Takayasu arteritis: Year of the Zebra 2026

Takayasu arteritis is a rare inflammatory disease affecting large arteries, particularly the aorta and its major branches, including the carotid and subclavian arteries, which supply blood to the head, neck and arms. It predominantly affects young females, especially those of Asian descent, and typically begins before age 40.

The exact cause is unknown, but it’s suspected to involve an autoimmune process in which immune cells mistakenly attack arterial walls. This chronic inflammation causes two main problems. First, it causes the vessel walls to become thickened, which gradually narrows the space for the blood to flow through. Second, despite this thickening, the arterial walls become structurally weaker because most of the elastic fibers and smooth muscle cells that allow the arteries to stretch and recoil get replaced by scar tissue. Over time, these structural changes can weaken the vessel wall. The affected arteries become less flexible and prone to aneurysms, which are balloon-like bulges in the weakened areas that risk rupture. This results in an overall reduction of blood flow to the arms and head.

Clinically, patients initially present with unspecific systemic symptoms, which can include fever, weight loss, night sweats, malaise, and fatigue. As the disease progresses, the blood vessels become damaged.

If the inflammation happens around branches that serve the arms, it can cause a weak or nonexistent pulse on one side of the body, which is why Takayasu arteritis is also called the “pulseless disease.” This can also lead to a blood pressure discrepancy between the arms that’s greater than 10 millimeters of mercury, as well as bruits, which are whooshing sounds heard over narrowed arteries. Decreased blood flow to the arms can also cause claudication, meaning pain or muscle fatigue that gets worse during activity.

On the other hand, inflammation affecting the arteries that supply the head and neck can cause visual disturbances and neurological symptoms, such as headaches, dizziness, fainting, or stroke in severe cases.

Takayasu arteritis can also involve the lower aorta, especially the renal arteries, which causes systemic high blood pressure.