Differential Blood Pressure in Arms

A 26-year woman comes to the office complaining about pain and numbness in her upper arms, exacerbated by strenuous activity. She also reports a 12-pound weight loss, joint pain and fatigue in the past six months. She has no smoking history and denies any use of illicit drugs. Her blood pressure is 143/89 mmHg in the right arm and 87/56 mmHg in the left. Her temperature is 37.6°C (99.68°F) and her heart rate is 90 bpm. Auscultation of the heart shows no murmurs and lungs are clear. The brachial pulses in her left arm are decreased compared to her right arm. No skin or mucosa lesions are identified, and the abdominal examination is unremarkable. The results of complete blood count and renal function are normal, except for mild anemia and an erythrocyte sedimentation rate (ESR) of 56 mm/hr.

Which of the following is the most likely diagnosis in this patient?

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