reduced over time.
Often, other immune suppression medications are used in addition to steroids to reduce the need for long-term steroids and for control of disease activity. Examples include:
- Methotrexate (a weekly medication given as oral tablets of subcutaneous injections in the thighs or abdomen), azathioprine, leflunomide and mycophenolate mofetil
- Biologic medications are targeted medications given intravenously or subcutaneously into the abdomen or thighs (e.g. tocilizumab, infliximab, adalimumab)
- Newer targeted oral medications may be given in select patients (JAK inhibitors such as tofacitinib)
Blood pressure medications may be required to treat high blood pressure, which may develop if the arteries supplying the kidneys or heart are affected by the vasculitis. Patients may also be started on blood thinning medications (e.g. aspirin) and cholesterol lowering medications (e.g. statins) to ensure sufficient oxygen reaches the various parts of the body. In some patients, procedures like angioplasty (balloon procedure with/without a wire mesh inserted) or bypass surgery may be needed to restore blood flow if the arteries are severely narrowed with signs of organ damage. Such procedures are usually performed when the inflammation is controlled.
To prevent infections when on high doses of immune suppression medications, prophylactic antibiotics and certain vaccinations are encouraged (e.g. influenza, pneumococcal, COVID-19, shingles and respiratory syncytial virus).
As several organ systems may be affected in the same patient, patients with Takayasu arteritis are often managed by a team of medical professionals from different specialties. Your treatment plan will be coordinated and tailored to your symptoms and preferences. Other co-existing medical conditions will also be addressed.
Patients with Takayasu arteritis are able to live active lives with the right treatment and support. Some recommended lifestyle changes include:
• Eat a balanced diet. Avoid raw and partially cooked food to reduce risks of infections, especially if you are on medications that suppress the immune system (e.g. steroids).
• Avoid smoking.
• Stay active and exercise in moderation. Ensure sufficient rest and sleep well.
• Attend regular medical check-ups to monitor your health. Participate actively in your care and ask questions during your clinic consultations.
• Take your medications as prescribed, even when you feel well, to avoid disease flares.
• Seek medical attention early if you suspect a flare of the disease.
This is a common concern amongst patients with Takayasu arteritis as the disease often affects women of childbearing age. Patients with Takayasu arteritis can have successful pregnancies if their disease is well controlled with no major complications. Pregnancy plans should be deferred in active disease or soon after disease flares to reduce risks of complications during pregnancy and delivery. Some medications are not suitable for pregnancy and will need to be switched prior to conception. Hence, it is crucial to have family planning discussions early with your rheumatologist.
Seek a doctor's advice. You will be referred to a specialist (rheumatologist) who can confirm the diagnosis and start you on the appropriate treatment. Once diagnosed, it is important to start treatment early and follow your rheumatologist’s advice. This condition is managed by the
Division of Rheumatology and Allergy.
