Sharma et al modified Ishikawa's criteria for Takayasu arteritis to address certain aspects that limited their usefulness in clinical practice. The authors are from the University of Manitoba in Canada and the Post-Graduate Institute of Medical Education and Research in Chandigarh, India.
Modifications to the Ishikawa's criteria (Table 3, page 314, Sharma, 1995):
(1) Removal of the obligatory criterion of age. There is addition of a third major criterion with "characteristic signs and symptoms".
(2) Removal of age from the third minor criterion
(3) Deletion of the absence of aorto-iliac lesion from the ninth minor criterion
(4) Addition of a 10th minor criterion: Coronary artery lesion in a person < 30 years of age in the absence of risk factors such as hyperlipidemia, diabetes mellitus or other known risk factor.
(5) The presence of (2 major) or (1 major and 2 minor criteria) or (the presence of four minor criteria) should suggest a high probability of Takayasu arteritis
Major criteria:
(1) left mid-subclavian artery lesion: The most severe stenosis or occlusion is present in the mid-portion from the point 1 cm proximal to the left vertebral artery orifice to that 3 cm distal to the orifice determined by angiography.
(2) right mid-subclavian artery lesion: similar to left subclavian artery lesion
(3) "characteristic signs and symptoms" of at least 1 month duration in patient history. Characteristic signs and symptoms include: limb claudication, pulselessness or pulse difference, unobtainable blood pressure or a significant blood pressure difference > 10 mm in systolic pressure, fever, neck pain, transient amaurosis (blindness without obvious cause), blurred vision, syncope, dyspnea or palpitations.
where:
• For characteristic signs and symptoms, it is unspecified the number that must be present. I have implemented it with just 1, but it could be set to 2 or more.
Minor criteria:
(1) high erythrocyte sedimentation rate (ESR): Unexplained, persistent high ESR > 20 mm/h (Westergren method) at diagnosis, or recorded in patient history.
(2) carotid artery tenderness: Unilateral or bilateral tenderness of common carotid arteries by physician palpation. Neck muscle tenderness is unacceptable.
(3) hypertension: Persistent blood pressure > 140/90 mm Hg brachial or > 160/90 mm Hg popliteal.
(4) aortic regurgitation or annuloaortic ectasia: Demonstrated by Doppler echocardiography or angiography; regurgitation also by auscultation.
(5) pulmonary artery lesion: (a) Lobar or segmental arterial occlusion or equivalent determined by angiography or perfusion scintigraphy; or (b) 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 artery lesion: The 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: The presence of the most severe stenosis or occlusion in the distal third lesion determined by angiography.
(8) descending thoracic aorta lesion: Narrowing, dilatation, or aneurysm, luminal irregularity or any lesion combination determined by angiography. Tortuosity alone is not acceptable.
(9) abdominal aorta lesion: Narrowing, dilatation or aneurysm, luminal irregularity or any combination determined by angiography.
(10) Coronary artery lesion documented on angiography in a person < 30 years of age in the absence of risk factors such as hyperlipidemia, diabetes mellitus or other known risk factor.
A high probability of Takayasu arteritis is suggested with:
(1) 2 major criteria,
(2) 1 major and 2 minor criteria, OR
(3) the presence of four minor criteria
Purpose: To evaluate a patient for Takayasu arteritis using the modifications of Ishikawa's criteria as proposed by Sharma et al.
Specialty: Immunology/Rheumatology
Objective: criteria for diagnosis
ICD-10: M31.4,
