For purposes of classification, a patient shall be said to have Takayasu's arteritis if at least three of these six criteria are present. The presence of any three or more criteria yields a sensitivity of 90.5% and a specificity of 97.8%. BP = blood pressure (systolic) difference between arms

 

 

Ishikawa's Criteria for Takayasu's Arteritis (Modified According to Sharma et al.)

 

Three major criteria:

1. Left mid subclavian artery lesion: The most severe stenosis or occlusion present in the mid portion from the point 1 cm proximal to the vertebral artery orifice up to that 3 cm distal to the orifice determined by angiography

2. Right mid subclavian artery lesion: The most severe stenosis or occlusion present in the mid portion from the right vertebral artery orifice to the point 3 cm distal to orifice determined by angiography

3. Characteristic signs and symptoms of at least one month duration: These include limb claudication, pulselessness or pulse differences in limbs, an unobtainable  or significant blood pressure difference (> 10 mmHg systolic blood pressure difference in limb), fever, neck pain, transient amaurosis, blurred vision, syncope, dyspnea or palpitations.

 

Ten minor criteria

1. High ESR: Unexplained persistent high erythrocyte sedimentation rate (ESR) >20 mm/h (Westergren) at diagnosis or presence of the evidence in patients history

2. Carotid artery tenderness: Unilateral or bilateral tenderness of common arteries on palpation. Neck muscle tender ness is unacceptable

3. Hypertension: Persistent blood pressure > 140/90 mmHg brachial or > 160/90 mmHg popliteal

4. Aortic regurgitation or Anuloaortic ectasia: Aortic regurgitation by auscultation or Doppler echocardiography or angiography; or Anuloaortic ectasia  by angiography or two-dimensional echocardiography

5. Pulmonary artery lesion: Lobar or segmental arterial occlusion or equivalent determined by angiography or perfusion scintigraphy, or presence of stenosis, aneurysm, luminal  irregularity or any combination in pulmonary trunk or in unilateral or bilateral pulmonary arteries determined by angiography.

6. Left mid common carotid lesion: Presence of the most severe stenosis or occlusion in the mid portion of 5 cm in length from the point 2 cm distal to its orifice determined by angiography.

7. Distal brachiocephalic trunk lesion:. Presence of the most stenosis or occlusion in the distal third determined by angiography

8. Descending thoracic aorta lesion: Narrowing, dilatation or aneurysm, luminal irregularity or any combination determined by angiography: tortuosity alone is unacceptable.

9. Abdominal aorta lesion: Narrowing, dilatation or aneurysm, luminal irregularity or aneurysm combination.

10. Coronary artery lesion: Documented on angiography below the age of 30 years in the absence of risk factors like hyperlipidemia or diabetes mellitus

 

Presence of two major or one major and two minor criteria or four minor criteria suggests a high probability of Takayasu's arteritis

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References:

1. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. 1990 Aug;33(8):1129-34. [Medline]

2. Sharma BK, Siveski-Iliskovic N, Singal PK. Takayasu arteritis may be underdiagnosed in North America. Can J Cardiol. 1995 Apr;11(4):311-6. [Medline]

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