Impolite Immunity

Shwetha Chawadi
Published: September 2019

Dr. Ted Kaptchuk rightly said “Health is an episode between two illnesses”.

In the era of women’s movements gaining attention gradually and women being elected to state and National legislatures, the topic of women’s health still remains in the bush-league. The nation seems to be a mixed bag of concerns, when it comes to women’s health.

Although there are substantial research developments in the treatment and prevention of a number of diseases, there are many diseases where one is unaware of the symptoms, which lead to a major life churning experience. One such ailment is Takayasu Arteritis (TAK), if you are a woman between age 20-40 and cannot feel your pulse on one or both of your wrists and arms and having oscillating blood pressure in high grades frequently, then it’s time you visit the cardiologist and get a thorough check up.

A very rare form of disease, Takayasu Arteritis is commonly called `pulseless disease’, for its difficulty in identifying peripheral pulses that occasionally transpire as a result of vascular narrowing. Though a rare ailment, Takayasu arteritis has a global distribution, predominantly affecting Asian women aged under 40, with 2 or 3 cases ensuing each year per million people.

It is an infrequent, long-lasting inflammatory arteritis, which primarily affects the aorta and its major branches and the pulmonary arteries. The vessel inflammation leads to wall thickening, formation of excess fibrous connective tissue in an organ, narrowing of the spaces within the spine and creation of a blood clot inside a blood vessel, barricading the flow of blood through the circulatory system.

Dr. Mikito Takayasu chronicled the first event of pulseless disease in 1908 in the Annual Meeting of the Japan Ophthalmology Society; hence the ailment goes by the name Takayasu Arteritis. Since TAK is a prolonged inflammatory condition affecting the primary blood vessel in the body (the aorta) and its branches, the complications ascend directly or indirectly from the mutilation to these blood vessels.
Warning signs

The symptoms are a result of meagre blood supply to the concerned body parts and can be divided into two parts. The initial phase is largely not indicative for majority of the patients with simple signs of fever, low energy, unexpected weight loss, arthritis and negligent muscle aches and pains.

Since these symptoms are more or less treated as a common health issue in India, they are unintentionally neglected. Some even disregard the rise of the erythrocyte sedimentation rate (ESR) during this phase.

During the second phase, patients start to develop symptoms triggered by the narrowing of the affected arteries. At this stage, patients start witnessing many complications gradually. Blood vessels in the legs are affected due to very little blood flow, hence repetitive pain in the limbs are caused. Dizziness, acute headache, anaemia (low red blood cell count), memory and visual problems, unexplained cramps, diarrhoea and high blood pressure are all symptoms in the occlusive phase of TAK. Meanwhile the affected blood vessels narrow down, normal pulses in the wrist, elbow and neck cannot be felt and getting accurate blood pressure readings becomes difficult.

Analysis

Identifying if one has TAK itself is a very challenging task and can be an extremely difficult one, since the symptoms are that of a typical health issue a human could face. Certain common symptoms such as fluctuating blood pressures and inexplicable pain in various body parts are the alarm bells for the diagnosis. To confirm the same, doctors use an imaging technique commonly known as angiography which evaluates every kind of deformity in the blood vessels. Further an MRI (magnetic resonance imaging) study or a PET (positron emission tomography) scan is carried out to diagnose the intensity of the ailment.

In addition to this, thinning of blood vessels upshots the tempestuous blood flow through the conical area and creates an unfamiliar sound known as `bruit’ that can be known to a physician through the stethoscope. This presence of bruit can also be a factor in diagnosing TAK.

Causes

A reliable reasoning of what causes TAK is not known even to this day. What exactly activates the initial inflammation of the arteries is not known, while doctors suspect that some virus or an infection might trigger the disease. Thus the doctors have concluded it to be a state which is probably an autoimmune disease in which the immune system attacks its own arteries by mistake.

With an active TAK, the aorta and the principal arteries gradually show changes including shrinking, tapering and mutilating, which affects the arteries leading to the head and the kidneys.

Treatment

As the precise cause for Takayasu Arteritis remains a mystery, an effective drug to prevent the disease is yet to be devised. That does not mean that TAK cannot be treated. Though a chronic prognosis is not anticipated, the main focus of treatment for a person suffering from TAK is to control the inflammation. The treatment involves suppressing the inflammation with steroids in the form of oral medication or intravenous therapy which suppress the immune system.

Although the medications are known to have side effects, they are the only guiding light in the dark world of TAK.

Dr. Vijay Rao,Rheumatologist

“Unfortunately not many are aware of this ailment and many General Physicians are also clueless about TAK. The warning signs are usually mistaken for common health problems and hence neglected. Lack of education and unfamiliarity of this disease amongst the common man and the doctor community as well is a major problem faced by Rheumatologists today. The time taken to identify and analyse the problem is enormous and by the time the patients are referred to the right kind of doctors the problem is elevated and the patient is in a critical condition. Having the right kind of knowledge and spreading awareness about TAK is the need of the hour.”

Shruthi, TAK Patient

“I was not aware of something called Takaysu Arteritis until I faced it. The initial few days when I was diagnosed with TAK, it was a nightmare for me, but now I have accepted it and with the right kind of medication I have moved on in life. The medication and the treatment just to control the inflammation and not curing it, costs a fortune and this is sometimes depressing. I am a fighter and I have learnt and accepted TAK to be a part of my life. I just hope that someday in future there is a cure to this. It is not easy for someone to live with this kind of ailment, but being strong is the only way to deal with it.”