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.