What should be the focus of physical exam for Takayasu arteritis?

Updated: Nov 14, 2018
  • Author: Jefferson R Roberts, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

A thorough physical examination is essential, with particular attention paid to peripheral pulses, blood pressure in all 4 extremities, and ophthalmologic examination. The most discriminatory finding is a systolic blood pressure difference (>10 mm Hg) between arms.

Hypertension due to renal artery involvement (and sometimes leading to hypertensive encephalopathy) is found in approximately 50% of patients. Carotidynia may be present. Aortic regurgitation is a common finding.

Absent or diminished pulses are the clinical hallmark of Takayasu arteritis, but pulses are normal in many patients and upper limbs are affected more often than lower limbs. When pulselessness occurs, patient monitoring can be difficult or impossible, and often, calf blood pressures must be obtained.

Ophthalmologic examination may show retinal ischemia, retinal hemorrhages, cotton-wool exudates, venous dilatation and beading, microaneurysms of peripheral retina, optic atrophy, vitreous hemorrhage, and classic, wreathlike peripapillary arteriovenous anastomoses (extremely rare). Fundus fluorescein angiography may show segmented retinal blood flow, also known as “boxcarring". [26]

Skin changes resembling erythema nodosum or ulcerating nodular lesions may be seen.


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