Takayasu's Arteritis is a group of disorders that cause inflammation of arteries, mainly affecting the aorta, the main artery that supplies oxygen-rich blood to the body, and its branches. It is an uncommon condition that can lead to narrowed or blocked arteries, or bulging of an artery wall (aneurysm) and scarring. Takayasu's Arteritis can cause arm or chest pain, high blood pressure, and even heart failure or stroke. It is named after Japanese ophthalmologist Dr. Mikoto Takayasu, who first described the disorder in 1908.
Sometimes, narrowing of the arteries causes difficulty in detecting peripheral pulses. As a result, Takayasu's Arteritis is also known as "pulseless disease". It is a rare disease, with an estimated occurrence of 2 or 3 cases per million people in a population each year.
Takayasu's arteritis is often treated with corticosteroids, commonly referred to as steroids. Some patients may be able to gradually discontinue medication without a relapse. One may need surgery, in severe cases. But, for women with Takayasu's arteritis, pregnancy can be risky. Should you consider termination of pregnancy if you're diagnosed with this disorder?
Takayasu's arteritis: Understand the causes and risk factors
Takayasu's arteritis is commonly diagnosed in girls and women younger than 40. While it occurs worldwide, most patients are from Asia. What causes Takayasu's arteritis is not exactly known, but it is thought to be an autoimmune disease which happens when your immune system attacks your arteries by mistake, possibly triggered by a viral, bacterial, or other infection.
In some cases, this rare disorder is known to be genetic. Certain genes associated with the condition have also been identified. In 2013, a study led by researchers at the University of Michigan identified five more genes linked to Takayasu arteritis. Genetic risk areas for Takayasu arteritis have been found in the human leukocyte antigen or HLA (an inherited group of genes) as well as outside the HLA. These include HLA-B, HLA-DQB1/HLA-DRB1, FCGR2A/FCGR3A, and PSMG1.
Signs and symptoms of Takayasu's arteritis
In the early stage of Takayasu's arteritis, one may experience fatigue, unintended weight loss, muscle and joint aches and pains, mild fever, sometimes accompanied by night sweats. However, not all will develop these early signs and symptoms.
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When arteries become narrow due to inflammation, which is the second stage of Takayasu's arteritis, one may develop symptoms like weakness or pain in the limbs, a weak pulse, lightheadedness, headaches or visual changes, memory problems or trouble thinking, chest pain, shortness of breath, high blood pressure, diarrhea, and anemia.
See a doctor without delay if you have signs or symptoms that worry you. Takayasu's arteritis can be effectively treated if detected early.
Diagnosis of Takayasu's Arteritis
If you have suspected symptoms of Takayasu's arteritis, your doctor may recommend a few tests like blood tests, MRI or CT scan, angiography, magnetic resonance angiography, and doppler ultrasound to rule out other conditions with similar symptoms. These tests are also necessary for monitoring the disease progression and efficacy of the treatment as it tends to go into remission and then recur in flare-ups, even after treatment.
How to expect when you have Takayasu's arteritis and pregnant?
Not just the disease, but the drugs used to treat it can also affect your fertility and pregnancy. Corticosteroids, biologics and immune-suppressing medications that may be used to treat Takayasu's arteritis can have serious side effects, including an increased risk of infection.
If you're diagnosed with Takayasu's arteritis and are planning to conceive, talk to your doctor who can help develop a plan to limit complications during pregnancy.
Pregnancy with Takayasu's arteritis can increase risk of complications such as stroke, sudden death, cardiac failure, etc.
Having said so, it is possible to have a healthy pregnancy with Takayasu's arteritis.
Mumbai woman with Takayasu's arteritis delivers a healthy baby
Recently, a 28-year-old pregnant woman with the rare disorder successfully delivered a healthy baby in Mumbai. She was detected with Takayasu's arteritis when she was 3 months into her first pregnancy. She had constant high BP and also unequal BP pulse in both her arms. Additionally, she was diagnosed with Coarctation of Aorta. Because it could be life threatening, she was advised to terminate the pregnancy. But she decided to continue the pregnancy. At Wockhardt Hospitals Mira Road, she successfully delivered a healthy baby boy weighing 2.4 kgs.
The patient said that she knew the condition could put her life at risk but her desire to cherish motherhood was stronger than that. With the right support and care from the doctors, she was able to deliver the baby safely and enjoy her motherhood.
Dr. Rajashri Tayshete Bhasale, Consultant Gynaecologist & Obstetrician, Laparoscopic Surgeon Wockhardt Hospitals Mira Road, recalled that the patient came in emergency at 9 months of pregnancy with BP in right arm 190/110 & left arm 120/90. Despite being on anti-hypertension medication, her leg pulses were absent, and her ECHO showed severe Coarctation of Aorta (narrowing of the main artery) with Mitral Regurgitation.
It was a case of a rare disease called Aortoarteritis and the patient had a significant narrowing of the main artery which supplies the lower part of the body, and blood supply to the lower body was reduced, stated Dr. Mayuresh Pradhan, Consultant Cardiovascular & Thoracic Surgeon, Wockhardt Hospitals Mira Road.
In such cases, termination of pregnancy is advised but this patient decided to continue the pregnancy. Such pregnancy cannot have a normal vaginal delivery and requires Caesarean Section. "Such patients can land up in Heart failure once the baby is delivered. The surgery was uneventful and now the patient will require treatment for her narrowing of the main artery which in medical terms is called Coarctation of aorta," the surgeon said.
As simultaneous monitoring of upper and lower limb pressure is required to maintain good lower body perfusion, anaesthesia turned out to be quite challenging.
Although delivery in such a condition comes with a lot of complications, the patient responded well. She has recovered well and is now enjoying her motherhood, Dr. Rajashri Tayshete added.
An elective LSCS (lower segment Caesarean section) was done alongwith cardiac anaesthesia team to deliver the baby. As simultaneous monitoring of upper and lower limb pressure is required to maintain good lower body perfusion, anaesthesia turned out to be quite challenging for the anaesthesia team.