Diferencia entre revisiones de «Takayasu arteritis»
(Created page with "==Background== *A vasculitis that affects large vessels leading to fibrosis and narrowing of the vessels <ref>Hellmann, DB et al. Chapter 31. Takayasu Arteritis. In: Imboden J...") |
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==Background== | ==Background== | ||
* | *Large-vessel [[vasculitis]], leads to fibrosis and narrowing of the vessels <ref>Hellmann, DB et al. Chapter 31. Takayasu Arteritis. In: Imboden JB, Hellmann DB, Stone JH. eds. CURRENT Diagnosis & Treatment: Rheumatology, 3e New York, NY: McGraw-Hill; 2013.</ref> | ||
*Most often affects women of Asian descent during reproductive age | *Most often affects women of Asian descent during reproductive age | ||
*Diagnosis is often delayed due to the rarity of the disease and varied symptoms | *Diagnosis is often delayed due to the rarity of the disease and varied symptoms | ||
*The disease process chronically improves and relapses<ref>Hellmann, DB et al. Rheumatologic, Immunologic, & Allergic Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. Current Medical Diagnosis & Treatment 2017 New York, NY: McGraw-Hill</ref> | *The disease process chronically improves and relapses<ref>Hellmann, DB et al. Rheumatologic, Immunologic, & Allergic Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. Current Medical Diagnosis & Treatment 2017 New York, NY: McGraw-Hill</ref> | ||
{{Primary Vasculitis DDX}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Hypertension | *[[Hypertension]] | ||
*Congestive Heart Failure | *[[Congestive Heart Failure]] | ||
*CVA | *[[CVA]] | ||
*Dizziness | *[[Dizziness]] | ||
*Pulselessness | *Pulselessness | ||
*Claudication | *Claudication | ||
*Bruits | *Bruits | ||
*Visual | *[[Visual disturbances]] | ||
* | *[[Arthralgia]]s/[[Myalgia]]s | ||
*Aortic Regurgitation | *[[Aortic Regurgitation]] | ||
*Weight Loss | *Weight Loss | ||
*Arterial Aneurysm | *Arterial Aneurysm | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Systemic lupus erythematosus]] | *[[Systemic lupus erythematosus]] | ||
*[[Syphilis]] | *[[Syphilis]] | ||
*[[Rheumatoid Arthritis]] | *[[Rheumatoid Arthritis]] | ||
*[[Sarcoidosis]] | *[[Sarcoidosis]] | ||
==Evaluation== | ==Evaluation== | ||
[[File:Takayasu_MRA.png|thumb|An MRA showing occlusion of the left subclavian artery and significant narrowing of the left common carotid artery]] | [[File:Takayasu_MRA.png|thumb|An MRA showing occlusion of the left subclavian artery and significant narrowing of the left common carotid artery]] | ||
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*Angiography revealing narrowing/occlusion of large vessels (e.g. Aorta) is the gold standard <ref>Lin, PH et al. Arterial Disease. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e New York, NY: McGraw-Hill; 2015.</ref> | *Angiography revealing narrowing/occlusion of large vessels (e.g. Aorta) is the gold standard <ref>Lin, PH et al. Arterial Disease. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e New York, NY: McGraw-Hill; 2015.</ref> | ||
*MRA or CTA can be used as well to appreciate vascular stenoses | *MRA or CTA can be used as well to appreciate vascular stenoses | ||
==Management== | ==Management== | ||
*Oral [[Prednisone]] 1 mg/kg for the first month followed by a taper | *Oral [[Prednisone]] 1 mg/kg for the first month followed by a taper | ||
**Taper to approximately 10 mg/day | **Taper to approximately 10 mg/day | ||
*The addition of [[Methotrexate]] or [[Mycophenolate mofetil]] to [[Prednisone]] therapy may be more effective | *The addition of [[Methotrexate]] or [[Mycophenolate mofetil]] to [[Prednisone]] therapy may be more effective than monotherapy | ||
*Additional processes (e.g. Hypertension or Congestive Heart Failure) will require disease specific treatments | *Additional processes (e.g. Hypertension or Congestive Heart Failure) will require disease specific treatments | ||
*In advanced disease processes, Cardiac or Vascular Surgery or Interventional Radiology may be required for angioplasty, stenting, or valvular repair | *In advanced disease processes, Cardiac or Vascular Surgery or Interventional Radiology may be required for angioplasty, stenting, or valvular repair | ||
==Disposition== | ==Disposition== | ||
* | *Disposition dependent on presentation and disease severity | ||
*Admit patients with severe [[aortic regurgitation]], large aortic aneurysm, or other concerning features | |||
* | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Rheumatology]] [[Category:Vascular]] | [[Category:Rheumatology]] [[Category:Vascular]] | ||
Revisión actual - 17:35 2 ago 2023
Background
- Large-vessel vasculitis, leads to fibrosis and narrowing of the vessels [1]
- Most often affects women of Asian descent during reproductive age
- Diagnosis is often delayed due to the rarity of the disease and varied symptoms
- The disease process chronically improves and relapses[2]
Vasculitis Syndrome Types
- Large vessel
- Takayasu arteritis
- Giant cell arteritis (temporal arteritis)
- Medium-vessel
- Kawasaki disease
- Polyarteritis nodosa
- Thromboangiitis obliterans (Buerger's disease)
- Primary angiitis of the central nervous system
- Small-vessel
- Henoch-Schönlein purpura
- ANCA-associated vasculitides
- Granulomatosis with polyangiitis (Wegner's)
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
- Microscopic polyangiitis
- Cutaneous leukocytoclastic angiitis (“hypersensitivity vasculitis”)
- Essential cryoglobulinemia, cryoglobulinemic vasculitis due to hepatitis C
- Behçet's disease]
- Secondary vasculitides and other/miscellaneous
- Drug-induced vasculitis
- Serum sickness
- Vasculitis associated with other rheumatic diseases (e.g. SLE)
Clinical Features
- Hypertension
- Congestive Heart Failure
- CVA
- Dizziness
- Pulselessness
- Claudication
- Bruits
- Visual disturbances
- Arthralgias/Myalgias
- Aortic Regurgitation
- Weight Loss
- Arterial Aneurysm
Differential Diagnosis
Evaluation
- Work up should be tailored to the patient's symptoms as this disease process affects multiple organ systems due to vascular damage
Laboratory
- ESR, CRP, WBC may or may not be elevated
- Anemia may be present
Imaging
- Angiography revealing narrowing/occlusion of large vessels (e.g. Aorta) is the gold standard [3]
- MRA or CTA can be used as well to appreciate vascular stenoses
Management
- Oral Prednisone 1 mg/kg for the first month followed by a taper
- Taper to approximately 10 mg/day
- The addition of Methotrexate or Mycophenolate mofetil to Prednisone therapy may be more effective than monotherapy
- Additional processes (e.g. Hypertension or Congestive Heart Failure) will require disease specific treatments
- In advanced disease processes, Cardiac or Vascular Surgery or Interventional Radiology may be required for angioplasty, stenting, or valvular repair
Disposition
- Disposition dependent on presentation and disease severity
- Admit patients with severe aortic regurgitation, large aortic aneurysm, or other concerning features
References
- ↑ Hellmann, DB et al. Chapter 31. Takayasu Arteritis. In: Imboden JB, Hellmann DB, Stone JH. eds. CURRENT Diagnosis & Treatment: Rheumatology, 3e New York, NY: McGraw-Hill; 2013.
- ↑ Hellmann, DB et al. Rheumatologic, Immunologic, & Allergic Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. Current Medical Diagnosis & Treatment 2017 New York, NY: McGraw-Hill
- ↑ Lin, PH et al. Arterial Disease. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e New York, NY: McGraw-Hill; 2015.