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Tests and diagnosis
By Mayo Clinic staffTakayasu's arteritis can be challenging to detect, and some people go years without an accurate diagnosis. Your doctor may use some of the following steps and tests to help rule out other conditions that closely resemble Takayasu's arteritis and to confirm the diagnosis:
- Medical history and physical exam. Your doctor will examine you and ask you questions about your general health, including questions about heart and vascular disease.
- Blood tests. Your doctor may order blood tests to check for signs of inflammation in your body, such as a high white blood cell count or high levels of C-reactive protein, an inflammatory substance produced by your liver. Another blood test commonly used to help identify inflammatory disorders is called the erythrocyte sedimentation rate (sed rate). Your doctor may also check for anemia.
- Angiography. Traditionally, doctors have used an X-ray test called an angiogram as one of the more definitive tests for diagnosing Takayasu's arteritis. During an angiogram, a thin, flexible tube called a catheter is inserted into a large blood vessel. A special dye (contrast medium) is then injected into the catheter, and X-rays are taken as the dye fills your arteries or veins. The resulting images allow your doctor to see if blood is flowing normally or if it's being slowed or interrupted due to narrowing (stenosis) or blockage of a blood vessel. A person with Takayasu's arteritis generally has several areas of stenosis.
- Magnetic resonance angiography (MRA). Increasingly, doctors are using this less invasive form of angiography in place of traditional angiography as a test for Takayasu's arteritis. MRA produces detailed images of your blood vessels without the use of catheters or X-rays, although an intravenous contrast medium generally is used. MRA works by using radio waves in a strong magnetic field to produce data that a computer turns into detailed images of tissue slices.
- Magnetic resonance imaging (MRI). An MRI is similar to an MRA in that it uses radio waves and a magnetic field to create detailed images of organs in the body and allows your doctor to check for possible damage. MRI doesn't use a contrast medium, however.
- Computerized tomography (CT) angiography. This is another noninvasive form of angiography combining computerized analysis of X-ray images with the use of intravenous contrast dye to allow your doctor to check the structure of your aorta and its nearby branches and to monitor blood flow.
- Ultrasonography. Doppler ultrasound, a more sophisticated version of the common ultrasound, has the ability to produce very high-resolution images of the walls of certain arteries, such as those in the neck (carotid arteries) and those in the shoulder (subclavian arteries). It may be able to detect subtle changes in these arteries before other imaging techniques can. Doppler ultrasound can also help distinguish between Takayasu's arteritis and atherosclerosis, a much more common condition caused by the buildup of cholesterol particles and other cellular debris in your arteries.
Unlike other types of vasculitis, the removal and analysis of tissue (biopsy) is not usually used to diagnose Takayasu's arteritis.
Because Takayasu's arteritis has a tendency to recur or flare up after being in remission for a while, these tests may be used not only for diagnosis but also for monitoring the progress of the disease and following up on effectiveness of treatment. Some of the medications used for Takayasu's arteritis may have potentially harmful effects over the long run, so it's important for you and your doctor to know when medication is beneficial and when its risks outweigh its benefits.
References
- Takayasu's arteritis. Vasculitis Foundation. http://staging.vasculitisfoundation.org/education/forms/takayasus-arteritis/ Accessed Jan. 22, 2013.
- Imboden JB, et al. Current Rheumatology Diagnosis & Treatment. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2007. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=38. Accessed Jan. 22, 2013.
- Minagar A, et al. Neurologic presentations of systemic vasculitides. Neurology Clinics. 2010;28:171.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Jan. 22, 2013.
- Takayasu's arteritis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/takayasusartritis.asp. Accessed Jan. 22, 2013.
- Mandal D, et al. Takayasu arteritis in pregnancy: An analysis from eastern India. Archives in Gynecology and Obstetrics. 2012;285:567.
- Ohigashi H, et al. Improved prognosis of Takayasu arteritis over the past decade. Circulation Journal. 2012;76:1004.
- Schmidt J, et al. Tumor necrosis factor inhibitors in patients with Takayasu arteritis: Experience from a referral center with long-term follow-up. Arthritis Care and Research. 2012;64:1079.
- Comarmond C, et al. Anti TNF-alpha in refractory Takayasu's arteritis: Cases series and review of the literature. Autoimmunity Reviews 2012;11:678.
- Salvarani C, et al. Tocilizumab:A novel therapy for patients with large-vessel vasculitis. Rheumatology. 2012;51:151.
- Shields RC (expert opinion). Mayo Clinic, Rochester, Minn., Feb. 10, 2013.
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