Giant Cell Arteritis with or without Aortitis at Diagnosis. A Retrospective Study of 22 Patients with Longterm Followup

Espitia, O.; Néel, A.; Leux, Christophe; Connault, J.; Espitia-Thibault, A.; Ponge, T.; Dupas, B.; Barrier, J.; Hamidou, M.; Agard, C.

doi:10.3899/jrheum.120511

Cited by 90 publications

(57 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Usually, it is found in complementary investigations after other symptoms gave the clue to diagnosis. Anyhow, its disclosure is of importance since patients with initial aortic involvement tend to more frequently experience cardiovascular complications and a higher rate of recurrence [17], thus probably requiring more intense treatment. On the other hand, aortic manifestation may develop in the course of disease of formerly unaff ected patients.…”

Section: Giant Cell Arteritis (Gca)mentioning

confidence: 99%

See 1 more Smart Citation

Inflammatory diseases of the aorta

Caspary

2016

Vasa

View full text Add to dashboard Cite

Summary:Infl ammatory aortic diseases may occur with and without dilatation and are complicated by obstruction, rupture and dissection. Infections originate from periaortic foci or septicaemia and tend to result in the rapid development of aneurysms. Large vessel vasculitis due to Takayasu arteritis in younger and giant cell arteritis (GCA) in older patients is located in all layers of the aortic wall and prevails in the thoracic section. GCA patients are prone to developing aortic complications in the late course of disease. In Behçet's disease, aneurysms may have an unusual morphology and localisation. The diagnosis of aortitis is usually obtained by vascular imaging, but partly made only by biopsy on occasion of an operation, especially in case of isolated aortitis of the ascending aorta which mostly remains inapparent until dissection or large aneurysms have developed. Periaortitis typically occurs in the abdominal aorta and may lead to infl ammatory aortic aneurysm (IAA). It is looked upon as a special form of vasculitis, with an overlap to primary retroperitoneal fi brosis (RF). An identical pathology is discussed for the three diseases. On the other hand, about 50 % of isolated aortitides and periaortitides as well as retroperitoneal fi broses can be classed among IgG4-related diseases. Periaortitis also is observed after treatment of aortic aneurysms by stent-graft implantation. Special attention should be paid to ureteral obstruction along with RF or IAA. Once infection is ruled out, immunosuppression is applied to all forms of infl ammatory aortic diseases, primarily with glucocorticoids. However, after successful surgery for isolated thoracic aortitis or infl ammatory aortic aneurysm immunosuppression may be dispensable and it is not required if periaortic tissue enlargement persists in chronic inactive disease. For some patients with periaortitis and RF, tamoxifen may be a valuable alternative.

show abstract

Section: Giant Cell Arteritis (Gca)mentioning

confidence: 99%

“…Aspirin 100 mg/d is advised in addition. No controlled studies are available, but due to the number of cardiovascular events especially in patients with aortic involvement [17] a benefi t of aspirin is expectable.…”

Section: Giant Cell Arteritis (Gca)mentioning

confidence: 99%

Inflammatory diseases of the aorta

Caspary

2016

Vasa

View full text Add to dashboard Cite

show abstract

“…CTA is more traditionally used to assess the lumen, and can therefore also detect stenotic and aneurysmal lesions that can complicate GCA [25]. Aneurysmal lesions at onset may indicate resistant disease and worse vascular prognosis [3]. Unusual patterns of stenosis not characteristic of atherosclerosis may alert a radiologist to the possibility of LVV.…”

Section: Computed Tomography and Computed Tomographic Angiographymentioning

confidence: 98%

“…Sight loss has been reported to occur in between 15 and 25 % of patients at presentation [1]. Extracranial involvement is frequent [2][3][4][5] and can be complicated by aortic aneurysm formation and dissection, reported as occurring at a rate of 18 % in a report from the Mayo clinic, along with large artery stenosis at a rate of 13 % [6].…”

Section: Introductionmentioning

confidence: 96%

Imaging in Giant Cell Arteritis

Khan

Dasgupta

2015

Curr Rheumatol Rep

View full text Add to dashboard Cite

Much progress has been made in the use of imaging as a diagnostic tool in giant cell arteritis (GCA), which assists in the management of patients where the initial diagnosis is unclear. This includes patients with atypical cranial symptoms, or with predominantly systemic, constitutional or limb symptoms. Ultrasound and magnetic resonance imaging are capable of visualising both the cranial and extracranial large vessel circulation, with vessel wall thickening and stenotic lesions being visualised. Computed tomographic angiography is helpful in visualising the aorta for aneurysm complicating GCA but can also detect vessel wall thickening in established large vessel vasculitis. PET-CT is a very sensitive test for early vascular inflammation in extracranial large vessel vasculitis, before aneurysmal or stenotic lesions have developed, of use in the patient with unexplained constitutional symptoms. The place of imaging in the follow-up of GCA is being investigated, and repeated imaging may be useful in select cases. Generally, vascular abnormalities become less defined once glucocorticoid treatment has been started, and therefore, imaging studies must be conducted early as part of a GCA fast-track assessment.

show abstract

“…L'hypothèse que ce sous-groupe d'ACG est à plus haut risque de développer ultérieurement des anévrismes est confortée par le fait que des patients, nouvellement diagnostiqués, ayant une ACG et une atteinte des gros vaisseaux en TEP-TDM au 18 FDG, ont un diamètre aortique plus grand sur des angio-TDM réalisés en moyenne 4 ans plus tard comparativement aux patients atteints d'ACG sans anomalies au TEP-TDM initial [36]. Dans une 959 Mise au point Artérite à cellules géantes et maladie de Takayasu étude avec un suivi de 12 ans, les patients atteints d'ACG avec atteinte des gros vaisseaux en angio-TDM avaient une évolu-tion émaillée de plus de rechutes et de plus d'événements cardiovasculaires que ceux sans atteinte des gros vaisseaux [37]. En l'absence d'information claire sur la signification pronostique d'une atteinte des gros vaisseaux, on ne peut probablement pas recommander de chercher une telle anomalie infraclinique pour tous les patients chez qui une ACG est diagnostiqué.…”

Section: Figureunclassified