Anemia and marked elevation of the ESR are often present. This phase gradually subsides and is followed by a more chronic stage characterized by inflammatory and obliterative changes in the aorta and its branches. In the late stage, weakness of the arterial walls may give rise to localized aneurysms. The vessels of the aortic arch are particularly vulnerable, and any or all may be occluded. Muscle mass may be lost from the face and arms.
Visual disturbances are common.
Occlusive changes in the descending thoracic aorta sometimes produce a form of acquired coarctation. Heart failure is not uncommon and can stem from severe hypertension, coronary artery involvement, or infrequent cases of aortic insufficiency caused by the disease. Rarely, pulmonary artery occlusion leads to pulmonary hypertension. Physical examination typically reveals markedly diminished or absent pulses and low or unobtainable BP in the involved arteries arising from the aortic arch. Unless an acquired coarctation is present, these pulses contrast sharply with the generally brisk pulses in the legs, where the true BP must be determined and followed.