A Daumas1, P Rossi2, F Bernard-Guervilly2, Y Francès2, J Berbis3, J-M Durand4, G Kaplanski4, M Ebbo4, J-R Harlé4, P-J Weiller5, J Serratrice5, P Disdier5, S Gayet6, P Villani6, B Granel2. 1. Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, post-urgences et thérapeutique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. Electronic address: Aurelie.Daumas@ap-hm.fr. 2. Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 15, France. 3. Aix-Marseille université, 13284 Marseille, France; EA 3279, laboratoire de santé publique, évaluation des systèmes de soins et santé perçue, UFR médecine, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France. 4. Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France. 5. Aix-Marseille université, 13284 Marseille, France; Fédération de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. 6. Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, post-urgences et thérapeutique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
Abstract
PURPOSE: Aortic involvement that occurs in temporal arteritis is probably underestimated because it is usually asymptomatic. The characteristics of giant cell arteritis with aortic involvement are still poorly described and the relationship between aortitis and vascular outcome of the disease has not been clearly delineated. The objective of this retrospective study of 63 patients with giant cell arteritis, including 26 with aortic involvement, was to compare the features of patients with and without aortitis, and to assess the contribution of CT-scan and FDG-PET-scan in screening for vascular disease, monitoring, and therapeutic management of patients. METHODS: This retrospective study was conducted in the internal medicine department of the university hospital in Marseille, France, from January 1, 2005 to September 30, 2011. Patients had at least three out of the five American College of Rheumatology criteria for temporal arteritis and aortic involvement was investigated in all patients using CT-scan. Aortic wall thickness greater or equal to 3mm was considered to be abnormal. RESULTS: Of 63 patients diagnosed with giant cell arteritis, 26 (41.3%) had aortic involvement diagnosed by aortic CT-scan. Age at diagnosis was significantly younger (66.8 vs 73.8 years; P=0.002) in the group with aortitis. Inflammatory dorsal and low back pain, signs of vascular disease of the upper limbs (P=0.009), and higher level of acute phase reactants were associated with aortitis. Aneurysmal lesions of the aorta were significantly more frequent in the group with aortitis. Twenty patients had both aortic CT-scan and FDG-PET-scan. For patients in whom aortic involvement was not demonstrated with CT-scan, FDG-PET-scan was always non-contributive. With corticosteroids, aortitis resolved within 6 months in all patients as evaluated by aortic CT-scan. However, aortitis persisted in 80% of cases at 6 months when evaluated with FDG-PET-scan, and in 66% of cases at 12 months, without influencing the treatment. CONCLUSION: This case series shows no specific features of aorta and its main roots involvement in giant cell arteritis, justifying a systematic screening by CT-scan. The high frequency of this arterial involvement could help physicians in the diagnosis of giant cell arteritis. Aortitis seems to be associated with vascular complications as highlighted by the frequency of aortic aneurysm and a case of early aortic dissection. Finally, the role of PET-CT-scan for screening vascular disease and therapeutic monitoring remains to be clarified.
PURPOSE: Aortic involvement that occurs in temporal arteritis is probably underestimated because it is usually asymptomatic. The characteristics of giant cell arteritis with aortic involvement are still poorly described and the relationship between aortitis and vascular outcome of the disease has not been clearly delineated. The objective of this retrospective study of 63 patients with giant cell arteritis, including 26 with aortic involvement, was to compare the features of patients with and without aortitis, and to assess the contribution of CT-scan and FDG-PET-scan in screening for vascular disease, monitoring, and therapeutic management of patients. METHODS: This retrospective study was conducted in the internal medicine department of the university hospital in Marseille, France, from January 1, 2005 to September 30, 2011. Patients had at least three out of the five American College of Rheumatology criteria for temporal arteritis and aortic involvement was investigated in all patients using CT-scan. Aortic wall thickness greater or equal to 3mm was considered to be abnormal. RESULTS: Of 63 patients diagnosed with giant cell arteritis, 26 (41.3%) had aortic involvement diagnosed by aortic CT-scan. Age at diagnosis was significantly younger (66.8 vs 73.8 years; P=0.002) in the group with aortitis. Inflammatory dorsal and low back pain, signs of vascular disease of the upper limbs (P=0.009), and higher level of acute phase reactants were associated with aortitis. Aneurysmal lesions of the aorta were significantly more frequent in the group with aortitis. Twenty patients had both aortic CT-scan and FDG-PET-scan. For patients in whom aortic involvement was not demonstrated with CT-scan, FDG-PET-scan was always non-contributive. With corticosteroids, aortitis resolved within 6 months in all patients as evaluated by aortic CT-scan. However, aortitis persisted in 80% of cases at 6 months when evaluated with FDG-PET-scan, and in 66% of cases at 12 months, without influencing the treatment. CONCLUSION: This case series shows no specific features of aorta and its main roots involvement in giant cell arteritis, justifying a systematic screening by CT-scan. The high frequency of this arterial involvement could help physicians in the diagnosis of giant cell arteritis. Aortitis seems to be associated with vascular complications as highlighted by the frequency of aortic aneurysm and a case of early aortic dissection. Finally, the role of PET-CT-scan for screening vascular disease and therapeutic monitoring remains to be clarified.
Keywords:
(18F)fluorodeoxyglucose positron emission tomography; Angioscanner; Aortite; Aortitis; Artérite à cellules géantes; Computed tomography scan; Giant cell arteritis; Large vessel vasculitis; Maladie de Horton; Tomographie par émission de positons au (18)fluorodéoxyglucose; Vascularite des gros vaisseaux
Authors: Hubert de Boysson; Anael Dumont; Eric Liozon; Marc Lambert; Jonathan Boutemy; Gwénola Maigné; Nicolas Martin Silva; Audrey Sultan; Kim Heang Ly; Nicolas Aide; Alain Manrique; Boris Bienvenu; Achille Aouba Journal: Eur J Nucl Med Mol Imaging Date: 2017-07-24 Impact factor: 9.236
Authors: Elisabeth De Smit; Eoin O'Sullivan; David A Mackey; Alex W Hewitt Journal: Graefes Arch Clin Exp Ophthalmol Date: 2016-08-05 Impact factor: 3.117
Authors: Hubert de Boysson; Eric Liozon; Marc Lambert; Jean-Jacques Parienti; Nicolas Artigues; Loïk Geffray; Jonathan Boutemy; Yann Ollivier; Gwénola Maigné; Kim Ly; Damien Huglo; Eric Hachulla; Pierre-Yves Hatron; Achille Aouba; Alain Manrique; Boris Bienvenu Journal: Medicine (Baltimore) Date: 2016-06 Impact factor: 1.889
Authors: Sara Monti; Ana F Águeda; Raashid Ahmed Luqmani; Frank Buttgereit; Maria Cid; Christian Dejaco; Alfred Mahr; Cristina Ponte; Carlo Salvarani; Wolfgang Schmidt; Bernhard Hellmich Journal: RMD Open Date: 2019-09-16