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Rheumatology

Takayasu arteritis

Classification

2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis

Absolute requirements

Age ≤60 years at diagnosis

Imaging evidence of large‐vessel vasculitis

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Evidence of vasculitis in the aorta or branch arteries must be confirmed by vascular imaging (e.g., computed tomographic/catheter-based/magnetic resonance angiography, ultrasound, positron emission tomography).

Clinical criteria

Female sex

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Angina or ischemic cardiac pain

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Arm or leg claudication

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Vascular bruit

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Bruit detected by auscultation of a large artery, including the aorta, carotid, subclavian, axillary, brachial, renal, or iliofemoral arteries.
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Reduced pulse in upper extremity

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Reduction or absence of pulse by physical examination of the axillary, brachial, or radial arteries.
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Carotid artery abnormality

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Reduction or absence of pulse of the carotid artery or tenderness of the carotid artery.
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Systolic blood pressure difference in arms ≥ 20 mm Hg

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Imaging criteria

Number of affected arterial territories

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Number of arterial territories with luminal damage (e.g., stenosis, occlusion, or aneurysm) detected by angiography or ultrasonography from the following nine territories: thoracic aorta, abdominal aorta, mesenteric, left or right carotid, left or right subclavian left or right renal arteries

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Symmetric involvement of paired arteries

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  1. Bilateral luminal damage (stenosis, occlusion, or aneurysm) detected by angiography or ultrasonography in any of the following paired vascular territories: carotid, subclavian, or renal arteries.
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Abdominal aorta involvement with renal or mesenteric involvement

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Luminal damage (stenosis, occlusion, aneurysm) detected by angiography or ultrasonograph) involving the abdominal aorta and either the renal or mesenteric arteries.
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Statistics

Sensitivity: 93.8%

Specificity: 99.2%

Considerations

The tool is for educational use only, is not meant to be a substitute for professional advice and should not be used for medical diagnosis and/or medical treatment.

  • These classification criteria should be applied to classify the patient as having giant cell arteritis when a diagnosis of medium-vessel or large- vessel vasculitis has been made
  • Alternate diagnoses mimicking vasculitis should be excluded prior to applying the criteria
Reference

Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, Merkel PA; DCVAS Study Group. 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis. 2022 Dec;81(12):1654-1660. doi: 10.1136/ard-2022-223482. Epub 2022 Nov 9. PMID: 36351705.

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