Takayasu arteritis beyond the young: What to consider?

Abstract

Background

Takayasu arteritis (TA), also known as the pulseless disease, is a rare systemic inflammatory condition that damages medium and larger arteries. With an incidence rate of 2–6 per million, it predominantly affects individuals aged 20–40. Clinical manifestations vary from asymptomatic cases to severe vascular damage, often complicating diagnosis. This report aims to shed light on diagnosing Takayasu arteritis in older women.

Case Summary

A 57-year-old Southeast Asian woman presented with intermittent claudication of the upper and lower limbs. Examination revealed a significant systolic blood pressure discrepancy of 60 mmHg between the left and right leg, and vascular bruits over the subclavian arteries. Laboratory tests showed high inflammatory markers and positive ANA. Imaging with duplex ultrasound and CT scan revealed total occlusion of bilateral superficial femoral artery and stenosis of the subclavian arteries. Based on the findings, the patient was diagnosed with Takayasu arteritis. Treatment with high-dose corticosteroids and methotrexate (Methotrexate), along with antihypertensive and antiplatelet drugs, led to symptom improvement and no adverse events at the 1-year follow-up.

Discussion

Takayasu arteritis, while primarily affecting the young, can manifest in older individuals, presenting diagnostic challenges due to its rarity and non-specific symptoms. This case underscores the importance of including TA in the differential diagnosis for older patients with vascular symptoms. Individualized and tailored management of immunosuppressive therapy and regular monitoring are essential to control disease progression and improve outcomes.