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Introduction
  • Includes 
    • Takayasu arteritis
    • giant cell (temporal) arteritis
  • Chart overview of vasculitides  
Takayasu Arteritis
  • Overview
    • characterized by granulomatous thickening of aortic arch and/or proximal great vessels 
  • Epidemiology
    • primarily affects Asian females < 40 years of age
  • Presentation
    • symptoms
      • flu-like symptoms
        • fever, night sweats, and myalgia
      • arthritis symptoms
    • physical exam
      • weak pulses in upper extremities
      • "pulseless disease"
      • skin nodules
      • ocular disturbances
  • Evaluation
    • labs
      • elevated ESR
    • imaging
      • diagnosis generally confirmed by arteriography
      • CT angiography with IV dye injection may be adequate in some cases
  • Treatment
    • pharmacologic
      • high dose steroids
        • indications
          • for patients with symptoms or serologic markers of active disease (increased ESR)
      • cytotoxic agents
        • indications
          • helpful in patients who fail to respond or who relapse on tapering steroids
Giant Cell (Temporal) Arteritis
  • Overview 
    • vasculitis affecting large arteries
      • usually involves superficial temporal and/or ophthalmic arteries
      • characterized histologically by granulomatous inflammation
    • affects adults > 50 years
    • associated with polymyalgia rheumatica
  • Presentation
    • symptoms
      • unilateral temporal headache
      • jaw claudication (pain with chewing)
      • impaired vision
  • Evaluation
    • labs
      • elevated ESR
        • definitive diagnosis with vessel biopsy but due to risk of rapid blindness must use ESR to determine if steroid treatment should be given immediately
  • Treatment
    • pharmacologic 
      • high-dose steroids 
  • Complications
    • monocular blindness
      • as a result of occlusion of ophthalmic artery that may lead to irreversible blindness
 

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