Takayasu’s Arteritis

What is Takayasu's Arteritis?

Takayasu's arteritis is a rare, long-lasting inflammation of the aorta (the body's main artery) and its major branches. It can cause the vessel walls to thicken and narrow, close off, or bulge into aneurysms.^{[1, 2]} It is not a condition that can be managed with complementary care alone, and it needs ongoing care from a rheumatologist or other specialist.

Common symptoms

The early stage often brings vague symptoms such as fever, tiredness, weight loss and general aches, along with high inflammation markers on blood tests. This stage is easy to miss.^[3]

As the arteries narrow, the later stage can bring:

• Weak or missing pulses, or a blood pressure that differs between the two arms
• High blood pressure, especially when the kidney arteries are involved
• Dizziness, limb pain on exertion, or chest pain
• Stroke-like symptoms, vision loss or heart failure in severe cases^{[1, 3]}

Causes and risk factors

The cause is not known. An abnormal immune response, in which immune cells attack the artery wall, appears to be central.^[1] The disease mostly affects women, with onset typically between ages 20 and 40, and it is seen more often in parts of Asia than in the United States.^[2] Genetic differences in immune-related genes are thought to explain part of this, while the role of environmental triggers is poorly understood.^[2]

How it is diagnosed and treated conventionally

Diagnosis rests on suspicion from symptoms and examination, supported by imaging of the arteries, such as CT, MRI or angiography, and blood markers of inflammation.^{[1, 2]} Imaging is also central to follow-up.^[2]

Treatment normally starts with glucocorticoids combined with another immune-suppressing drug, and biologic medicines are used for disease that relapses or does not respond.^{[4, 5]} Many of the recommendations in the 2021 American College of Rheumatology guideline are conditional because the supporting evidence is of low quality.^[4] Blocked or damaged arteries may need angioplasty, stenting or surgery, and lifelong monitoring is considered essential because relapses and new artery damage can occur.^[3]

Why Takayasu's Arteritis calls for a whole-person approach

The disease itself is driven by the immune system and must be treated by specialists. Living with it also involves things the medicines do not fully address, including the effects of long-term glucocorticoids, fatigue, sleep, stress and blood pressure.

This is the area where supportive care may have a role. The evidence below is about those symptoms in general. It is not evidence that any of these therapies affects the disease.

Immune activity and inflammation

Researchers describe Takayasu's arteritis as inflammation of the artery wall driven by abnormal immune activity, which is why treatment aims to suppress it.^{[1, 3]} Some laboratory and review literature proposes that acupuncture influences inflammatory signaling, but this has not been tested as a treatment for large-vessel vasculitis.^[6]

Treatment side effects

Long-term glucocorticoid use can thin the bones, and the American College of Rheumatology publishes guidance on assessing and treating glucocorticoid-induced osteoporosis. That care belongs with your physician.^[7]

Blood pressure

High blood pressure is a common feature when the kidney arteries are narrowed, and it is managed with medicines by your physicians.^[3]

Sleep, stress and fatigue

Fatigue is among the earliest and most persistent complaints.^[3] Stress, poor sleep and fatigue are the symptoms where supportive therapies have been studied most, although not in people with this disease.

Acupuncture as supportive care in Takayasu's Arteritis

What the research shows

No clinical trials of acupuncture for Takayasu's arteritis were found in PubMed. The evidence below concerns symptoms that people with the disease may share, and it was gathered in other patient groups.

For high blood pressure, a meta-analysis of 23 trials (1,788 patients) found that acupuncture added to blood pressure medicine lowered readings more than sham acupuncture added to medicine, based on only two trials. Acupuncture alone did not lower blood pressure more than medication. The authors judged the trials to be of limited quality and called for larger studies.^[8] Your blood pressure must stay under your physician's management.

For fatigue, a meta-analysis of 16 trials in chronic fatigue syndrome found that acupuncture was more effective than sham acupuncture and other treatments, but most studies were of low quality, so no firm conclusion could be drawn.^[9]

For sleep, a meta-analysis of 24 trials in insomnia found improvement against drug treatment after about three weeks, with very different results across trials.^[10]

In rheumatoid arthritis, another autoimmune disease, a review of 13 trials suggested possible benefit for pain, function and quality of life. Ten of those were published in China and the authors said the evidence was not strong enough for a clinical guideline.^[11]

How acupuncture may work

A review of the anti-inflammatory effects of acupuncture proposes that it may release nerve signaling molecules that affect blood vessels and inflammatory messengers. It also notes that large randomized trials showing a sustained effect were missing.^[6] This is a proposed mechanism from 2003, not a demonstrated effect in Takayasu's arteritis.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A course of several visits is followed by a reassessment of whether it is helping.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or a mark at the needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell your practitioner first if you take blood thinners, have a bleeding disorder, are pregnant, or have a pacemaker, and mention that your immune system is suppressed by medication, since this can affect how you heal and how infections are handled.

Ayurvedic medicine as supportive care in Takayasu's Arteritis

The Ayurvedic view

In Ayurveda, diseases of the blood vessels with pain and reduced circulation are described under the heading of Vata disorders. A published case report used the term Siragata Vata, meaning vitiated Vata affecting the blood vessels, for Takayasu's arteritis.^[13] This is a traditional framework and not a medical diagnosis.

Therapies that may be used

Ayurvedic care is chosen for the individual. In a supportive role it may include:

• Dietary and daily routine advice aimed at regular meals, steady sleep and stress reduction
• Gentle oil massage and relaxation practices
• Individually prescribed herbs such as ashwagandha, traditionally used for stress and low energy

Panchakarma, including medicated enemas and sweating therapies, is not appropriate during pregnancy, acute illness or frailty. It is also not suitable while the disease is active or while a person is on high-dose immune-suppressing treatment, and it should be considered only with the agreement of the treating specialist. Any herbal preparation applied to the skin (transdermal medication therapy) is a supportive option only, and we make no claim of benefit for it in this disease.

What the research shows

Research on Ayurveda for Takayasu's arteritis is very limited: a search found one single-patient case report and no trials. The case report described a 42-year-old woman treated with an extensive Panchakarma and herbal program who was reported to improve on a disease activity score.^[13] One case without a comparison cannot show that the treatment caused the change.

For related symptoms, two meta-analyses of randomized trials found that ashwagandha extract reduced stress and anxiety scores compared with placebo. One reviewed 12 trials and rated the certainty of evidence as low.^{[14, 15]} A meta-analysis of five trials found a small improvement in sleep, with limited long-term safety data.^[16] These trials were mostly in healthy or anxious adults, not people with vasculitis or on immunosuppressants.

Herbal medicine as supportive care in Takayasu's Arteritis

Herbs and formulas that have been studied

No herbal formula has been tested in trials for Takayasu's arteritis. Turmeric (curcumin) is the only herb for which any related evidence was found. A review of 31 trials in ten autoimmune diseases included one trial in arteritis and reported that clinical results improved there, without saying which type of arteritis it was. The authors said Takayasu arteritis did not have enough clinical data for pooling and that larger trials were needed.^[17]

What the research shows

There is no confirmed trial evidence for herbal medicine in this disease. The curcumin review found data too sparse for any conclusion about Takayasu arteritis.^[17] Symptom-level evidence exists for ashwagandha and stress, anxiety and sleep, as described above, and its certainty is low.^{[14, 16]}

Safety and herb-drug interactions

This matters more here than in many conditions, because people with Takayasu's arteritis often take immune-suppressing medicines and may take blood thinners or blood pressure drugs. A review of herb-drug interactions describes St. John's wort lowering levels of the immunosuppressants cyclosporine and tacrolimus, and case reports of bleeding when danshen, garlic or ginkgo were taken with warfarin or aspirin.^[18] A review of warfarin cases also lists dang gui, ginger and Boswellia.^[19]

Product quality is another concern. In one study about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually by a qualified practitioner after review of your full medicine list. Tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine would describe blocked flow of qi and blood in the vessels, and Ayurveda describes disturbed Vata in the blood vessels.^[13] Researchers study ideas that loosely parallel such pictures, including inflammatory signaling, blood vessel tone and the nervous system's response to stress.^[6]

No study has shown that a traditional pattern corresponds to the immune injury of the artery wall in Takayasu's arteritis. The traditional language is used to guide supportive care for the person, not to explain the disease.

How this care fits with your medical care

Supportive care here is complementary. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Keep your rheumatologist, and your cardiologist or vascular specialist if you have one, and do not stop or change prescribed medicines, including glucocorticoids, without your prescriber.

We do not diagnose or monitor the disease, assess disease activity or adjust medication. Please bring your diagnosis, recent imaging and blood test results, your full list of medicines and supplements, and your blood pressure readings. If you take immune-suppressing drugs, tell us so that we can choose supportive care appropriately.

When to seek urgent medical care

Takayasu's arteritis can cause sudden, serious complications from blocked or weakened arteries.^[3]

• Sudden weakness, numbness, trouble speaking, or loss or blurring of vision
• Chest pain, shortness of breath or fainting
• Severe headache with a very high blood pressure reading
• Sudden severe pain in the chest, back or abdomen
• A cold, pale, painful or numb arm or leg
• Fever with a new flare of symptoms while on immune-suppressing medicine

If any of these occur, call 911 or go to the nearest emergency department.