Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
Background/Purpose: 65% of patients with newly diagnosed, biopsy-proven GCA showed radiologic finding of aortitis using CTA in a prospective study of 40 patients.
By segments, the involvement was as follows: ascending aorta 30%, aortic arch 57,5%, descending thoracic aorta 57,5%, and abdominal aorta 47,5%. Moreover, 15% of patients already had aortic dilation at the time of diagnosis.
The objective of our study was to prospectively evaluate the outcome of aortic involvement by comparing CTA findings at the time of diagnosis and those obtained after 1 year of treatment in the same patient cohort.
Methods: All the patients included in the first study were prospectively treated and followed by the investigators according to a defined protocol, and a new CTA were performed after 1 year of treatment. Vessel wall thickness and vessel diameter at the aforementioned four aortic segments were evaluated. Aortitis was defined as circumferential aortic wall thickness ≥2 mm with or without contrast enhancement of the vessel wall observed in zones without adjacent atheroma.
Results: Five out of the 40 patients were lost to follow-up or declined a new CTA, so follow-up CTA has been completed in the remaining 35 patients. CTA findings of aortitis were still present in 16 (72% of the patients who initially had aortitis). Nevertheless, significant reduction in mean wall thickening was detected in all of the aortic segments: ascending aorta (1,51±0,81 vs 1,22±0,59 mm, p=0,018), aortic arch (2,31±1,02 vs 1,77±0,87 mm; p=0,002), descending thoracic aorta (2,74±1,06 vs 2,02±0,95 mm; p<0,001), and abdominal aorta (1,68±0,8 vs 1,31±0,6 mm; p=0,012). None of the 35 patients evaluated developed new lesions in previously unaffected areas and no patients lacking aortitis in the first CTA developed new aortic involvement. Similar to the first evaluation, aortic arch and descending thoracic aorta were the most affected segments, followed by the abdominal aorta and ascending aorta, respectively. Interestingly, aortic diameters remained stable, and no patients developed new aortic dilation or increase in previous dilations.
Conclusion: CTA signs of aortitis persisted in 72% of the patients who presented initial aortic inflammation after one year of steroid treatment. Nevertheless, aortic thickening significantly decreased and there were no changes in aortic diameters during this period of time. In order to rule out clinical significance of these inflammatory findings and their possible relationship with dilatation longer follow-up is mandatory.
Supported by SAF 08/0438 and SAF 11/30073.
M. A. Alba,
M. C. Cid,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcome-of-aortic-involvement-in-giant-cell-arteritis-gca-after-1-year-follow-up-prospective-study-in-35-patients-using-computed-tompography-angiography-cta/