Atypical Takayasu arteritis: late onset and arthritic manifestations: report of two cases

We recently experienced two cases of Takayasu arteritis rendered atypical by late onset (over 60 years of age) of disease, involvement of distal branch arteries, and association with rheumatoid arthritis. In both cases, roentgenologic examination revealed typical appearance of the abdominal aorta and stenosis of the subclavian artery entirely compatible with Takayasu arteritis. In addition, Case 1 had occlusive lesions of the superficial femoral arteries and Case 2 manifested occlusion of the axillary artery. Laboratory findings showed increased ESR and CRP but negative HLA B52 locus. Both cases showed arthritis symptoms with swelling, pain, and tenderness in joints. Case 1 did not manifest erosive lesions and positive RA test; Case 2 showed roentgenologic erosive lesions in hand joints with positive RA test. A surgical specimen from the femoral artery of Case 1 showed lesions suggesting Takayasu arteritis. Based upon these findings, we diagnosed the two patients as having atypical Takayasu arteritis with late middle age onset and arthritic manifestations.