Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Giant Cell Arteritis with or without Suspicion of Aortitis At Diagnosis. A Retrospective Study of 22 Patients with a 12-Year Follow-up.
Espitia1, Olivier, Neel1, Antoine, Leux2, Christophe, Connault3, Jerome, Ponge4, Thierry D., Dupas2, Beno|$$^[inodot]t, Hamidou3, Mohamed
Internal Medicine, Nantes University Hospital, Nantes, France
Nantes University Hospital, Nantes, France
Service de médecine interne, Hôpital Universitaire de Nantes, Nantes, France, Nantes, France
Hotel-Dieu, Nantes CEDEX 1, France
During giant cell arteritis (GCA), aortitis is frequently suspected, up to 3050% of cases, using different medical imaging techniques. Images of aortic involvement may be non symptomatic and their real outcome remain elusive. The objective of this study was to describe the long-term outcome of patients with or without suspicion of aortitis at the time of diagnosis of GCA.
In 1999, 22 patients with newly diagnosed biopsy-proven GCA were explored using aortic computed tomodensitometry (CT). Ten patients (group 1) had aortic inflammatory thickenings >= 3mm (n=7) and/or aneurism (n=3), whereas 12 patients had no suspicion of aortitis (group 2). A retrospective study of these 2 groups was conducted in 2011. We contacted and questioned the patients, their family and general practitioner, and analysed each medical file. The following items were investigated: demographic data, cardio-vascular risk factors, total and cardio-vascular mortality, cardio-vascular events, GCA relapses, corticosteroids regimen. Satistics were made using R development Core Team (2009) software.
Seventeen women and 5 men (mean age at diagnosis=73.7±7.2y) were included. Inflammatory parameters and cardio-vascular risk factors were similar in group 1 and 2. The mean follow-up was 94.8 months. Twelve years after diagnosis of GCA, the total mortality was 50% without differences between group 1 (7/10) and group 2 (5/12). However, the 12y cardio-vascular mortality was statistically higher in patients with initial suspicion of aortitis (50%), than in patients without (0%, p=0.029, Log rank test). In group 1, the causes of deaths of cardiovascular origin were: rupture of abdominal aortic aneurism (n=1), thoracic aortic dissection (n=1), stroke (n=1), heart failure (n=1), peripheral arterial disease (n=1). Twelve cardio-vascular events occured in 7/10 patients of group 1 whereas only 5 occured in 4/12 patients of group 2. Stroke were statistically more frequent in group 1 (40% vs 0% in group 2, p=0.03). Recurrent GCA relapses were noted in 5/10 patients of group 1, 0/12 patients of group 2 and this difference was statistically significant (p=0.01). Moreover, definitive steroid treatment discontinuation was more frequent in group 2 (n=2) than in group 1 (n=8, p<0.05).
Despite the limitations due to its retrospective character and its small number of patients, our study suggests that GCA clinical course may differ according to initial CT signs of aortic involvement. CT suspicion of aortitis may lead to aortic fatal events and aortic thickenings deserve to be monitored. Initial aortic CT involvements seem to sign a particular form of GCA, with higher rate of cardio-vascular events and mortality, and with frequent relapses requiring longer steroids treatment.
To cite this abstract, please use the following information:
Espitia, Olivier, Neel, Antoine, Leux, Christophe, Connault, Jerome, Ponge, Thierry D., Dupas, Beno|$$^[inodot]t, et al; Giant Cell Arteritis with or without Suspicion of Aortitis At Diagnosis. A Retrospective Study of 22 Patients with a 12-Year Follow-up. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1510