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.
Key red flags
Focal neurological deficit, transient retinal loss or cerebral hypoperfusion symptoms require emergency stroke and vascular imaging.
Dizziness, syncope, retinal symptoms, TIA or stroke with carotid or vertebral bruits indicates threatened cerebral flow.
Investigation priorities
Map pulse, pressure, bruit and perfusion abnormalities and establish a clinical baseline.
Management branches
A young person has inflammatory symptoms with pulse, pressure, bruit or organ-ischaemic findings.
- Perform four-limb pressures, pulses, bruits, cardiac and neurological examination and obtain inflammation, renal and organ baseline tests.
- Request MRA or CTA from aortic root through major branches and add ultrasound, PET or coronary and pulmonary imaging for the phenotype.
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.
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.