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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Takayasu arteritis

Rheumatology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Critical large-artery ischaemia or aortic complication

Stroke, myocardial ischaemia, threatened limb, mesenteric ischaemia, severe renovascular hypertension, acute aortic regurgitation, aneurysm or dissection requires emergency vascular and rheumatology coordination.

Action: Stabilise the affected organ, obtain urgent CTA or MRA of the aorta and branches, involve vascular, cardiac or neurological teams, and treat active arteritis while revascularising threatened tissue when delay would cause infarction.

Synopsis

Recognise Takayasu arteritis in young people with inflammatory and pulse-deficit phenotypes, confirm arterial-wall disease with whole-aorta imaging, separate active inflammation from fixed stenosis, and coordinate immunosuppression, revascularisation and pregnancy care.

  • Suspect Takayasu arteritis in a person usually younger than fifty with unexplained inflammation, limb claudication, bruits, absent pulses, inter-arm pressure difference, renovascular hypertension or cerebral symptoms.
  • Measure blood pressure in both arms and, when upper-limb disease makes values unreliable, use an unaffected limb or validated lower-limb strategy with vascular advice.
  • Examine carotid, subclavian, aortic, renal and limb territories, heart murmurs and end-organ perfusion; normal peripheral oxygen saturation does not assess arterial supply.
  • Use MRA or CTA of the entire aorta and major branches for diagnosis and anatomical mapping; ultrasound helps accessible arteries and FDG-PET can support activity assessment.
  • Inflammatory markers support but neither prove nor exclude active disease, particularly during glucocorticoid or IL-6 blockade.
  • Obtain tissue only when surgery or another diagnosis provides a safe opportunity; large-artery biopsy is not a routine confirmatory route.
  • Start high-dose glucocorticoid for active disease and add a conventional steroid-sparing agent early because relapse during steroid monotherapy is common.
  • Use biologic therapy, commonly TNF inhibition or tocilizumab, for refractory or relapsing disease under specialist off-label and commissioning pathways.
  • Perform elective angioplasty or bypass when inflammation is controlled where possible because active wall disease increases restenosis and procedural complications.
  • Treat critical cerebral, coronary, mesenteric, renal or limb ischaemia immediately; threatened tissue overrides the preference to wait for inflammatory remission.

Key red flags

Focal neurological deficit, transient retinal loss or cerebral hypoperfusion symptoms require emergency stroke and vascular imaging.

Chest pain, troponin rise, new heart failure or aortic regurgitant murmur suggests coronary ostial or aortic-root disease.

Severe abdominal pain or lactate rise may reflect mesenteric ischaemia and needs urgent surgical review.

Marked inter-arm pressure difference, absent pulses or limb rest pain indicates critical stenosis rather than constitutional inflammation alone.

Pregnancy with uncontrolled renovascular hypertension, aortic disease or active inflammation requires high-risk maternal cardiovascular care.

Cerebrovascular disease

Dizziness, syncope, retinal symptoms, TIA or stroke with carotid or vertebral bruits indicates threatened cerebral flow.

Aortic and coronary disease

Chest pain, heart failure, aortic regurgitation or unequal pulses may indicate coronary ostial, root, aneurysmal or dissecting disease.

Investigation priorities

01
Four-limb vascular examinationFirst step

Map pulse, pressure, bruit and perfusion abnormalities and establish a clinical baseline.

Management branches

First-line imagingMap the entire arterial tree

A young person has inflammatory symptoms with pulse, pressure, bruit or organ-ischaemic findings.

  1. Perform four-limb pressures, pulses, bruits, cardiac and neurological examination and obtain inflammation, renal and organ baseline tests.
  2. Request MRA or CTA from aortic root through major branches and add ultrasound, PET or coronary and pulmonary imaging for the phenotype.
  3. Discuss imaging in a large-vessel vasculitis service and record active wall features, fixed damage and immediately threatened territory separately.

Key medicines

PrednisoloneFor active Takayasu arteritis use 0.5–1 mg/kg orally once daily, commonly up to 60 mg/day, then taper after clinical and imaging response with early steroid-sparing therapy.Exclude infection, monitor glucose, pressure using a reliable limb, mood, eyes and bone and provide prophylaxis according to total immune risk. Never stop prolonged therapy abruptly.
Methotrexate with folic acidGive 7.5–15 mg by mouth or subcutaneous injection on one day each week; prescribe folic acid at least 5 mg on a separate day. Increase if needed, commonly to 20–25 mg weekly.Write the weekday clearly and never permit daily dosing. Monitor full blood count, transaminases and renal function; pause for serious infection and do not combine with trimethoprim or co-trimoxazole. Maternal treatment stops at least one month before conception.
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Sources and review status6 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • EULAR large-vessel vasculitis imaging recommendationsWhole-artery imaging, activity assessment and modality selection.
  • EULAR large-vessel vasculitis management recommendationsGlucocorticoid, steroid-sparing and revascularisation principles.
  • ESC 2024 hypertension guidelineBilateral pressure measurement and use of the higher reliable arm when stenosis creates asymmetry.
  • BSR pregnancy prescribing guidelineMedicine compatibility around pregnancy.
  • NICE NG203 chronic kidney diseaseRenovascular CKD and cardiovascular protection.
  • Adalimumab UK product informationBiologic infection, TB and reproductive safety.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom