Do you know? Open the door┋"Oriental Beauty Disease" - Takayasu Arteritis

Written by: He Tingting, a master's student in rheumatology and immunology at the First Clinical Medical College of Xinjiang Medical University; Hu Yongwei, a resident physician in the Department of Rheumatology and Immunology at the First Affiliated Hospital of Xinjiang Medical University.

Reviewer : Luo Li, Chairman of the Clinical Immunology Branch of the Xinjiang Immunology Society; Vice President of the Xinjiang Uygur Autonomous Region Immunology Society; Director, Professor and Chief Physician of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University.

0 1What is Takayasu arteritis?

Takayasu arteritis (TA) refers to a chronic progressive nonspecific inflammatory disease of the aorta and its main branches. Lesions are more common in the aortic arch and its branches, followed by the descending aorta, abdominal aorta and renal arteries. In layman's terms, it is an immune disease. Under normal circumstances, the human immune system will protect the body from invasion by viruses, bacteria, etc., but when the immune system is damaged, it will in turn attack itself. Takayasu arteritis is an attack by the immune system on its own arteries, causing thickening of the arterial walls in different parts. The lumen is narrowed and the blood flow is slowed, resulting in insufficient blood supply. In severe cases, it can lead to ischemia and necrosis of various organs. It is also called Takayasu disease and pulseless disease.

0 2What are the symptoms of Takayasu arteritis?

First , systemic manifestations: Some people may experience general discomfort, fatigue, fever, loss of appetite, nausea, sweating, physical deterioration, muscle aches, arthritis and erythema nodosum, etc. These symptoms may be acute or latent.

Secondly, local manifestations: Different symptoms and signs may occur depending on the affected blood vessels, such as headache, dizziness, syncope, stroke, decreased vision, fatigue during intermittent activity of the limbs, weakened or absent pulsation of the brachial or femoral arteries, and vascular murmurs may be heard in some arterial regions. The systolic blood pressure difference between the two upper limbs is greater than 10 mmHg.

Takayasu arteritis can be divided into the following four types based on local manifestations:

(1) Brachiocephalic artery type (aortic arch syndrome): Stenosis and occlusion of the carotid and vertebral arteries can cause varying degrees of brain ischemia, resulting in dizziness, vertigo, headache, memory loss, black spots on one or both sides of the vision, decreased vision, narrowed visual field or even blindness, and weakness of the masticatory muscles. A few people may also experience tooth loss and facial muscle atrophy. Severe cerebral ischemia may also cause repeated syncope, convulsions, aphasia, hemiplegia or coma. Upper limb ischemia may also cause unilateral or bilateral upper limb weakness, coldness, soreness, numbness, and even muscle atrophy. The carotid, radial and brachial artery pulsations weaken or disappear. Studies have shown that more than half of patients can hear a systolic murmur of grade II or above in the neck or supraclavicular region, and a few are accompanied by tremor.

(2) Thoraco-abdominal aorta type: Due to ischemia, symptoms such as weakness, soreness, cold skin and intermittent claudication appear in the lower limbs, especially when the iliac vessels are affected. When the renal arteries are affected, hypertension will occur, and there may also be dizziness, headache and palpitations. Hypertension is the most important clinical manifestation, especially the significant increase in diastolic blood pressure, which is mainly renal vascular hypertension caused by renal artery stenosis. In addition, severe stenosis of the thoracic aorta will cause most of the heart blood flow to the upper limbs, which can cause increased blood pressure in the upper limbs.

Some patients can hear systolic vascular murmurs beside the sternum or on both sides of the back spine. The location and range of aortic stenosis can be determined by the location of the murmur. For example, in severe thoracic aorta stenosis, superficial arterial pulsation of the chest wall can be observed, and blood pressure in the upper limbs is higher than that in the lower limbs. Most patients can hear vascular murmurs in the upper abdomen.

(3) Extensive type: It has the common characteristics of the brachiocephalic artery type and the thoraco-abdominal artery type. Generally, the patient's condition is more serious.

(4) Pulmonary artery type: Pulmonary artery involvement is not uncommon, accounting for about half of cases. Other types can be combined with pulmonary artery involvement; pulmonary hypertension is mostly a late complication, accounting for about a quarter, and mild or moderate cases are more common. The main manifestations are palpitations and shortness of breath. In severe cases, heart failure may occur. Systolic murmurs and hyperactivity of the second heart sound of the pulmonary valve can be heard in the pulmonary valve area.

03Who is susceptible to Takayasu arteritis?

Aortic artery disease is known as the "Oriental Beauty Disease" because it is more common in young women, especially women under 30 years old, with a much higher incidence than other groups. It is also named because the incidence is higher in Asia and the Middle East. However, there is no research on the cause of this disease, which may be related to genetic hormones, infection and sex hormones.

04How to diagnose Takayasu arteritis and seek medical treatment in time?

In life, people know relatively little about immune system diseases, which are difficult to identify and easily delay the onset of the disease. Therefore, when women under the age of 40 have weakened or disappeared limb arterial pulses in one or both limbs, low or unmeasured blood pressure, or even cerebral artery ischemia, that is, weakened or disappeared carotid artery pulses, and murmurs in the neck blood vessels. If complications such as persistent hypertension, unexplained low fever, abnormal pulse changes, pulselessness, and fundus lesions occur, this disease should be highly suspected.

Some people may wonder, when should you see a doctor? Which department should you go to?

If you experience fever, dizziness, shortness of breath, neck, chest or arm pain, lower limb weakness, or signs of stroke, such as facial droop, arm weakness, or difficulty speaking , please go to a regular hospital and visit the rheumatology and immunology department in a timely manner for a complete examination under the guidance of a professional physician to clarify your condition.

05What are the comprehensive examinations needed to diagnose Takayasu arteritis?

(1) Laboratory examination: In the acute phase or active phase of the disease, elevated white blood cell and platelet counts, accelerated erythrocyte sedimentation rate, and elevated C-reactive protein may be present, but may be normal during the remission phase.

(2) Vascular imaging examinations: Color Doppler ultrasound, arterial angiography or CT angiography (CTA), magnetic resonance angiography (MRA), PET-CT, etc. are necessary means to diagnose the disease.

06How should Takayasu arteritis be treated and followed up regularly?

The principle of diagnosis and treatment of Takayasu arteritis is early diagnosis, early and individualized diagnosis and treatment based on a comprehensive assessment of the disease, to achieve long-term and sustained remission of the disease.

Drugs that improve the condition include corticosteroids, immunosuppressants, and biologics.

▶ Glucocorticoids: can effectively relieve the condition and improve symptoms. The general dosage varies from person to person and is related to the severity of the disease. It needs to be used strictly under the guidance of a doctor. For the adverse reactions that may be caused by hormones, active prevention and monitoring, regular follow-up, and adjustment of drug dosage and course of treatment are required.

▶Immunosuppressants: Used in combination with hormones, they can enhance the efficacy and help reduce the dosage of glucocorticoids. The type and dosage should also be used under the guidance of a specialist according to the condition.

▶Biologics: They can improve the symptoms of Takayasu arteritis and slow the progression of the disease. Before use, a specialist physician is still required to conduct a specific assessment based on the patient's condition.

Follow-up is still a key step to a better prognosis of the disease. Regular follow-up should be as follows:

① Have good medical compliance, actively complete relevant examinations, and clarify the degree of disease progression;

② After formulating a treatment plan, patients should strictly follow the doctor's instructions to take medications. It is strictly forbidden to stop or reduce medications on their own. Patients should visit the rheumatology and immunology clinic regularly.

③ Regularly follow up serological and imaging indicators and monitor blood pressure, blood sugar, etc.

07How should patients with Takayasu arteritis improve their lifestyle?

In addition to actively seeking medical treatment, lifestyle is also closely related to the prognosis of Takayasu arteritis.

First of all, in daily life, especially when the disease flares up, you should pay attention to rest, and bed rest is best. After the disease is relieved, you can increase physical exercise appropriately to strengthen your physical fitness, improve your immunity, and prevent recurrence of the disease.

Secondly, you need to have a regular life and avoid staying up late. Excessive fatigue can cause dizziness, headaches and other discomforts. Avoid infection. Low immunity can easily cause infection. Repeated infection poses a risk of aggravating immune diseases. You should pay attention to keeping warm and avoid going to areas with heavy traffic.

Finally, the diet should be balanced and reasonable. You can eat more foods that are high in nutrition, easy to digest, and rich in vitamins, such as eggs, milk, lean meat, freshwater fish, soy products, fungus, green vegetables, fruits, etc. Obese patients should strictly control their weight and reduce the intake of high-fat foods.

Living with illness is normal. When you are sick, don't be overly anxious, seek medical treatment in time, follow the instructions, and there will always be a turning point.

If you have the "Oriental Beauty Disease" and experience dizziness, upper limb pain, weakened or absent pulse, please see a rheumatologist promptly, actively seek treatment, live an optimistic and healthy life, have regular follow-up examinations, and take medication on time to keep your "beauty" beautiful forever.

References:

[1] Chinese expert group on multidisciplinary chronic disease management consensus for Takayasu arteritis. Chinese expert consensus on multidisciplinary chronic disease management for Takayasu arteritis throughout the entire course of disease[J]. Journal of Fudan University (Medical Edition), 2023, 50(5): 633-654.

[2] Wu Bingjie, Ma Lingying, Xiang Yijin, et al. Research progress on the diagnosis and treatment of Takayasu arteritis by integrated traditional Chinese and Western medicine[J]. Journal of Fudan University (Medical Science), 2023, 50(5): 761-764.

[3] Luo Jiayin, Li Ruihao, Miao Yuqing, et al. Current status of quality of life in patients with Takayasu arteritis and analysis of influencing factors[J]. Chinese Journal of Cardiology, 2023, 28(5): 435-440.

[4] Wang Gang, Guan Sheng, Tang Hejia Ke, et al. Advances in clinical diagnosis and treatment of Takayasu arteritis[J]. Journal of Vascular and Endovascular Surgery, 2023, 9(7): 829-835.