Match!

Prospective long term follow-up of a cohort of patients with giant cell arteritis screened for aortic structural damage (aneurysm or dilatation)

Published on Oct 1, 2014in Annals of the Rheumatic Diseases14.299
· DOI :10.1136/annrheumdis-2013-203322
Ana García-Martínez23
Estimated H-index: 23
(University of Barcelona),
Pedro Arguis13
Estimated H-index: 13
(University of Barcelona)
+ 6 AuthorsMaria C. Cid52
Estimated H-index: 52
(University of Barcelona)
Abstract
Background Aortic structural damage (ASD) may complicate the course of patients with giant cell arteritis (GCA). However the frequency and outcome of ASD has not been assessed in long term prospective studies. Methods In a previous screening of 54 biopsy proven GCA patients, significant ASD was detected in 12 (22.2%) after a median follow-up of 5.4 years. These patients were periodically evaluated (every 4 years) over a median of 10.3 years (range 4–16.6 years) in order to investigate the development of new ASD and the outcome of previously detected abnormalities. Results 18 of the 54 patients abandoned the study due to death or other reasons. The remaining 36 patients were subjected to a second screening and 14 to a third screening. 12 (33.3%) of the 36 patients re-screened and 16 (29.6%) of the initial cohort developed ASD, all but one in the thoracic aorta. Aortic diameters at the ascending and descending aorta significantly increased over time. One patient (1.9% of the initial cohort) died from aortic dissection. Surgery was advised in eight (50%) patients with ASD but could only be performed in three patients (37.7%). The development of ASD was not associated with persistence of detectable disease activity. Conclusions The incidence of ASD is maximal within the first 5 years after diagnosis but continues developing over time, affecting up to 33.3% of individuals after long term follow-up. Once ASD occurs, dilatation increases over time, underlining the need for periodic evaluation. Surgical repair is feasible in about one-third of candidates.
  • References (25)
  • Citations (56)
📖 Papers frequently viewed together
169 Citations
137 Citations
124 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References25
Newest
#1Sarah L. MackieH-Index: 19
Last. Colin T. Pease (Leeds Teaching Hospitals NHS Trust)H-Index: 32
view all 4 authors...
Objectives To review the literature in order to estimate how many previously unknown thoracic aortic aneurysms (TAAs) and thoracic aortic dilatations (TADs) might be detected by systematic, cross-sectional aortic imaging of patients with giant cell arteritis (GCA). Methods A systematic literature review was performed using Ovid Medline, Embase and the Cochrane Library. Studies potentially relevant to TAA/TAD were evaluated by two authors independently for relevance, bias and heterogeneity. Meta-...
38 CitationsSource
#1Tanaz A. Kermani (UCLA: University of California, Los Angeles)H-Index: 18
#2Kenneth J. Warrington (Mayo Clinic)H-Index: 33
Last. Eric Lawrence Matteson (Mayo Clinic)H-Index: 70
view all 7 authors...
137 CitationsSource
#1J. C. Jennette (UNC: University of North Carolina at Chapel Hill)H-Index: 3
#2Ronald J. Falk (UNC: University of North Carolina at Chapel Hill)H-Index: 71
Last. Richard A. Watts (UEA: University of East Anglia)H-Index: 49
view all 28 authors...
2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides J. Jennette;R. Falk;P. Bacon;N. Basu;M. Cid;F. Ferrario;L. Flores-Suarez;W. Gross;L. Guillevin;E. Hagen;G. Hoffman;D. Jayne;C. Kallenberg;P. Lamprecht;C. Langford;R. Luqmani;A. Mahr;E. Matteson;P. Merkel;S. Ozen;C. Pusey;N. Rasmussen;A. Rees;D. Scott;U. Specks;J. Stone;K. Takahashi;R. Watts; Arthritis & Rheumatism
2,020 CitationsSource
#1Olivier EspitiaH-Index: 6
#2Antoine NéelH-Index: 19
Last. Christian AgardH-Index: 22
view all 10 authors...
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 even...
41 CitationsSource
#1Carlo SalvaraniH-Index: 70
#2Nicolò PipitoneH-Index: 35
Last. Gene G. Hunder (Mayo Clinic)H-Index: 77
view all 4 authors...
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory disorders that commonly occur in the elderly and whose disease patterns variably overlap. In this Review, Salvarani and colleagues describe the main clinical features of both PMR and GCA, detailing the pathogenesis, diagnosis, classification and management of these disorders, offering practical guidance to clinicians.
101 CitationsSource
#2Pedro ArguisH-Index: 13
Last. Maria C. Cid (University of Barcelona)H-Index: 52
view all 10 authors...
169 CitationsSource
Last. Maria C. CidH-Index: 52
view all 6 authors...
Vasculitis encompasses a heterogeneous group of disorders characterized by inflammation of blood vessels. Inflammation affects vessels of any type and size, and causes a wide range of clinical manifestations, depending on the vascular bed involved. The preferential size of involved vessels and the targeted tissues determine the clinical presentation and serve as key elements for classification (Watts & Scott, 2009). Vasculitis may occur as a primary process or may be secondary to an underlying d...
3 CitationsSource
#1Reinhart GrundmannH-Index: 1
8 CitationsSource
#1Haner Direskeneli (Marmara University)H-Index: 39
#2Sibel Zehra Aydin (Marmara University)H-Index: 29
Last. Peter A. Merkel (BU: Boston University)H-Index: 67
view all 12 authors...
Giant cell (GCA) and Takayasu’s arteritis (TAK) are 2 forms of large-vessel vasculitis (LVV) that involve the aorta and its major branches. GCA has a predilection for the cranial branches, while TAK tends to affect the extracranial branches. Both disorders may also cause nonspecific constitutional symptoms. Although some clinical features are more common in one or the other disorder and the ages of initial presentation differ substantially, there is enough clinical and histopathologic overlap be...
61 CitationsSource
#1Mark E. Lindsay (Johns Hopkins University)H-Index: 18
#2Harry C. Dietz (Johns Hopkins University)H-Index: 90
Aortic aneurysm is common, accounting for 1–2% of all deaths in industrialized countries. Early theories of the causes of human aneurysm mostly focused on inherited or acquired defects in components of the extracellular matrix in the aorta. Although several mutations in the genes encoding extracellular matrix proteins have been recognized, more recent discoveries have shown important perturbations in cytokine signalling cascades and intracellular components of the smooth muscle contractile appar...
285 CitationsSource
Cited By56
Newest
#1Takahiko Sugihara (Tokyo Medical and Dental University)H-Index: 13
#2Hitoshi Hasegawa (Ehime University)H-Index: 34
Last. Noriyoshi Ogawa (Hamamatsu University)H-Index: 13
view all 21 authors...
BACKGROUND: Relapses frequently occur in giant cell arteritis (GCA), and long-term glucocorticoid therapy is required. The identification of associated factors with poor treatment outcomes is important to decide the treatment algorithm of GCA. METHODS: We enrolled 139 newly diagnosed GCA patients treated with glucocorticoids between 2007 and 2014 in a retrospective, multi-center registry. Patients were diagnosed with temporal artery biopsy, 1990 American College of Rheumatology classification cr...
Source
#1António Mesquita (NSU: Nova Southeastern University)
Last. Vítor BrotasH-Index: 1
view all 4 authors...
A 60-year-old man was hospitalised with persistent fever, arm pain, dry cough and cholestasis. Diagnostic workup was remarkable for elevated inflammatory markers. Infectious diseases and autoimmune screening were negative. Imaging modalities excluded a neoplastic aetiology. Liver biopsy was negative for granulomatous or lymphomatous infiltrations. Giant cell arteritis (GCA) was suspected, but temporal artery Doppler ultrasound and biopsy were non-diagnostic. A positron emission tomography scan s...
Source
#1Sarah L. Mackie (University of Leeds)H-Index: 19
#2Christian Dejaco (University of Graz)H-Index: 27
Last. Alexandre Wagner Silva de Souza (UNIFESP: Federal University of São Paulo)H-Index: 13
view all 36 authors...
Source
#1M. VautierH-Index: 4
#2Axelle Dupont (Paris Diderot University)H-Index: 1
Last. Patrice CacoubH-Index: 72
view all 12 authors...
Abstract Objectives To assess prognosis factors and outcome of large vessel involvement (LVI) in large vessels vasculitis (LVV) patients. Methods Retrospective multicenter study of characteristics and outcomes of 417 patients with LVI including 299 Takayasu arteritis (TAK) and 118 Giant cell arteritis (GCA-LVI) were analyzed. Logistic regression analysis assessed prognosis factors in LVV patients. Outcome of LVI among TAK and GCA-LVI patients (ischemic complications, aneurysms complications, rel...
Source
#1Mohammad Bardi (UBC: University of British Columbia)H-Index: 1
Large vessel vasculitis (LVV) is the most common form of primary vasculitis comprising of giant cell arteritis (GCA), Takayasu’s arteritis (TAK) and idiopathic aortitis. Early diagnosis and treatment of LVV are paramount to reduce the risk of ischemic complications such as visual loss and strokes, vascular stenosis and occlusion, and aortic aneurysm formation. Use of imaging modalities [ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and [18F]-fluorodeoxyglucose posit...
1 CitationsSource
#1Sara MontiH-Index: 9
#2Ana Filipa ÁguedaH-Index: 3
Last. Bernhard HellmichH-Index: 35
view all 11 authors...
Objectives To analyse the current evidence for the management of large vessel vasculitis (LVV) to inform the 2018 update of the EULAR recommendations. Methods Two systematic literature reviews (SLRs) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, were performed. Medline, Embase and Cochrane databases were searched from inception to 31 December 2017. Evidence on imaging was excluded as recently published in dedicated EULAR recommendations. This paper focuses on ...
2 CitationsSource
#1Stephan ImfeldH-Index: 13
#2Markus AschwandenH-Index: 26
Last. Thomas DaikelerH-Index: 24
view all 7 authors...
Source
#2Olivier Espitia (University of Nantes)H-Index: 6
Last. Christian AgardH-Index: 22
view all 4 authors...
Points essentiels Une aortite, definie par un epaississement parietal de l’aorte, est observee chez environ 50 % des patients ayant une arterite a cellules geantes (ACG). Des lesions structurales de l’aorte, ectasie ou anevrisme, peuvent survenir, avec ou sans aspect inflammatoire de l’aorte, parfois des le diagnostic d’ACG, mais le plus souvent au cours du suivi. La mise en evidence de l’atteinte aortique, a rechercher chez tout patient des le diagnostic d’ACG, repose sur une imagerie de l’aort...
Source
#1Christian Löffler (University of Tübingen)H-Index: 2
#2Bernhard Hellmich (University of Tübingen)H-Index: 35
Aufgrund ihrer hohen Inzidenz und des hohen Risikos fur Erblindung und Apoplexie muss die Diagnose einer Riesenzellarteriitis rasch gestellt werden. Bei entsprechender klinischer Konstellation mit temporalen Kopfschmerzen, Kauclaudicatio, plotzlichem Visusverlust, Polymyalgia-rheumatica-Symptomatik und konstitutionellen Symptomen ist es mithilfe der Duplexsonografie in der Regel moglich, die Erkrankung zu diagnostizieren. Typische sonografische Befunde als Ausdruck der Gefaswandinflammation sind...
Source
#1Helena Florez (University of Barcelona)H-Index: 2
#2Sergio Prieto-González (University of Barcelona)H-Index: 21
Last. José Hernández-Rodríguez (University of Barcelona)H-Index: 33
view all 5 authors...
AbstractGiant cell arteritis (GCA) is a primary large vessel vasculitis in which glucocorticoid (GC) therapy is the mainstay of treatment. During GC tapering, relapses may occur in about half of GCA patients, most of them occurring within the first two years of treatment. Recurrences beyond two years of GC withdrawal are extremely rare. We report a GCA patient with initial lower limb arterial involvement presenting with polymyalgia rheumatica after 34 years of being in remission with no treatmen...
Source