Takayasu's Arteritis: Vasculitis of Large Vessels, Diagnosis and Treatment | Omicron Clinic<\/title>\n<meta name=\"description\" content=\"L'art\u00e9rite de Takayasu est une vascularite granulomateuse des grands vaisseaux causant st\u00e9noses et an\u00e9vrismes aortiques. 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34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n L'art\u00e9rite de Takayasu (AT) \u2014 d\u00e9sign\u00e9e \u00e9galement \u00ab maladie sans pouls \u00bb (<em>Pulseless disease<\/em>) + aortic arch disease + or Martorell syndrome + a disease described in 1908 by the Japanese ophthalmologist Mikito Takayasu, who observed characteristic retinal arteriovenous anastomoses in a young woman - is a chronic granulomatous vasculitis of the large vessels (aorta + its main branches) belonging to the group of large-vessel vasculitides with giant cell arteritis (GCA), distinguished from the latter by its age of onset, typically in young women (before age 40 - peak incidence 15-25 + F:H = 8-9:1) and its predilection for Asian and Latin American populations + although cases are reported worldwide. The pathogenesis is autoimmune: infiltration of the aortic wall and its branches by cytotoxic T lymphocytes (CD8+) + NK cells + macrophages \u2192 granulomatous reaction \u2192 fibrinoid necrosis of the media + fibrosis of the adventitia and intima \u2192 vascular consequences: stenoses (80-90 % of cases) + aneurysms (25-30 %) + occlusions + dissections \u2192 ischemia of target organs. TA classically evolves in two phases: an early inflammatory phase (systemic phase) with fever + fatigue + arthralgias + nocturnal sweating + elevated CRP\/VS - often misdiagnosed as a fever of unknown origin - followed by a late fibro-occlusive phase (vascular phase) with ischemic sequelae (renovascular hypertension + limb claudication + stroke + aortic insufficiency + ischemic retinopathy). The average diagnostic delay remains long (median 19-24 months) due to the rarity of the disease + its initial non-specific presentation + and the absence of a pathognomonic blood biomarker.\n <\/div>\n\n <h2>Clinical manifestations according to affected areas<\/h2>\n <ul class=\"co-list\">\n <li><strong>Phase syst\u00e9mique pr\u00e9coce (inflammatoire) :<\/strong> moderate fever (38\u201339 \u00b0C) + profound fatigue + joint pain + muscle pain + night sweats + weight loss + headaches + elevated ESR and CRP \u2192 often diagnosed as fever of unknown origin + chronic infection + or tuberculosis (TB and tuberculosis share a geographic association + and tuberculosis can trigger TB)<\/li>\n <li><strong>Atteinte des art\u00e8res sous-clavi\u00e8res et axillaires (la plus fr\u00e9quente) :<\/strong> pouls radial absent ou asym\u00e9trique + claudication des membres sup\u00e9rieurs (douleur + fatigue du bras \u00e0 l'effort) + diff\u00e9rence de pression art\u00e9rielle entre les deux bras (> 10 mmHg = significative + > 20 mmHg = forte suspicion) + souffles vasculaires aux creux axillaires et sous-claviers + le classique \u00ab pouls absent \u00bb = cons\u00e9quence des st\u00e9noses sous-clavi\u00e8res<\/li>\n <li><strong>Atteinte des art\u00e8res carotides et vert\u00e9brales :<\/strong> Ischemic strokes + TIAs + syncope + headaches + visual disturbance + carotid bruit + dilatation and tortuosity of retinal arteries (retinal arteriovenous anastomoses described by Takayasu)<\/li>\n <li><strong>Atteinte de l'aorte (coarctation aortique acquise) :<\/strong> Upper extremity hypertension + lower extremity hypotension + high arm\/ankle pressure difference + lower extremity claudication + postprandial abdominal pain (mesenteric ischemia if mesenteric arteries are affected)<\/li>\n <li><strong>Atteinte des art\u00e8res r\u00e9nales :<\/strong> Renovascular hypertension ++ (main cause of hypertension in young women in endemic countries) + Severe refractory hypertension + Renal echo-Doppler (renal artery stenosis) + Kidney failure<\/li>\n <li><strong>Coronary involvement<\/strong> rare + IDM in a young woman without classic risk factors \u2192 consider TA + coronary arteritis<\/li>\n <li><strong>Aortic insufficiency<\/strong> aortic root dilatation + progressive aortic regurgitation + heart failure + valvular surgery if severe<\/li>\n <\/ul>\n\n <h2>Crit\u00e8res diagnostiques \u2014 ACR 1990 (6 crit\u00e8res, 3 requis)<\/h2>\n <ul class=\"co-list\">\n <li><strong>Crit\u00e8re 1 \u2014 \u00c2ge de d\u00e9but \u2264 40 ans<\/strong><\/li>\n <li><strong>Crit\u00e8re 2 \u2014 Claudication des extr\u00e9mit\u00e9s :<\/strong> fatigue or discomfort of the extremity muscles during use<\/li>\n <li><strong>Crit\u00e8re 3 \u2014 Diminution du pouls brachial :<\/strong> Diminished pulse in the brachial artery (one or both arms)<\/li>\n <li><strong>Crit\u00e8re 4 \u2014 Diff\u00e9rence de pression art\u00e9rielle bras > 10 mmHg<\/strong><\/li>\n <li><strong>Crit\u00e8re 5 \u2014 Souffle sur l'art\u00e8re sous-clavi\u00e8re ou l'aorte :<\/strong> auscultated souffle on the abdominal aorta + the subclavian artery + or the iliac arteries<\/li>\n <li><strong>Crit\u00e8re 6 \u2014 Anomalie art\u00e9riographique :<\/strong> narrowing + occlusion + or aneurysm of the aorta + its branches + or proximal pulmonary arteries not explained by another cause + sensitivity 90.5 % + specificity 97.8 % if \u2265 3 criteria<\/li>\n <\/ul>\n\n <h2>Vascular imaging<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Review<\/th>\n <th>Contributions<\/th>\n <th>Indications<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Angioscanner (angio-CT)<\/td>\n <td>\u00c9paississement pari\u00e9tal + rehaussement mural (inflammation) + st\u00e9noses + occlusions + an\u00e9vrismes + calcifications + accessible + rapide + bonne r\u00e9solution spatiale<\/td>\n <td>Bilan initial + suivi des complications structurales + \u00e9valuation des st\u00e9noses et an\u00e9vrismes + guidage chirurgical<\/td>\n <\/tr>\n <tr>\n <td>Angio-MRI<\/td>\n <td>\u00c9paississement + rehaussement pari\u00e9tal + activit\u00e9 inflammatoire (gadolinium) + pas d'irradiation + visualisation de la lumi\u00e8re et de la paroi + de r\u00e9f\u00e9rence pour le suivi longitudinal<\/td>\n <td>Diagnostic initial + suivi de l'activit\u00e9 inflammatoire + grossesse (pas d'irradiation) + r\u00e9p\u00e9titions fr\u00e9quentes<\/td>\n <\/tr>\n <tr>\n <td>PET-TDM with FDG<\/td>\n <td>Captation du FDG par les macrophages activ\u00e9s dans la paroi vasculaire \u2192 d\u00e9tecte l'inflammation active des grands vaisseaux + identifie les sites d'activit\u00e9 avant les modifications structurales + tr\u00e8s sensible en phase pr\u00e9coce<\/td>\n <td>Diagnostic en phase inflammatoire pr\u00e9coce avant les st\u00e9noses + \u00e9valuation de l'activit\u00e9 + guide les d\u00e9cisions th\u00e9rapeutiques + particuli\u00e8rement utile si CRP normale mais activit\u00e9 clinique suspect\u00e9e<\/td>\n <\/tr>\n <tr>\n <td>\u00c9cho-Doppler vasculaire<\/td>\n <td>Non invasif + disponible + \u00e9paississement de l'intima-m\u00e9dia aortique + st\u00e9noses des carotides + sous-clavi\u00e8res + r\u00e9nales + mesure des indices de r\u00e9sistance<\/td>\n <td>D\u00e9pistage initial + suivi des art\u00e8res accessibles + surveillance des st\u00e9noses des art\u00e8res r\u00e9nales et carotides<\/td>\n <\/tr>\n <tr>\n <td>Art\u00e9riographie conventionnelle<\/td>\n <td>Gold standard historique pour les st\u00e9noses et an\u00e9vrismes + mais invasive + irradiante + risque li\u00e9 au cath\u00e9t\u00e9risme<\/td>\n <td>R\u00e9serv\u00e9e \u00e0 la planification des interventions endovasculaires + ou si imagerie non invasive insuffisante<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Cortico\u00efdes syst\u00e9miques (traitement de premi\u00e8re ligne) :<\/strong> prednisone 40\u201360 mg\/day \u2192 remission in 60\u2013100 % of cases in active inflammatory phase + gradual tapering over 1\u20132 years + relapse in 50\u201370 % of cases during tapering \u2192 frequent need for prolonged maintenance therapy or corticosteroid-sparing agents<\/li>\n <li><strong>M\u00e9thotrexate (\u00e9pargnant cortiso\u00efdes \u2014 2e ligne) :<\/strong> 15\u201325 mg\/week + folic acid + effective for maintaining remission + reduce corticosteroid dose + time to efficacy 4\u20138 weeks<\/li>\n <li><strong>Mycoph\u00e9nolate mof\u00e9til + azathioprine :<\/strong> Alternatives if methotrexate is not tolerated or insufficient<\/li>\n <li><strong>Tocilizumab (anti-IL-6R):<\/strong> Reference biotherapy for relapse or corticosteroid dependence + TAKT clinical trial (2017) inconclusive for relapse reduction but favorable observational data + 162 mg SC\/week + or 8 mg\/kg IV\/4 weeks + approved in some countries for refractory RA + QuantiFERON mandatory before<\/li>\n <li><strong>Anti-TNF (infliximab + adalimumab):<\/strong> positive observational data in methotrexate-refractory forms + or if tocilizumab unavailable + QuantiFERON mandatory<\/li>\n <li><strong>Vascular treatment (endovascular or surgical):<\/strong> Percutaneous angioplasty \u00b1 stent (symptomatic renal + subclavian artery stenoses) + aortocoronary or aortorenal bypass + aneurysm resection + aortic replacement \u2192 ideally performed during remission (controlled inflammation) to reduce the risk of restenosis + increased perioperative mortality if performed during active phase<\/li>\n <li><strong>Aspirin + statins:<\/strong> Cardiovascular risk reduction + aspirin 81\u2013100 mg\/day if no contraindications (risk of stroke + thrombosis)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Chez une femme jeune avec une HTA r\u00e9sistante aux antihypertenseurs + un souffle abdominal + une diff\u00e9rence de pression entre les deux bras ou entre bras et chevilles + des pouls asym\u00e9triques, \u00e9voquer syst\u00e9matiquement l'art\u00e9rite de Takayasu. La mesure de la pression art\u00e9rielle aux quatre membres est un examen simple et essentiel dans le bilan de toute HTA de la femme jeune. Une diff\u00e9rence de plus de 20 mmHg entre les deux bras doit toujours \u00eatre investig\u00e9e.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgent medical consultation<\/div>\n <p>Consulter un m\u00e9decin ou un rhumatologue rapidement si une femme de moins de 40 ans pr\u00e9sente une fi\u00e8vre prolong\u00e9e inexpliqu\u00e9e + une fatigue importante + des pouls asym\u00e9triques ou absents + des souffles vasculaires + une diff\u00e9rence de pression art\u00e9rielle entre les deux bras + ou des signes d'isch\u00e9mie c\u00e9r\u00e9brale ou des membres \u2014 ces signes \u00e9voquent une art\u00e9rite de Takayasu n\u00e9cessitant un angioscanner + un PET-TDM + et une prise en charge rhumatologique urgente. Consulter aux urgences si des signes d'AVC + d'isch\u00e9mie des membres + ou d'insuffisance cardiaque aigu\u00eb surviennent. Pour le bilan initial et l'orientation vers la rhumatologie, Clinique Omicron offre des consultations dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron \u00e9voquent l'art\u00e9rite de Takayasu devant toute HTA inexpliqu\u00e9e de la femme jeune + une fi\u00e8vre prolong\u00e9e d'origine inconnue + des pouls asym\u00e9triques ou des souffles vasculaires, prescrivent le bilan initial (VS + CRP + NFS + cr\u00e9atinine + bilan lipidique + imagerie), mesurent la pression art\u00e9rielle aux quatre membres, orientent vers la rhumatologie + la cardiologie + la chirurgie vasculaire pour la prise en charge multidisciplinaire, et assurent le suivi des comorbidit\u00e9s cardiovasculaires et des effets des traitements immunosuppresseurs. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un rhumatologue sp\u00e9cialis\u00e9 en vascularites. L'art\u00e9rite de Takayasu est une maladie rare n\u00e9cessitant un suivi sp\u00e9cialis\u00e9 multidisciplinaire \u00e0 long terme. La CRP et la VS peuvent \u00eatre normales malgr\u00e9 une activit\u00e9 inflammatoire persistante \u2014 le PET-TDM est plus sensible pour d\u00e9tecter une activit\u00e9 vasculaire infraclinique.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Art\u00e9rite de Takayasu : vascularite des grands vaisseaux, diagnostic et traitement | Clinique Omicron Rhumatologie & M\u00e9decine vasculaire & M\u00e9decine interne Art\u00e9rite de Takayasu L’art\u00e9rite de Takayasu (AT) \u2014 d\u00e9sign\u00e9e \u00e9galement \u00ab maladie sans pouls \u00bb (pulseless disease) + maladie de l’arc aortique + ou syndrome de Martorell + maladie d\u00e9crite en 1908 par l’ophtalmologue… <a href=\"https:\/\/cliniqueomicron.ca\/en\/maladie-takayasu\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Takayasu's Arteritis: Vasculitis of Large Vessels, Diagnosis and Treatment | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Takayasu (art\u00e9rite de) | Brossard | Clinique Omicron","_metasync_otto_description":"Takayasu (art\u00e9rite de) Takayasu (art\u00e9rite de) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Rhumatologie & M\u00e9decine vasculaire & M\u00e9decine interne<\/span>\n <h1>Takayasu's arteritis<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n L'art\u00e9rite de Takayasu (AT) \u2014 d\u00e9sign\u00e9e \u00e9galement \u00ab maladie sans pouls \u00bb (<em>Pulseless disease<\/em>) + aortic arch disease + or Martorell syndrome + a disease described in 1908 by the Japanese ophthalmologist Mikito Takayasu, who observed characteristic retinal arteriovenous anastomoses in a young woman - is a chronic granulomatous vasculitis of the large vessels (aorta + its main branches) belonging to the group of large-vessel vasculitides with giant cell arteritis (GCA), distinguished from the latter by its age of onset, typically in young women (before age 40 - peak incidence 15-25 + F:H = 8-9:1) and its predilection for Asian and Latin American populations + although cases are reported worldwide. The pathogenesis is autoimmune: infiltration of the aortic wall and its branches by cytotoxic T lymphocytes (CD8+) + NK cells + macrophages \u2192 granulomatous reaction \u2192 fibrinoid necrosis of the media + fibrosis of the adventitia and intima \u2192 vascular consequences: stenoses (80-90 % of cases) + aneurysms (25-30 %) + occlusions + dissections \u2192 ischemia of target organs. TA classically evolves in two phases: an early inflammatory phase (systemic phase) with fever + fatigue + arthralgias + nocturnal sweating + elevated CRP\/VS - often misdiagnosed as a fever of unknown origin - followed by a late fibro-occlusive phase (vascular phase) with ischemic sequelae (renovascular hypertension + limb claudication + stroke + aortic insufficiency + ischemic retinopathy). The average diagnostic delay remains long (median 19-24 months) due to the rarity of the disease + its initial non-specific presentation + and the absence of a pathognomonic blood biomarker.\n <\/div>\n\n <h2>Clinical manifestations according to affected areas<\/h2>\n <ul class=\"co-list\">\n <li><strong>Phase syst\u00e9mique pr\u00e9coce (inflammatoire) :<\/strong> moderate fever (38\u201339 \u00b0C) + profound fatigue + joint pain + muscle pain + night sweats + weight loss + headaches + elevated ESR and CRP \u2192 often diagnosed as fever of unknown origin + chronic infection + or tuberculosis (TB and tuberculosis share a geographic association + and tuberculosis can trigger TB)<\/li>\n <li><strong>Atteinte des art\u00e8res sous-clavi\u00e8res et axillaires (la plus fr\u00e9quente) :<\/strong> pouls radial absent ou asym\u00e9trique + claudication des membres sup\u00e9rieurs (douleur + fatigue du bras \u00e0 l'effort) + diff\u00e9rence de pression art\u00e9rielle entre les deux bras (> 10 mmHg = significative + > 20 mmHg = forte suspicion) + souffles vasculaires aux creux axillaires et sous-claviers + le classique \u00ab pouls absent \u00bb = cons\u00e9quence des st\u00e9noses sous-clavi\u00e8res<\/li>\n <li><strong>Atteinte des art\u00e8res carotides et vert\u00e9brales :<\/strong> Ischemic strokes + TIAs + syncope + headaches + visual disturbance + carotid bruit + dilatation and tortuosity of retinal arteries (retinal arteriovenous anastomoses described by Takayasu)<\/li>\n <li><strong>Atteinte de l'aorte (coarctation aortique acquise) :<\/strong> Upper extremity hypertension + lower extremity hypotension + high arm\/ankle pressure difference + lower extremity claudication + postprandial abdominal pain (mesenteric ischemia if mesenteric arteries are affected)<\/li>\n <li><strong>Atteinte des art\u00e8res r\u00e9nales :<\/strong> Renovascular hypertension ++ (main cause of hypertension in young women in endemic countries) + Severe refractory hypertension + Renal echo-Doppler (renal artery stenosis) + Kidney failure<\/li>\n <li><strong>Coronary involvement<\/strong> rare + IDM in a young woman without classic risk factors \u2192 consider TA + coronary arteritis<\/li>\n <li><strong>Aortic insufficiency<\/strong> aortic root dilatation + progressive aortic regurgitation + heart failure + valvular surgery if severe<\/li>\n <\/ul>\n\n <h2>Crit\u00e8res diagnostiques \u2014 ACR 1990 (6 crit\u00e8res, 3 requis)<\/h2>\n <ul class=\"co-list\">\n <li><strong>Crit\u00e8re 1 \u2014 \u00c2ge de d\u00e9but \u2264 40 ans<\/strong><\/li>\n <li><strong>Crit\u00e8re 2 \u2014 Claudication des extr\u00e9mit\u00e9s :<\/strong> fatigue or discomfort of the extremity muscles during use<\/li>\n <li><strong>Crit\u00e8re 3 \u2014 Diminution du pouls brachial :<\/strong> Diminished pulse in the brachial artery (one or both arms)<\/li>\n <li><strong>Crit\u00e8re 4 \u2014 Diff\u00e9rence de pression art\u00e9rielle bras > 10 mmHg<\/strong><\/li>\n <li><strong>Crit\u00e8re 5 \u2014 Souffle sur l'art\u00e8re sous-clavi\u00e8re ou l'aorte :<\/strong> auscultated souffle on the abdominal aorta + the subclavian artery + or the iliac arteries<\/li>\n <li><strong>Crit\u00e8re 6 \u2014 Anomalie art\u00e9riographique :<\/strong> narrowing + occlusion + or aneurysm of the aorta + its branches + or proximal pulmonary arteries not explained by another cause + sensitivity 90.5 % + specificity 97.8 % if \u2265 3 criteria<\/li>\n <\/ul>\n\n <h2>Vascular imaging<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Review<\/th>\n <th>Contributions<\/th>\n <th>Indications<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Angioscanner (angio-CT)<\/td>\n <td>\u00c9paississement pari\u00e9tal + rehaussement mural (inflammation) + st\u00e9noses + occlusions + an\u00e9vrismes + calcifications + accessible + rapide + bonne r\u00e9solution spatiale<\/td>\n <td>Bilan initial + suivi des complications structurales + \u00e9valuation des st\u00e9noses et an\u00e9vrismes + guidage chirurgical<\/td>\n <\/tr>\n <tr>\n <td>Angio-MRI<\/td>\n <td>\u00c9paississement + rehaussement pari\u00e9tal + activit\u00e9 inflammatoire (gadolinium) + pas d'irradiation + visualisation de la lumi\u00e8re et de la paroi + de r\u00e9f\u00e9rence pour le suivi longitudinal<\/td>\n <td>Diagnostic initial + suivi de l'activit\u00e9 inflammatoire + grossesse (pas d'irradiation) + r\u00e9p\u00e9titions fr\u00e9quentes<\/td>\n <\/tr>\n <tr>\n <td>PET-TDM with FDG<\/td>\n <td>Captation du FDG par les macrophages activ\u00e9s dans la paroi vasculaire \u2192 d\u00e9tecte l'inflammation active des grands vaisseaux + identifie les sites d'activit\u00e9 avant les modifications structurales + tr\u00e8s sensible en phase pr\u00e9coce<\/td>\n <td>Diagnostic en phase inflammatoire pr\u00e9coce avant les st\u00e9noses + \u00e9valuation de l'activit\u00e9 + guide les d\u00e9cisions th\u00e9rapeutiques + particuli\u00e8rement utile si CRP normale mais activit\u00e9 clinique suspect\u00e9e<\/td>\n <\/tr>\n <tr>\n <td>\u00c9cho-Doppler vasculaire<\/td>\n <td>Non invasif + disponible + \u00e9paississement de l'intima-m\u00e9dia aortique + st\u00e9noses des carotides + sous-clavi\u00e8res + r\u00e9nales + mesure des indices de r\u00e9sistance<\/td>\n <td>D\u00e9pistage initial + suivi des art\u00e8res accessibles + surveillance des st\u00e9noses des art\u00e8res r\u00e9nales et carotides<\/td>\n <\/tr>\n <tr>\n <td>Art\u00e9riographie conventionnelle<\/td>\n <td>Gold standard historique pour les st\u00e9noses et an\u00e9vrismes + mais invasive + irradiante + risque li\u00e9 au cath\u00e9t\u00e9risme<\/td>\n <td>R\u00e9serv\u00e9e \u00e0 la planification des interventions endovasculaires + ou si imagerie non invasive insuffisante<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Cortico\u00efdes syst\u00e9miques (traitement de premi\u00e8re ligne) :<\/strong> prednisone 40\u201360 mg\/day \u2192 remission in 60\u2013100 % of cases in active inflammatory phase + gradual tapering over 1\u20132 years + relapse in 50\u201370 % of cases during tapering \u2192 frequent need for prolonged maintenance therapy or corticosteroid-sparing agents<\/li>\n <li><strong>M\u00e9thotrexate (\u00e9pargnant cortiso\u00efdes \u2014 2e ligne) :<\/strong> 15\u201325 mg\/week + folic acid + effective for maintaining remission + reduce corticosteroid dose + time to efficacy 4\u20138 weeks<\/li>\n <li><strong>Mycoph\u00e9nolate mof\u00e9til + azathioprine :<\/strong> Alternatives if methotrexate is not tolerated or insufficient<\/li>\n <li><strong>Tocilizumab (anti-IL-6R):<\/strong> Reference biotherapy for relapse or corticosteroid dependence + TAKT clinical trial (2017) inconclusive for relapse reduction but favorable observational data + 162 mg SC\/week + or 8 mg\/kg IV\/4 weeks + approved in some countries for refractory RA + QuantiFERON mandatory before<\/li>\n <li><strong>Anti-TNF (infliximab + adalimumab):<\/strong> positive observational data in methotrexate-refractory forms + or if tocilizumab unavailable + QuantiFERON mandatory<\/li>\n <li><strong>Vascular treatment (endovascular or surgical):<\/strong> Percutaneous angioplasty \u00b1 stent (symptomatic renal + subclavian artery stenoses) + aortocoronary or aortorenal bypass + aneurysm resection + aortic replacement \u2192 ideally performed during remission (controlled inflammation) to reduce the risk of restenosis + increased perioperative mortality if performed during active phase<\/li>\n <li><strong>Aspirin + statins:<\/strong> Cardiovascular risk reduction + aspirin 81\u2013100 mg\/day if no contraindications (risk of stroke + thrombosis)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Chez une femme jeune avec une HTA r\u00e9sistante aux antihypertenseurs + un souffle abdominal + une diff\u00e9rence de pression entre les deux bras ou entre bras et chevilles + des pouls asym\u00e9triques, \u00e9voquer syst\u00e9matiquement l'art\u00e9rite de Takayasu. La mesure de la pression art\u00e9rielle aux quatre membres est un examen simple et essentiel dans le bilan de toute HTA de la femme jeune. Une diff\u00e9rence de plus de 20 mmHg entre les deux bras doit toujours \u00eatre investig\u00e9e.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgent medical consultation<\/div>\n <p>Consulter un m\u00e9decin ou un rhumatologue rapidement si une femme de moins de 40 ans pr\u00e9sente une fi\u00e8vre prolong\u00e9e inexpliqu\u00e9e + une fatigue importante + des pouls asym\u00e9triques ou absents + des souffles vasculaires + une diff\u00e9rence de pression art\u00e9rielle entre les deux bras + ou des signes d'isch\u00e9mie c\u00e9r\u00e9brale ou des membres \u2014 ces signes \u00e9voquent une art\u00e9rite de Takayasu n\u00e9cessitant un angioscanner + un PET-TDM + et une prise en charge rhumatologique urgente. Consulter aux urgences si des signes d'AVC + d'isch\u00e9mie des membres + ou d'insuffisance cardiaque aigu\u00eb surviennent. Pour le bilan initial et l'orientation vers la rhumatologie, Clinique Omicron offre des consultations dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron \u00e9voquent l'art\u00e9rite de Takayasu devant toute HTA inexpliqu\u00e9e de la femme jeune + une fi\u00e8vre prolong\u00e9e d'origine inconnue + des pouls asym\u00e9triques ou des souffles vasculaires, prescrivent le bilan initial (VS + CRP + NFS + cr\u00e9atinine + bilan lipidique + imagerie), mesurent la pression art\u00e9rielle aux quatre membres, orientent vers la rhumatologie + la cardiologie + la chirurgie vasculaire pour la prise en charge multidisciplinaire, et assurent le suivi des comorbidit\u00e9s cardiovasculaires et des effets des traitements immunosuppresseurs. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un rhumatologue sp\u00e9cialis\u00e9 en vascularites. L'art\u00e9rite de Takayasu est une maladie rare n\u00e9cessitant un suivi sp\u00e9cialis\u00e9 multidisciplinaire \u00e0 long terme. La CRP et la VS peuvent \u00eatre normales malgr\u00e9 une activit\u00e9 inflammatoire persistante \u2014 le PET-TDM est plus sensible pour d\u00e9tecter une activit\u00e9 vasculaire infraclinique.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Art\u00e9rite de Takayasu : vascularite des grands vaisseaux, diagnostic et traitement | Clinique Omicron Rhumatologie & M\u00e9decine vasculaire & M\u00e9decine interne Art\u00e9rite de Takayasu L’art\u00e9rite de Takayasu (AT) \u2014 d\u00e9sign\u00e9e \u00e9galement \u00ab maladie sans pouls \u00bb (pulseless disease) + maladie de l’arc aortique + ou syndrome de Martorell + maladie d\u00e9crite en 1908 par l’ophtalmologue… <a href=\"https:\/\/cliniqueomicron.ca\/en\/maladie-takayasu\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Takayasu's Arteritis: Vasculitis of Large Vessels, Diagnosis and Treatment | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Takayasu (art\u00e9rite de) | Brossard | Clinique Omicron","_metasync_otto_description":"Takayasu (art\u00e9rite de) Takayasu (art\u00e9rite de) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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