What is the cause of buttock pain relieved by walking, suspected Takayasu (Takayasu arteritis) arteritis, and abdominal pain?

From the Guidelines

Buttock pain relieved by walking in suspected Takayasu arteritis with abdominal pain is likely due to claudication caused by inflammation of large blood vessels, and treatment should include corticosteroids and immunosuppressants, as well as lifestyle modifications, under the guidance of a rheumatologist or vascular specialist. The condition involves inflammation of the aorta and its branches, which can lead to narrowing of the blood vessels and subsequent ischemic pain during activity, as described in the 2010 guidelines for the diagnosis and management of patients with thoracic aortic disease 1. The clinical manifestations of Takayasu arteritis typically develop in two phases: acute and chronic, with symptoms such as weight loss, fatigue, night sweats, anorexia, and malaise in the acute phase, and symptoms referable to the organs involved in the chronic phase, including upper extremity claudication, cerebrovascular insufficiency, and carotid artery pain 1. The diagnosis of Takayasu arteritis can be made using the 1990 American College of Rheumatology criteria, which include age of onset younger than 40 years, intermittent claudication, diminished brachial artery pulse, subclavian artery or aortic bruit, systolic blood pressure variation of greater than 10 mm Hg between arms, and angiographic evidence of aorta or aortic branch vessel stenosis 1. Treatment of Takayasu arteritis typically includes high-dose glucocorticoids, such as prednisone (starting at 40-60mg daily with gradual tapering), often combined with immunosuppressants such as methotrexate (15-25mg weekly) or azathioprine (2mg/kg daily), as recommended in the 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis 1. Some key points to consider in the management of Takayasu arteritis include:

• Regular monitoring of inflammatory markers (ESR, CRP) and vascular imaging is essential to assess disease activity and response to treatment 1.
• Lifestyle modifications, including regular gentle exercise, smoking cessation, and maintaining healthy blood pressure, are important complementary approaches to medication therapy.
• The use of noninvasive imaging, such as MR or CT angiography, is recommended over catheter-based dye angiography as a disease activity assessment tool 1.
• Surgical intervention may be considered in patients with symptomatic and/or findings of active disease on imaging, as well as those with vascular changes identified on imaging studies 1.

From the Research

Causes of Buttock Pain Relieved by Walking, Suspected Takayasu Arteritis, and Abdominal Pain

• The causes of buttock pain relieved by walking, suspected Takayasu arteritis, and abdominal pain can be related to the inflammation of large blood vessels, which results in vascular stenosis, occlusion, and aneurysm formation 2, 3, 4, 5, 6.
• Takayasu arteritis (TAK) is a rare disease characterized by inflammation of large blood vessels, which can lead to stenosis, occlusion, or aneurysmal degeneration of large arteries 4, 5.
• The symptoms of TAK are non-specific and can include buttock pain, abdominal pain, and other systemic symptoms, making early diagnosis difficult 2, 3, 4, 5.
• The pathogenesis of TAK seems to be mainly due to an abnormal cell-mediated immunity, although other molecular and genetic abnormalities may contribute 4.
• Imaging studies play a principal role in the diagnosis and control of TAK, as they can help visualize arterial stenosis and monitor disease progression 3, 5.

Relationship Between Buttock Pain, Takayasu Arteritis, and Abdominal Pain

• Buttock pain relieved by walking can be a symptom of TAK, as the inflammation of large blood vessels can lead to stenosis or occlusion of the arteries that supply blood to the buttock region 2, 4.
• Abdominal pain can also be a symptom of TAK, as the inflammation of large blood vessels can lead to stenosis or occlusion of the arteries that supply blood to the abdominal organs 2, 5.
• The relationship between buttock pain, TAK, and abdominal pain is complex and can be influenced by various factors, including the location and severity of the inflammation, as well as the presence of other systemic symptoms 3, 4, 5.

Diagnostic and Treatment Approaches

• The diagnosis of TAK is based on clinical and arteriographic findings, as well as the use of acute phase responses and biomarkers 2, 3, 4, 5.
• The treatment of TAK involves the use of glucocorticoids, immunosuppressive drugs, and biological therapy, with the goal of suppressing both vascular and systemic inflammation 2, 5, 6.
• The use of imaging studies, such as digital subtraction angiography, computed tomography angiography, and magnetic resonance imaging/angiography, can help monitor disease progression and guide treatment decisions 3, 5.