TAK

Q: Which of the following is NOT among the classic 1990 American College of Rheumatology (ACR) classification criteria for Takayasu arteritis (TAK)? - select one

A) Age at disease onset ≤40 years

B) Claudication of the extremities

C) Decreased pulsation of one or both brachial arteries

D) Bruit over one or both femoral arteries

E) Difference of at least 10 mmHg in systolic blood pressure between the arms

Answer: D

The 1990 American College of Rheumatology (ACR) classification criteria were developed to help distinguish one form of vasculitis from another. Patients are said to have TAK if at least three of the six criteria are present.

1. Age at disease onset ≤40 years
2. Claudication of the extremities
3. Decreased pulsation of one or both brachial arteries
4. Difference of at least 10 mmHg in systolic blood pressure between the arms
5. Bruit over one or both subclavian arteries or the abdominal aorta
6. Arteriographic narrowing or occlusion of the entire aorta, its primary branches, or large arteries in the proximal upper or lower extremities, not due to arteriosclerosis, fibromuscular dysplasia, or other causes

The criteria are criticized due to their possible limitations in clinical practice.

To update, the ACR/European Alliance of Associations for Rheumatology (EULAR) created new criteria for TAK using a weighted algorithm that includes clinical and imaging components (reference # 4).

Unfortunately, none of these criteria has been validated for establishing clinical diagnoses.

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References:

1. Arend WP, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990; 33:1129.

2. Ishikawa K. Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu's arteriopathy. J Am Coll Cardiol 1988; 12:964.

3. Sharma BK, Jain S, Suri S, Numano F. Diagnostic criteria for Takayasu arteritis. Int J Cardiol 1996; 54 Suppl:S141.

4. Grayson PC, Ponte C, Suppiah R, et al. 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis. Arthritis Rheumatol 2022; 74:1872.