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Cotton C, Chatharoo S, Chaturvedi P. Aortic dissection secondary to giant cell arteritis. Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 37127415 DOI: 10.12968/hmed.2022.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Connor Cotton
- Department of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UK
| | - Sarah Chatharoo
- Department of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UK
| | - Pankaj Chaturvedi
- Department of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UK
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2
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Espitia O, Blonz G, Urbanski G, Landron C, Connault J, Lavigne C, Roblot P, Maillot F, Audemard-Verger A, Artifoni M, Durant C, Guyomarch B, Hamidou M, Magnant J, Agard C. Symptomatic aortitis at giant cell arteritis diagnosis: a prognostic factor of aortic event. Arthritis Res Ther 2021; 23:14. [PMID: 33413605 PMCID: PMC7792092 DOI: 10.1186/s13075-020-02396-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Giant cell arteritis (GCA) is frequently associated with aortic involvement that is likely to cause life-threatening structural complications (aneurysm, dissection). Few studies have investigated the occurrence of these complications, and no predictive factor has been identified so far. The aim of this study was to investigate factors associated with the risk of aortic complications in a cohort of GCA aortitis. Methods Data of all patients managed with aortitis (CT or 18 FDG PET) at the diagnosis of GCA in five hospitals from May 1998 and April 2019 were retrospectively collected. Clinical features were compared according to the presence of aortitis symptoms. The predictive factors of occurrence or aggravation of aortic structural abnormalities were investigated. Results One hundred and seventy-one patients with GCA aortitis were included; 55 patients (32%) had symptoms of aortitis (dorsal/lumbar/abdominal pain, aortic insufficiency) at diagnosis. The median follow-up was 38 months. Aortic complications occurred after a median time of 32 months. There were 19 new aortic aneurysms or complications of aneurysm and 5 dissections. Survival without aortic complication was significantly different between the symptomatic and non-symptomatic groups (Log rank, p = 0.0003). In multivariate analysis the presence of aortitis symptoms at diagnosis (HR 6.64 [1.95, 22.6] p = 0.002) and GCA relapse (HR 3.62 [1.2, 10.9] p = 0.02) were factors associated with the occurrence of aortic complications. Conclusion In this study, the presence of aortitis symptoms at the diagnosis of GCA aortitis and GCA relapse were independent predictive factors of occurrence of aortic complications during follow-up.
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Affiliation(s)
- Olivier Espitia
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
| | - Gauthier Blonz
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Cédric Landron
- Department of Internal Medicine, CHU Poitiers, Poitiers, France
| | - Jérôme Connault
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Pascal Roblot
- Department of Internal Medicine, CHU Poitiers, Poitiers, France
| | | | | | - Mathieu Artifoni
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Cécile Durant
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Béatrice Guyomarch
- Research Department, Methodology and Biostatistics Platform, CHU Nantes, Nantes, France
| | - Mohamed Hamidou
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Julie Magnant
- Department of Internal Medicine, CHRU Tours, Tours, France
| | - Christian Agard
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
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Sen G, Gordon P, Sado DM. Cardiac manifestations of rheumatological disease: a synopsis for the cardiologist. Heart 2020; 107:1173-1181. [PMID: 33310886 DOI: 10.1136/heartjnl-2019-316460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Gautam Sen
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital, London, UK
| | - Daniel M Sado
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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Agard C, Bonnard G, Samson M, de Moreuil C, Lavigne C, Jégo P, Connault J, Artifoni M, Le Gallou T, Landron C, Roblot P, Magnant J, Belizna C, Maillot F, Diot E, Néel A, Hamidou M, Espitia O. Giant cell arteritis-related aortitis with positive or negative temporal artery biopsy: a French multicentre study. Scand J Rheumatol 2019; 48:474-481. [PMID: 31766965 DOI: 10.1080/03009742.2019.1661011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To compare the clinical presentation and outcome of giant cell arteritis (GCA)-related aortitis according to the results of temporal artery biopsy (TAB).Method: Patients with GCA-related aortitis diagnosed between 2000 and 2017, who underwent TAB, were retrospectively included from a French multicentre database. They all met at least three American College of Rheumatology criteria for the diagnosis of GCA. Aortitis was defined by aortic wall thickening > 2 mm on computed tomography scan and/or an aortic aneurysm, associated with an inflammatory syndrome. Patients were divided into two groups [positive and negative TAB (TAB+, TAB-)], which were compared regarding aortic imaging characteristics and aortic events, at aortitis diagnosis and during follow-up.Results: We included 56 patients with TAB+ (70%) and 24 with TAB- (30%). At aortitis diagnosis, patients with TAB- were significantly younger than those with TAB+ (67.7 ± 9 vs 72.3 ± 7 years, p = 0.022). Initial clinical signs of GCA, inflammatory parameters, and glucocorticoid therapy were similar in both groups. Coronary artery disease and/or lower limb peripheral arterial disease was more frequent in TAB- patients (25% vs 5.3%, p = 0.018). Aortic wall thickness and type of aortic involvement were not significantly different between groups. Diffuse arterial involvement from the aortic arch was more frequent in TAB- patients (29.1 vs 8.9%, p = 0.03). There were no differences between the groups regarding overall, aneurism-free, relapse-free, and aortic event-free survival.Conclusion: Among patients with GCA-related aortitis, those with TAB- are characterized by younger age and increased frequency of diffuse arterial involvement from the aortic arch compared to those with TAB+, without significant differences in terms of prognosis.
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Affiliation(s)
- C Agard
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - G Bonnard
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon, University of Burgundy, Dijon, France
| | - C de Moreuil
- Department of Internal Medicine, University Hospital of Brest, University of Bretagne Occidentale, Brest, France
| | - C Lavigne
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - P Jégo
- Department of Internal Medicine, University Hospital of Rennes, Rennes University, Rennes, France
| | - J Connault
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Artifoni
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - T Le Gallou
- Department of Internal Medicine, University Hospital of Rennes, Rennes University, Rennes, France
| | - C Landron
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers University, Poitiers, France
| | - P Roblot
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers University, Poitiers, France
| | - J Magnant
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - C Belizna
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - F Maillot
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - E Diot
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - A Néel
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Hamidou
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - O Espitia
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
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5
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Enfrein A, Espitia O, Bonnard G, Agard C. Aortite de l’artérite à cellules géantes : diagnostic, pronostic et traitement. Presse Med 2019; 48:956-967. [DOI: 10.1016/j.lpm.2019.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/10/2019] [Accepted: 04/15/2019] [Indexed: 01/16/2023] Open
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Chaudet A, Goujon JM, Ghazali AD. Febrile abdominal pain revealing Horton's disease. Am J Emerg Med 2017; 35:1583.e3-1583.e5. [PMID: 28712642 DOI: 10.1016/j.ajem.2017.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Horton's disease is a systemic inflammatory vasculitis, usually found in persons over 50years old. It affects medium and large-sized arteries stemming from the external carotid, especially the superficial temporal arteries. It can affect extracranial large vessels but only rarely the aorta. Diagnosis of aortitis is difficult and its incidence is probably underestimated. CASE PRESENTATION A 68-year-old Caucasian woman consulted in an emergency department for febrile abdominal pain with inflammatory syndrome. Abdomen was soft with right-side flank sensitivity. A contrast-enhanced CT scan showed aortitis from the descending aorta to the iliac arteries without complication. Because of age, clinical presentation and aortitis, Horton disease was suspected. The temporal artery biopsy showed a histological aspect of degenerative endarteritis with intimal thickening and luminal stenosis. High-dose corticosteroid therapy was introduced which improved clinical conditions and resulted in the amendment of the pain. DISCUSSION In the present case, this patient had Horton's disease, based on 3 criteria of The American College of Rheumatology (age, temporal artery abnormalities and inflammatory syndrome) associated with aortitis. However, aortitis is a rare complication of Horton disease and is a major cause of mortality inasmuch as it can be complicated by aneurysm and dissection. It is unusual to diagnose Horton's disease from aortitis symptoms without complications. The aorta represents the most severe localization of Horton's disease. It should not be ignored in etiological hypotheses regarding febrile abdominal pain in the elderly. Corticosteroids should be started rapidly at high doses and temporal artery biopsy should be planned.
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Affiliation(s)
- Arnaud Chaudet
- Emergency Department, University Hospital of Poitiers, France
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Cinar I, Wang H, Stone JR. Clinically isolated aortitis: pitfalls, progress, and possibilities. Cardiovasc Pathol 2017; 29:23-32. [PMID: 28500877 DOI: 10.1016/j.carpath.2017.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 12/12/2022] Open
Abstract
Non-infectious aortitis may be caused by several distinct systemic rheumatologic diseases. In some patients, aortitis is identified either pathologically or radiologically in the absence of clinical evidence of a systemic vasculitis. By consensus nomenclature, such cases are referred to as clinically isolated aortitis (CIA). Some systemic disorders may initially present as CIA including giant cell arteritis (GCA), IgG4-related disease, infectious aortitis, and granulomatosis with polyangiitis. CIA most commonly occurs in women of European descent over the age of 50 and, thus, mirrors the gender, age, and geographic distribution of GCA. CIA most often demonstrates a granulomatous/giant cell pattern of inflammation (GPI), and CIA-GPI is pathologically indistinguishable from aortitis due to GCA. In many cases, CIA may be a manifestation of extracranial GCA. CIA is being identified both pathologically in resected aortic tissue and radiologically by computed tomography scanning, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography. However, there appears to be significant differences between pathologically defined CIA and radiologically defined CIA. Multiple studies have shown that patients with CIA are at increased risk for subsequent aortic events (new aneurysms or dissections) and thus it is recommended to monitor these patients with periodic aortic imaging. While the data is currently limited, there is increasing evidence that at least some patients with CIA may benefit from immunosuppressive therapy.
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Affiliation(s)
- Ilkay Cinar
- Department of Pathology, Prof. Dr. A. Ilhan Ozdemir Research Hospital, Giresun University, Giresun, Turkey
| | - He Wang
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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8
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Schmidt J, Duhaut P. Atteinte aortique dans la maladie de Horton. Rev Med Interne 2016; 37:239-44. [DOI: 10.1016/j.revmed.2015.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/12/2015] [Accepted: 12/21/2015] [Indexed: 01/16/2023]
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Abstract
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.
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Affiliation(s)
- Asad Khan
- Department of Rheumatology, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea, Essex, SS0 0RY, UK
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10
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Espitia O, Samson M, Le Gallou T, Connault J, Landron C, Lavigne C, Belizna C, Magnant J, de Moreuil C, Roblot P, Maillot F, Diot E, Jégo P, Durant C, Masseau A, Brisseau JM, Pottier P, Espitia-Thibault A, Santos AD, Perrin F, Artifoni M, Néel A, Graveleau J, Moreau P, Maisonneuve H, Fau G, Serfaty JM, Hamidou M, Agard C. Comparison of idiopathic (isolated) aortitis and giant cell arteritis-related aortitis. A French retrospective multicenter study of 117 patients. Autoimmun Rev 2016; 15:571-6. [PMID: 26903476 DOI: 10.1016/j.autrev.2016.02.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the study was to compare clinical/imaging findings and outcome in patients with idiopathic (isolated aortitis, IA) and with giant cell arteritis (GCA)-related aortitis. METHODS Patients from 11 French internal medicine departments were retrospectively included. Aortitis was defined by aortic wall thickening >2mm and/or an aortic aneurysm on CT-scan, associated to inflammatory syndrome. Patients with GCA had at least 3 ACR criteria. Aortic events (aneurysm, dissection, aortic surgeries) were reported, and free of aortic events-survival were compared. RESULTS Among 191 patients with non-infectious aortitis, 73 with GCA and 44 with IA were included. Patients with IA were younger (65 vs 70 years, p=0.003) and comprised more past/current smokers (43 vs 15%, p=0.0007). Aortic aneurisms were more frequent (38% vs 20%, p=0.03), and aortic wall thickening was more pronounced in IA. During follow-up (median=34 months), subsequent development of aortic aneurysm was significantly lower in GCA when compared to IA (p=0.009). GCA patients required significantly less aortic surgery during follow-up than IA patients (p=0.02). Mean age, sex ratio, inflammatory parameters, and free of aortic aneurism survival were equivalent in patients with IA ≥ 60 years when compared to patients with GCA-related aortitis. CONCLUSIONS IA is more severe than aortitis related to GCA, with higher proportions of aortic aneurism at diagnosis and during follow-up. IA is a heterogeneous disease and its prognosis is worse in younger patients <60 years. Most patients with IA ≥ 60 years share many features with GCA-related aortitis.
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Affiliation(s)
- Olivier Espitia
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon, Dijon, France
| | - Thomas Le Gallou
- Department of Internal Medicine, University Hospital of Rennes, Rennes, France
| | - Jérôme Connault
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Cedric Landron
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | - Christian Lavigne
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - Cristina Belizna
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - Julie Magnant
- Department of Internal Medicine, CHRU of Tours, Tours, France
| | - Claire de Moreuil
- Department of Internal Medicine, University Hospital of Brest, Brest, France
| | - Pascal Roblot
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | | | - Elisabeth Diot
- Department of Internal Medicine, CHRU of Tours, Tours, France
| | - Patrick Jégo
- Department of Internal Medicine, University Hospital of Rennes, Rennes, France
| | - Cécile Durant
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - A Masseau
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Jean-Marie Brisseau
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Pierre Pottier
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | | | | | - François Perrin
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Antoine Néel
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Julie Graveleau
- Department of Medicine, Hospital of Saint-Nazaire, Saint-Nazaire, France
| | - Philippe Moreau
- Department of Hematology, Hospital of Lorient, Lorient, France
| | - Hervé Maisonneuve
- Department of Hematology, Hospital of La Roche sur Yon, La Roche sur Yon, France
| | - Georges Fau
- Department of Radiology, University Hospital of Nantes, Nantes, France
| | | | - Mohamed Hamidou
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Christian Agard
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France.
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Influence of aortitis on late outcomes after repair of ascending aortic aneurysms. J Thorac Cardiovasc Surg 2015; 150:589-94. [DOI: 10.1016/j.jtcvs.2015.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/05/2015] [Accepted: 06/16/2015] [Indexed: 12/28/2022]
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Aortite et complications aortiques de l’artérite à cellules géantes (maladie de Horton). Rev Med Interne 2013; 34:412-20. [DOI: 10.1016/j.revmed.2013.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/21/2022]
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Fatal aortic dissection in a patient with giant cell arteritis: a case report and review of the literature. Case Rep Vasc Med 2013; 2013:590721. [PMID: 23533937 PMCID: PMC3600339 DOI: 10.1155/2013/590721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 01/30/2013] [Indexed: 11/18/2022] Open
Abstract
Giant cell arteritis may lead to catastrophic, large-vessel complications from chronic vascular wall inflammation without prompt diagnosis and treatment. We describe a rare case of acute aortic dissection without preceding aneurysm secondary to histologically confirmed giant cell arteritis (GCA) in an 85-year-old female with a four-year history of polymyalgia rheumatica and temporal arteritis diagnosed per biopsy six months prior to presentation. The literature is reviewed and the clinical implications of this case are discussed.
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Agard C, Espitia O, Néel A. Pronostic de l’artérite à cellules géantes (maladie de Horton). Presse Med 2012; 41:966-74. [DOI: 10.1016/j.lpm.2012.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 06/28/2012] [Accepted: 07/09/2012] [Indexed: 11/16/2022] Open
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ESPITIA OLIVIER, NÉEL ANTOINE, LEUX CHRISTOPHE, CONNAULT JÉROME, ESPITIA-THIBAULT ALEXANDRA, PONGE THIERRY, DUPAS BENOIT, BARRIER JACQUESH, HAMIDOU MOHAMEDA, AGARD CHRISTIAN. Giant Cell Arteritis with or without Aortitis at Diagnosis. A Retrospective Study of 22 Patients with Longterm Followup. J Rheumatol 2012; 39:2157-62. [DOI: 10.3899/jrheum.120511] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Studies have shown that aortitis may be present in half the patients with recent-onset giant cell arteritis (GCA). We assessed whether aortitis at diagnosis affects longterm outcome in patients with GCA.Methods.We retrospectively analyzed the longterm outcome of a prospective cohort of 22 patients with biopsy-proven GCA who all had aortic computed tomography (CT) evaluation at the time of diagnosis of GCA between May 1998 and November 1999. Longterm outcome, especially vascular events such as aortic aneurysm, mortality, relapses of GCA, and requirement for steroids, was assessed in 2011 by chart review and patient/physician interviews.Results.At disease onset, 10/22 patients had aortitis on CT scan. Patients with and without aortitis had similar baseline characteristics, including cardiovascular risk profile. At the time of the study, 12/22 (57%) patients had died. Vascular causes of death were more frequent in patients with aortitis (5/7 vs 0/5; p = 0.02). A higher number of vascular events was noted in patients with aortitis (mean events per patient 1.33 vs 0.25; p = 0.009). Stroke was more frequent in patients with aortitis. These patients seemed to exhibit a more chronic or relapsing disease course, and they were less likely to completely discontinue steroid therapy (p = 0.009, log-rank test).Conclusion.Our study suggests for the first time that inflammatory aortic involvement present at onset of GCA could predict a more chronic/relapsing course of GCA, with higher steroid requirements and an increased risk for vascular events in the long term.
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Giant cell aortitis: a difficult diagnosis assessing risk for the development of aneurysms and dissections. Cardiovasc Pathol 2011; 20:247-53. [DOI: 10.1016/j.carpath.2010.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/22/2010] [Accepted: 10/22/2010] [Indexed: 11/21/2022] Open
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Agard C, Said L, Ponge T, Connault J, Masseau A, Pistorius MA, Planchon B, Dupas B, Barrier JH, Hamidou MA. Fréquence de l’atteinte de l’aorte abdominale au diagnostic de maladie de Horton : étude de 20 patients par échographie-Doppler et angiotomodensitométrie. Presse Med 2009; 38:11-9. [DOI: 10.1016/j.lpm.2008.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 02/11/2008] [Accepted: 02/27/2008] [Indexed: 11/30/2022] Open
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18
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Agard C, Barrier JH, Dupas B, Ponge T, Mahr A, Fradet G, Chevalet P, Masseau A, Batard E, Pottier P, Planchon B, Brisseau JM, Hamidou MA. Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan. ACTA ACUST UNITED AC 2008; 59:670-6. [PMID: 18438900 DOI: 10.1002/art.23577] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The prevalence of the involvement of large vessels in giant cell arteritis (GCA) is 3-13%. Aortitis is the most serious complication of GCA. Computed tomodensitometric (CT) scan allows analysis of both the aortic wall and endoluminal part of the aorta. Therefore, we conducted a study using CT scan to analyze aortic abnormalities in patients with recent-onset GCA. METHODS This prospective controlled study compared patients with biopsy-proven GCA with a matched control group based on sex, age, and cardiovascular risk factors. During the 4-week period following diagnosis of GCA, patients underwent an aortic CT scan. The aortic imaging results were blindly compared between both groups. RESULTS From January 5, 1998 to January 11, 1999, 22 patients and 22 controls were screened by CT scan for aortic involvement. Thickening of the aortic wall was more frequent among patients than controls (45.4% versus 13.6%; P = 0.02). Aortic thickening (mean 3.3 mm) was located on the ascending part of the thoracic aorta in 22.7% of the patients, with no evidence of thickening in the controls (P = 0.05). Thickening of the abdominal aortic wall was noted in 27.3% of the patients and none of the controls (P = 0.02). CONCLUSION This study suggests that inflammatory aortic thickening, detected by CT scan, occurs frequently at the time of diagnosis of GCA, and that this condition predominantly occurs on the ascending part of the aorta.
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Affiliation(s)
- Christian Agard
- Internal Medicine, Hôtel-Dieu, Place Alexis Ricordeau, Nantes Cedex 01, France.
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Abstract
Giant cell arteritis is the most common systemic vasculitis in people over the age of 50 years. Ischaemic manifestations are well known. 'Occult' manifestations as aortic aneurysmal disease need consideration. The incidence of aortic aneurysm and/or dissection is about 18.5 per 1000 person-years at risk (18.9 in Lugo(4) and 18.7 in Olmsted County(3)). Predictive factors are hypertension, polymyalgia rheumatica, coronaropathy, and hyperlipaemia. Another factor is the apparition of an aortic regurgitation murmur as in this case. So, these patients should be monitored by echocardiography.
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Bibliography. Current world literature. Neuro-ophthalmology. Curr Opin Ophthalmol 2007; 18:515-17. [PMID: 18163005 DOI: 10.1097/icu.0b013e3282f292cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Agard C, Hamidou MA, Said L, Ponge T, Connault J, Chevalet P, Masseau A, Pistorius MA, Brisseau JM, Planchon B, Barrier JH. [Screening of abdominal aortic involvement using Doppler sonography in active giant cell (temporal) arteritis at the time of diagnosis. A prospective study of 30 patients]. Rev Med Interne 2007; 28:363-70. [PMID: 17275968 DOI: 10.1016/j.revmed.2006.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 12/23/2006] [Accepted: 12/26/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inflammatory involvement of extracranial large-sized arteries occurs in 10-20% of patients with giant cell (temporal) arteritis. Aortic involvement may reveal giant cell arteritis or occur as a late-onset complication, and represents one of the most serious manifestation of the disease with the risk of aortic dissection and/or aneurysm rupture. The thoracic aorta is more frequently involved but abdominal aortitis may also occur in giant cell arteritis. To date, few data are available about abdominal aorta changes at the initial stage of giant cell arteritis. PATIENTS AND METHODS This prospective monocentric study was conducted between May 1998 and May 2002, and included 30 consecutive patients with biopsy-proven giant cell arteritis. Standard clinical and biological data were collected. Each patient underwent an abdominal aortic Doppler-sonography that looked for aneurysm, ectasia, thickening of the vascular wall, and hypoechoic halo around the aorta. RESULTS Among the 30 patients of this study (25 women, 5 men, mean age 68.5 years), 4 (13%) had an abdominal aortic aneurysm, with a low diameter (23 to 27 mm), measuring 2 to 5.5 cm in length. A vascular wall thickening superior or equal to 3 mm was noted in 17 patients (68%). A 4 to 8 mm periaortic hypoechoic halo was found in 10 patients (33%). This halo was present in 3 out of the 4 patients with aneurysm. CONCLUSION Aortic involvement is a potentially serious complication of giant cell arteritis. The question of a systematic screening of this complication remains open to discussion. Our study shows that Doppler sonography may detect morphological abnormalities on the abdominal aorta at the initial stage of giant cell arteritis. These abnormalities comprise mild aneurysms, thickening of the vascular wall and periaortic halo, which could correspond to inflammatory locations of the disease. Complementary studies are needed to assess their specificity and their seriousness.
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Affiliation(s)
- C Agard
- Service de Médecine Interne, CHU Hôtel-Dieu, place Alexis-Ricordeau, 44035 Nantes cedex 01, France.
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