Takayasu arteritis — SCE Rheumatology MCQ

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ModerateVasculitisTakayasu arteritisSCE Rheumatology

A 24-year-old woman has arm claudication, dizziness and constitutional symptoms. Blood pressure is 142/86 in the right arm and 104/70 in the left. ESR is 78 mm/hour and bruits are audible over the subclavian arteries. CT angiography shows wall thickening and stenosis of the aortic arch branches. What is the most likely diagnosis?

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Correct answer: E — Takayasu arteritis

Explanation lettering: D = shown as A · A = shown as B · B = shown as D

Takayasu arteritis is best because large-vessel granulomatous arteritis in a young woman with limb claudication and pulse/BP asymmetry suggests Takayasu arteritis. A is less suitable because APS causes thrombosis rather than inflammatory arterial wall thickening; B is less suitable because fibromuscular dysplasia is non-inflammatory and usually affects renal/carotid arteries; C is less suitable because GCA usually affects people over 50 and presents with cranial symptoms or PMR; D is less suitable because PAN affects medium vessels and spares the aorta in this pattern. Clinical pearl: age and vascular territory separate Takayasu arteritis from GCA.

Reference: EULAR large-vessel vasculitis recommendations; Oxford Textbook of Rheumatology