skip to main content

Takayasu active disease — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisTakayasu active diseaseSCE Rheumatology

A 24-year-old woman with established Takayasu arteritis develops progressive exertional arm claudication. She has no rest pain, tissue loss or acute neurovascular compromise. C-reactive protein and erythrocyte sedimentation rate are raised, and bruits are audible over both subclavian arteries. MR angiography demonstrates new concentric arterial wall thickening and mural oedema affecting the subclavian arteries. What is the most appropriate next management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Start prednisolone 40–60 mg/day with a glucocorticoid-sparing agent

The progressive claudication, raised inflammatory markers and new mural oedema indicate active Takayasu arteritis. EULAR recommends remission induction with prednisolone 40–60 mg/day prednisone-equivalent and a glucocorticoid-sparing agent for all patients with Takayasu arteritis, making B the best answer. Glucocorticoid monotherapy is inadequate because relapse and cumulative steroid toxicity are common. Observation or aspirin alone would not control arterial inflammation; antiplatelet treatment is not a substitute for immunosuppression. Revascularisation may be required for persistent haemodynamically important lesions or critical ischaemia, but outcomes are generally better after inflammatory activity has been controlled. This patient has claudication without acute limb threat, so urgent angioplasty during active inflammation is inappropriate.

Reference: Mukhtyar CB et al. 2025 EULAR recommendations for the management of polymyalgia rheumatica and primary large vessel vasculitis. Annals of the Rheumatic Diseases. Published online 21 July 2026. https://pubmed.ncbi.nlm.nih.gov/31673416/