Abstract
Takayasu arteritis is a chronic granulomatous disease of the aorta and its major branches that usually affects women during the second and third decades of life, but it has been reported in young children. This review details the clinical, pathological and radiological features, differential diagnoses and management of the condition, focusing chiefly on the disease in children. The recent definition of Takayasu arteritis is discussed. The condition should be considered in patients with unexplained arterial hypertension or unexplained inflammatory syndromes without signs of localization. Since the disease may be life-threatening and progressive, early recognition is necessary to initiate appropriate therapy. Patients with persistent ischaemic symptoms including hypertension might benefit from revascularization procedures.
References
Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC, Kawasaki T, Lindsley C, Petty RE, Prieur AM, Ravelli A, Woo P (2006) EULAR/PRES endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 65:936–941
Lazzarin P, Pasero G, Marson P, Cecchetto A, Zanchin G (2005) Takayasu’s arteritis. A concise review and some observations on a putative case reported by Giovanni Battista Morgagni (1761). Reumatismo 57:305–313
Savoy WE (1856) Case of a young woman in whom the main arteries of both upper extremities and of the left side of the neck were throughout completely obliterated. Med Chir Transact 39:205–219
Takayasu M (1908) A case with peculiar changes of the central retinal vessels. Acta Soc Ophthalmol Jpn 12:554
Sano K (2008) Takayasu disease—pulseless disease. Brain Nerve 60:31–35
Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr, Mas AT, McShane DJ, Mills JA, Stevens MB, Wallace SL, Zvaifler NJ (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129–1134
Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CGM, McCluskey RT, Sinico RA, Rees AJ, van Es LA, Waldherr R, Wiik A (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37:187–192
Johnston SL, Lock RJ, Gompels MM (2002) Takayasu arteritis: a review. J Clin Pathol 55:481–486
Hall S, Barr W, Lie JT, Stanson AW, Kazmier FJ, Hunder GG (1985) Takayasu arteritis: a study of 32 North American patients. Medicine (Baltimore) 64:89–99
Kerr CS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS (1994) Takayasu’s arteritis. Ann Intern Med 120:919
Eke F, Balfe JW, Hardy BE (1984) Three patients with arteritis. Arch Dis Child 59:877–883
Ladhani S, Tulloh R, Anderson D (2001) Takayasu disease masquerading as interruption aorta in a 2 years old child. Cardiol Young 11:244–246
Jain S, Sharma N, Singh S, Bali HK, Kumar L, Sharma BK (2000) Takayasu arteritis in children and young Indians. Int J Cardiol 75:53–57
Hahn D, Thomson PD, Kala U, Beale PG, Levin SE (1998) A review of Takayasu arteritis in children in Gauteng, South Africa. Pediatr Nephrol 12:668–675
Korzets Z, Barenboim E, Bernheim J, Mekori Y, Bernheim J (1998) Mesangioproliferative glomerulonephritis, antiphospholipid antibodies and Takayasu’s arteritis—is there a link? Nephrol Dial Transplant 13:991–993
Cavatorta F, Campisi S, Trabassi E, Zollo A, Salvidio G (1995) IgA nephropathy associated with Takayasu’s arteritis: report of a case and review of the literature. Am J Nephrol 15:165–167
Yoshikawa Y, Truong LD, Mattioli CA, Lederer E (1988) Membranoproliferative glomerulonephritis in Takayasu’s arteritis. Am J Nephrol 8:240–244
Dash SC, Malhotra KK, Sharma RK, Bhuyan UN (1984) Renal amyloidosis and non-specific aortoarteritis—a hitherto unrecognized association. Postgrad Med J 60:626–628
Bahl VK, Seth S (2002) Takayasu arteritis revisited. Indian Heart J 54:147–151
Rodriguez-Pla A, Stone H (2006) Vasculitis and systemic infections. Cur Opin Rheumatol 18:39–47
Chauhan SK, Tripathy NK, Nityanand S (2006) Antigenic targets and pathogenicity of antiaortic endothelial cell antibodies in Takayasu arteritis. Arthritis Rheum 54:2326–2333
Chirinos JA, Corrales VF, Lichtstein DM (2005) ANCA-associated large vessel compromise. Clin Rheumatol 25:111–112
Hall S, Nelson AM (1986) Takayasu arteritis and juvenile rheumatoid arthritis. J Rheumatol 13:431–432
Opastirakul S, Chartapisak W, Sirivanichai C (2004) A girl with Takayasu arteritis with possible systemic lupus erythematosus. Pediatr Nephrol 19:463–466
Sen PK, Kinare SG, Kelkar MD, Nanivadkar SA (1972) Nonspecific stenosing arteritis of the aorta and its branches: a study of possible etiology. Mt Sinai J Med 39:221–242
Seko Y (2000) Takayasu arteritis. Insights into immunopathology. Jpn Heart J 41:15–26
Kothari SS (1995) Aetiopathogenesis of Takayasu’s arteritis and BCG vaccination: the missing link? Med Hypotheses 45:227–230
Aggarwal A, Chag M, Sinha N, Naik S (1996) Takayasu arteritis: role of Mycobacterium tuberculosis and its 65 kDa heat shock protein. Int J Cardiol 55:49–55
Chauhan SK, Tripathy NK, Sinha N (2004) Cellular and humoral immune responses to mycobacterial heat shock protein-65 and its human homologue in Takayasu’s arteritis. Clin Exp Immunol 138:547–553
Seko Y, Minota S, Kawasaki A (1994) Perforin secreting killer cell infiltration and expression of 65-KD heat shock protein in aortic tissue of patients with Takayasu’s arteritis. J Clin Invest 93:750–758
Enomoto S, Magara J, Iwasaki Y, Bannai S, Nara Y, Aizawa Y, Matsuoka A, Shibata A (1983) Aortitis syndrome in a pair of monozygotic twins. Nippon Naika Gakkai Zasshi 72:1553–1556
Dong RP, Kimur A, Numenno F, Nashimura Y, Sasazuki T (1992) HLA linked susceptibility and resistance to Takayasu arteritis. Heart Vessels Suppl 7:73–80
Kasuya K, Hashimoto Y, Numenno F (1992) Left ventricular dysfunction and HLA Bw52 antigen in Takayasu arteritis. Heart Vessels Suppl 7:116–119
Khraishi MM, Gladman DD, Dagenais P, Fam AG, Keystone EC (1992) HLA antigens in North American patients with Takayasu arteritis. Arthritis Rheum 35:573–575
Mehra NK, Jaini R, Baramurugan A, Kanga U, Prabhakaran D, Jain S, Talwar KK, Sharma BK (1998) Immunogenetic analysis of Takayasu arteritis in Indian patients. Int J Cardiol 66:S127–132
Hata A, Noda M, Moriwaki R, Numano F (1996) Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 54(Suppl):S155–S163
Tyagi S, Kaul UA, Satsangi DK, Arora R (1997) Percutaneous transluminal angioplasty for renovascular hypertension in children: initial and long-term results. Pediatrics 99:44–49
Hong CY, Yung YS, Choi JY, Sul JH, Lee KS, Cha SH, Hong YM, Lee HJ, Hong YJ, Sohn KC (1992) Takayasu arteritis in Korean children: clinical report of seventy cases. Heart Vessels 7:91–96
Ozen S, Bakkaloglu A, Dusunsel R, Soylemezoglu O, Ozaltin F, Poyrazoglu H, Kasapcopur O, Ozkaya O, Yalcinkaya F, Balat A, Kural N, Donmez O, Alpay H, Anarat A, Mir S, Gur-Guven A, Sonmez F, Gok F, Turkish Pediatric Vasculitis Study Group (2007) Childhood vasculitides in Turkey: a nationwide survey. Clin Rheumatol 26:196–200
Shrivastava S, Srivastava RN, Tandon R (1986) Idiopathic obstructive aortoarteritis in children. Indian Pediatr 23:403–410
Al abrawi S, Fouillet-Desjonqueres M, David L, Barral X, Cochat P, Cimaz R (2008) Takayasu arteritis in children. Pediatr Rheumatol Online J 6:17
Ishikawa K (1988) Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu’s arteriopathy. J Am Coll Cardiol 12:964–972
Sharma BK, Jain S, Suri S, Numano F (1996) Diagnostic criteria for Takayasu arteritis. Int J Cardiol 54(Suppl):S141–S147
Ozen S, Pistorio A, Filocamo G, Ravelli A, Espada G, Quartier P, Bagga A, Sztajnbok F, Estrella AI, Khubchandani R, Oliveira S, Silva CA, Al-Mayouf S, Bracaglia C, Russo R, Vilca I, Alpigiani MG, Brunner J, Horneff G, Lepore L, Martini A, Ruperto N, for the Pediatric Rheumatology International Trials Organisation (PRINTO) (2009) The 2009 EULAR/PRINTO/PRES criteria for childhood Takayasu arteritis. Ankara 2008. Ann Rheum Dis (in press)
Desai MY, Stone JH, Foo T, Hellmann DB, Lima J, Bluemke D (2005) Delayed contrast-enhanced MRI of the aortic wall in Takayasu arteritis: initial experience. AJR Am J Roentgenol 184:1427–1431
Sueyoshi E, Sakamoto I, Uetani M (2006) MRI of Takayasu’s arteritis: typical appearances and complications. AJR Am J Roentgenol 187:W569–W575
Tann OR, Tulloh RM, Hamilton MC (2008) Takayasu’s disease: a review. Cardiol Young 18:250–259
Henes JC, Müller M, Krieger J, Balletshofer B, Pfannenberg AC, Kanz L, Kötter I (2008) [18F] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol 26(3 Suppl 49):S47–S52
Tripathy NK, Gupta PC, Nityanand S (2006) High TNF-α and low IL-12 producing T cells characterize active disease in Takayasu’s arteritis. Clin Immunol 118:154–158
Chauhan SK, Tripathy NK, Sinha N, Nityanand S (2006) T-cell repertoire of circulating gamma delta T-cells in Takayasu’s arteritis. Clin Immunol 118:243–249
Verma DK, Tripathy NK, Verma NS, Tiwari S (2005) Interleukin-12 in Takayasu’s arteritis: plasma concentrations and relationship with disease activity. J Rheumatol 32:2361–2363
Park MC, Lee SW, Park YB, Lee SK (2006) Serum cytokine profiles and their correlations with disease activity in Takayasu’s arteritis. Rheumatology 45:545–548
Rodríguez-Osorio X, Blanco M, Arias S, Castillo J (2008) Biomarkers and PET for assessing the activity of Takayasu’s arteritis. Neurologia 23:329–332
Hoffman GS, Leavitt RY, Kerr GS, Rottem M, Sneller MC, Fauci AS (1994) Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum 37:578–582
Shelhamer JH, Volkman DJ, Parrillo JE, Lawley TJ, Johnston MR, Fauci AS (1985) Takayasu’s arteritis and its therapy. Ann Intern Med 103:121–126
Ozen S, Duzova A, Bakkaloglu A, Bliginer Y, Cil BE, Demircin M, Davin JC, Bakkaloglu M (2007) Takayasu arteritis in children: preliminary experience with cyclophosphamide induction and corticosteroids followed by methotrexate. J Pediatr 150:72–76
Rodríguez-Hurtado FJ, Sabio JM, Lucena J, Jiménez-Alonso J (2002) Ocular involvement in Takayasu’s arteritis: response to cyclophosphamide therapy. Eur J Med Res 28:128–130
Shinjo SK, Pereira RM, Tizziani VA, Radu AS, Levy-Neto M (2007) Mycophenolate mofetil reduces disease activity and steroid dosage in Takayasu arteritis. Clin Rheumatol 26:1871–1875
Daina E, Schieppati A, Remuzzi G (1999) Mycophenolate mofetil for the treatment of Takayasu arteritis: report of three cases. Ann Intern Med 130:422–426
Valsakumar AK, Valappil UC, Jorapur V, Garg N, Nityanand S, Sinha N (2003) Role of immunosuppressive therapy on clinical, immunological, and angiographic outcome in active Takayasu arteritis. J Rheumatol 30:1793–1798
Horigome H, Kamoda T, Matsui A (1999) Treatment of glucocorticoid-dependent Takayasu’s arteritis with cyclosporine. Med J Aust 170:566
Tanaka F, Kawakami A, Iwanaga N, Tamai M, Izumi Y, Aratake K, Arima K, Kamachi M, Nakamura H, Huang M, Ida H, Origuria T, Eguchi K (2006) Infliximab is effective for Takayasu arteritis refractory to glucocorticoid and methotrexate. Int Med 45:313–316
Hoffman GS, Merkel PA, Brasington RD, Lenschow DJ, Liang P (2004) Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum 50:2296–2304
Matsuyama A, Sakai N, Ishigami M, Hiraoka H, Kashine S, Hirata A, Nakamura T, Yamashita S, Matsuzawa Y (2003) Matrix metalloproteinases as novel disease markers in Takayasu arteritis. Circulation 108:1469–1473
Uthman IW, Chaaban H (2006) The use of sildenafil in pediatric Takayasu arteritis. Clin Rheumatol 25:550
Sharma S, Saxena A, Talwar KK, Kaul U, Mehta SN, Rajani M (1992) Renal artery stenosis caused by nonspecific arteritis (Takayasu disease): results of treatment with percutaneous transluminal angioplasty. AJR Am J Roentgenol 158:417–422
Tyagi S, Gambhir DS, Kaul UA, Verma P, Arora R (1996) A decade of subclavian angioplasty: aortoarteritis versus atherosclerosis. Indian Heart J 48:667–671
Maksimowicz-McKinnon K, Clark TM, Hoffman GS (2007) Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients. Arthritis Rheum 56:1000–1009
Lupi-Herrera E, Sanchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE (1977) Takayasu arteritis: clinical study of 107 cases. Am Heart J 93:94–103
Dabague J, Reyes PA (1996) Takayasu’s arteritis in Mexico: a 38 year clinical perspective through literature review. Int J Cardiol 54:S87–S93
Lagneau P, Michel JB, Vuong PN (1987) Surgical treatment of Takayasu disease. Ann Surg 205:157–166
Subramanyam R, Joy J, Balakrishnan K (1989) Natural history of aortoarteritis. Circulation 80:429–437
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gulati, A., Bagga, A. Large vessel vasculitis. Pediatr Nephrol 25, 1037–1048 (2010). https://doi.org/10.1007/s00467-009-1312-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-009-1312-9