CLINICAL PRESENTATION
Presentation of TA varies widely and can range from asymptomatic disease identified by pulse deficits or impalpable pulses to severe neurologic impairment. The early or prepulseless phase of TA is characterized by inflammatory changes.14 Signs and symptoms are frequently vague and nonspecific, particularly in this early phase, when fatigue, weight loss, and low-grade fever may be seen.12 Headache is another common symptom at the time of disease onset.5
In the later or chronic phase of the disease, individuals will begin to demonstrate signs and symptoms of vascular insufficiency.14 More common physical signs reflect the underlying arterial occlusive disease and include diminished or absent arterial pulses, asymmetrical arm blood pressures, bruits, extremity claudication, and hypertension.5,9,10 Hypertension, generally reflecting renal artery stenosis,10 is present in approximately 40% of cases in the United States and Europe.5,7,15 Neurologic features secondary to hypertension or ischemia affect more than half of patients; in addition to headache, these may include dizziness, syncope, vertigo, transient ischemic attack, and stroke.5
TA can also present with eye, lung, and skin manifestations; however, these features are less common. Although ocular involvement, including amaurosis fugax, has been reported in up to 26% of patients in TA series,5,7,16 permanent loss of vision in North American patients is uncommon.5,7 Pulmonary involvement affecting the large- or medium-sized pulmonary arteries has been reported to occur in approximately 55% of cases5; however, there is uncertainty regarding the prevalence of angiographically demonstrated pulmonary artery involvement, as studies have reported rates ranging from 14.3% to 70%.9,17-20 Pulmonary involvement is often asymptomatic, but features can include dyspnea, cough, and chest pain.5 Skin lesions are seen in up to 28% of cases, most commonly erythema nodosum, erythema induratum, tuberculoidlike eruptions, pyoderma gangrenosum, and cutaneous signs of necrotizing or granulomatous vasculitis.5,21
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