Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Aortic Involvement in Patients with Newly Diagnosed Giant Cell Arteritis (GCA). A Prospective Study Using Computed Tomography (CT) Angiography
Prieto-Gonzalez, Sergio, Arguis, Pedro, Garcia-Martinez, Ana, Espigol-Frigole, Georgina, Butjosa, Montserrat, Tavera, Itziar, Grau, Josep M.
Recent studies have shown that 22.5% of GCA patients develop aortic aneurysms during follow-up. Examination of necropsy or surgically removed specimens has evidenced that GCA may target the aorta. More recently, positron emission tomography has shown to be able to detect fluorodeoxyglucose uptake by the aorta in patients with active GCA, but the prevalence and topography of aortic involvement has not been accurately evaluated by imaging techniques in prospective studies. Our objective was to prospective assess the prevalence, topography and characteristics of aortic involvement (aortitis and dilatation) in patients with newly diagnosed GCA using CT angiography.
From July 2007 to June 2009, 32 patients were diagnosed with biopsy-proven GCA in our institution. Nine patients were excluded because of allergy to iodine (1), no consent to participate (1) or steroid treatment for >3 days (7 patients). Aortic CT angiography was performed to the remaining 24 patients, and the following features were evaluated: presence of aortitis (defined by contrast-enhanced circumferential aortic wall thickness >= 2 mm without adjacent atheroma), and significant dilatation (diameter > 4 cm in the ascending aorta, at least 4 cm in the rest of the thoracic aorta and loss of normal progressive reduction in the abdominal aortic calibre). Controls matched for gender, age and cardiovascular risk factors, were consecutively recruited from patients with no chronic inflammatory diseases, who underwent CT angiography for diagnosis or follow-up of neoplasia.
The study group consisted of 13 women and 11 men, aged 80 years (range 6789). None of the patients had previously diagnosed aortic valvulopathy or aneurysm. Structural abnormalities were detected in 18 patients (75%). Seventeen patients (70%) had aortitis and 3 patients (12,5%) had significant dilatation of the ascending aorta. Two patients had both findings, but dilatation was not coincident with aortitis in the same segment. Aortitis preferentially involved the thoracic descending aorta which was affected in 16 (94%) of patients with aortitis. The aortic arch was involved in 13 (76,5%) patients, the abdominal aorta in 8 (53%), and the ascending aorta in 3 (23%). No aortic abnormalities were observed in the control group.
Aortitis, as assessed by CT angiography, is highly frequent in patients with GCA at the time of diagnosis. Aortic dilatation is already present in 12,5% of patients at baseline evaluation. Aortic dilatation exclusively occurred in the ascending aorta and was no associated with CT angiography evidence of aortitis, suggesting the contribution of hemodynamic factors. Supported by SAF 08/04328. MTV3 06/0710.
To cite this abstract, please use the following information:
Prieto-Gonzalez, Sergio, Arguis, Pedro, Garcia-Martinez, Ana, Espigol-Frigole, Georgina, Butjosa, Montserrat, Tavera, Itziar, et al; Aortic Involvement in Patients with Newly Diagnosed Giant Cell Arteritis (GCA). A Prospective Study Using Computed Tomography (CT) Angiography [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1971