DISCUSSION
Takayasu arteritis, a chronic
disorder characterized by inflammation of the aorta or its branches is
also referred to as pulseless disease.(1) It has been more commonly
reported among young female patients of Asian origin. However, a more
diverse global occurrence has been described in recent decades mostly
among individuals under the age of 40 years.(2)
Clinical presentation is commonly non-specific underscoring the need for
a high index of suspicion to clinch the correct diagnosis. The highly
variable symptoms include fever, malaise, headaches, limb claudication
and hypertension with a classical triphasic pattern of presentation
characterized by an initial period of constitutional symptoms such as
fever and night sweats in phase I, followed by pain over arteries in
phase II and finally a fibrotic phase leading to ischemic symptoms due
to critical stenosis of large arteries has been described.(3) However,
literature seems to suggest that this picture is hardly seen in routine
clinical practice or in recent studies reports.(3,4). Due to extensive
vascular involvement, Takayasu arteritis patients can also present with
20mmHg systolic blood pressure measurement discrepancy between arms with
impalpable pulses on affected limb.(1) Thus, a through history and
clinical exam remain a crucial tool in teasing out Takayasu arteritis as
a possible diagnosis among patients in the at-risk age group.
Based on the deep-seated nature of the vessel inflammation affecting
large, high-pressure arteries such as the thoracic and abdominal aorta
or its branches, a tissue biopsy to confirm diagnosis is rarely feasible
outside autopsy. Therefore, clinical and radiological findings have been
considered the standard for routine diagnosis. Several diagnostic
criteria have been described.(5,6). One of the most widely used is the
American College of Rheumatology (ACR) criteria which has 6 criteria.
(See Table 1) Based on the ACR criteria, a diagnosis can be made with a
sensitivity of 90.5% and specificity of 97.8% when a patient meets at
least 3 of the 6 criteria.(5) Our
patient met four of the 6 criteria.