Systemic Vasculitis - Classification - Large Vessel Vasculitis

Large Vessel Vasculitis

Giant-cell arteritis and Takayasu's arteritis have much in common, but usually affect patients of different ages, with Takayasu's arteritis affecting younger people, and giant-cell arteritis having a later age of onset.

Aortitis can also be considered a large-vessel disease.

Takayasu arteritis. Primarily affects the aorta and its main branches. At least 3 out of 6 criteria yields sensitivity and specificity of 90.5 and 97.8%:

  • onset < 40 years affects young and middle -aged women (ages 15–45)
  • claudication of extremities
  • decreased pulsation of one or both brachial arteries
  • at least 10 mmHg systolic difference in both arms
  • bruit over one or both carotid arteries or abdominal aorta
  • arteriographic narrowing of aorta, its primary branches, or large arteries in upper or lower extremities
  • Ocular manifestation
    • visual loss or field defects
    • Retinal hemorrhages
  • Neurological abnormalitis
  • Treatment: steroids

Giant cell (temporal) arteritis. Chronic vasculitis of both large and medium vessels, primarily affecting cranial branches of the arteries arising from the aortic arch. At least 3 out of 5 criteria yields sensitivity and specificity of 95 and 91%:

  • Age at onset ≥ 50 years
  • New onset headache with localized tenderness
  • Temporal artery tenderness or decreased pulsation
  • Elevated ESR ≥ 50 mm/hour Westergren
  • Temporal artery biopsy showing vasculitis with mononuclear cell infiltrate or granulomatous inflammation, usually with multinucleated giant cells

Read more about this topic:  Systemic Vasculitis, Classification

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