Diferencia entre revisiones de «Takayasu arteritis»
Sin resumen de edición |
Sin resumen de edición |
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*Claudication | *Claudication | ||
*Bruits | *Bruits | ||
*[[Visual | *[[Visual disturbances]] | ||
*[[Arthralgia]]s/ | *[[Arthralgia]]s/[[Myalgia]]s | ||
*[[Aortic Regurgitation]] | *[[Aortic Regurgitation]] | ||
*Weight Loss | *Weight Loss | ||
*Arterial Aneurysm | *Arterial Aneurysm | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Giant cell arteritis]] | *[[Giant cell arteritis]] | ||
| Línea 25: | Línea 26: | ||
*[[Behcet's Disease]] | *[[Behcet's Disease]] | ||
*[[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]] | ||
| Línea 34: | Línea 36: | ||
*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 | ||
Revisión del 16:00 18 oct 2019
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]
Clinical Features
- Hypertension
- Congestive Heart Failure
- CVA
- Dizziness
- Pulselessness
- Claudication
- Bruits
- Visual disturbances
- Arthralgias/Myalgias
- Aortic Regurgitation
- Weight Loss
- Arterial Aneurysm
Differential Diagnosis
- Giant cell arteritis
- Thromboangiitis obliterans (Buerger's Disease)
- Systemic lupus erythematosus
- Syphilis
- Rheumatoid Arthritis
- Behcet's Disease
- Sarcoidosis
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.