Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
The doctor can find elevated blood pressure in over half of the
patients with Takayasu disease. Abnormal sounds of blood movement
through narrowed blood vessels can be heard sometimes with a stethoscope. Small notches in the ribs of
the back of the chest have sometimes been detected on routine chest
X-rays and are felt to be a result of abnormal pulsations of blood
vessels in these areas.
The diagnosis is supported by
the blood tests, such as a sedimentation rate (sed rate), that
suggest inflammation in the body. In fact, elevated blood pressure with an elevated sedimentation rate is distinctly uncommon in children and very helpful in suggesting Takayasu disease as a possible cause. Anemia (low red blood cell
count) is frequent.
Takayasu arteritis is ultimately diagnosed with an angiogram of the arteries (arteriogram) whereby a contrast material is injected into the blood vessels which makes them visible by
X-ray. With the arteriogram, the doctor can visualize the abnormally narrowed and constricted arteries. The diagnosis of Takayasu disease can be aided by magnetic resonance angiography (MRA, the combination of an MRI scan with angiogram) and CT angiography. These are noninvasive methods of diagnosing and monitoring patients with Takayasu disease.
How is Takayasu disease treated?
The treatment of Takayasu disease involves suppressing the inflammation with cortisone medication (prednisone, prednisolone). While most patients can improve, some do not or relapse. In cortisone-resistant patients, stronger medications which suppress the immune system (immunosuppressive drugs), thereby further decreasing active inflammation of the arteries, have been used. Examples include methotrexate (Rheumatrex, Trexall), cyclosporine, cyclophosphamide (Cytoxan), and azathioprine (Imuran). Strict control of elevated blood pressure (hypertension) is important.
Vascular surgery procedures and/or angioplasty with stents can be required to treat aneurysms and severe blood vessel narrowing.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Vasculitis is a general term for a group of uncommon diseases which feature inflammation of the blood vessels. Each form of vasculitis has its own characteristic pattern of symptoms. The diagnosis of vasculitis is definitively established after a biopsy of involved tissue demonstrates the pattern of blood vessel inflammation. Treatment is directed toward decreasing the inflammation of the arteries and improving the function of affected organs.
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