Takayasu arteritis — SCE Rheumatology MCQ

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EasyVasculitisTakayasu arteritisSCE Rheumatology

A 26-year-old woman presents with constitutional symptoms, dizziness and left-arm claudication. The left radial pulse is reduced, and the systolic blood pressure is 24 mmHg lower in the left arm than in the right. CRP is 45 mg/L. CT angiography demonstrates concentric mural thickening of the aortic arch and left subclavian artery. What is the most likely diagnosis?

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Correct answer: B — Takayasu arteritis

The diagnosis is Takayasu arteritis, a large-vessel vasculitis affecting the aorta and its major branches, typically in younger women. Limb claudication, a reduced upper-limb pulse, an inter-arm systolic blood-pressure difference of at least 20 mmHg, systemic inflammation and inflammatory mural thickening of the aortic arch branches form a characteristic pattern. Atherosclerotic subclavian stenosis is unlikely at age 26 and would not usually cause constitutional inflammation or concentric arteritic wall thickening. Fibromuscular dysplasia is non-inflammatory and most often affects renal and cervicocephalic medium-sized arteries. Giant cell arteritis principally occurs after age 50. Polyarteritis nodosa affects medium-sized arteries and classically produces aneurysms or stenoses rather than aortic wall inflammation.

Reference: Grayson PC et al. 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis. Arthritis Rheumatol. 2022;74:1872-1880. https://pubmed.ncbi.nlm.nih.gov/36349501/