Format

Send to

Choose Destination
Autoimmun Rev. 2018 Apr;17(4):391-398. doi: 10.1016/j.autrev.2017.11.029. Epub 2018 Feb 7.

Large-vessel involvement and aortic dilation in giant-cell arteritis. A multicenter study of 549 patients.

Author information

1
Department of Internal Medicine, Caen University Hospital, Caen, France; University of Normandy, Caen, France. Electronic address: deboysson-h@chu-caen.fr.
2
Department of Internal Medicine and Therapeutics, Timone Hospital, Marseille, France.
3
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, Paris, France.
4
Biostatistics and Clinical Research Unit, Caen University Hospital, France.
5
Department of Internal Medicine and Clinical Immunology, Limoges University Hospital, Limoges, France.
6
Department of Internal Medicine, Lille University Hospital, Lille, France.
7
Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.
8
Department of Internal Medicine, Caen University Hospital, Caen, France.
9
Department of Nuclear Medicine, Caen University Hospital, Caen, France.
10
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department, France; INSERM, Paris, France; CNRS, Paris, France.
11
Department of Internal Medicine, Caen University Hospital, Caen, France; University of Normandy, Caen, France.

Abstract

OBJECTIVES:

Large-vessel involvement (LVI) can occur in giant-cell arteritis (GCA) and may represent a distinct disease subgroup with a higher risk for aortic dilation. This study aimed to better characterize the presentation and evolution of LVI in patients with GCA.

PATIENTS AND METHODS:

A retrospective multicenter study enrolled 248 GCA patients with LVI and 301 GCA patients without LVI on imaging. Factors associated with aortic dilation were identified in a multivariable model.

RESULTS:

The patients with LVI were younger (p<0.0001), more likely to be women (p=0.01), and showed fewer cephalic symptoms (p<0.0001) and polymyalgia rheumatica (p=0.001) but more extracranial vascular symptoms (p=0.05) than the patients without LVI. Glucocorticoids (GC) management did not differ between the two groups, but the GC discontinuation rate was lower in the patients with LVI (p=0.0003). Repeated aortic imaging procedures were performed at 19months [range: 5-162months] and 17months [range: 6-168months] after diagnosis in 154 patients with LVI and 123 patients without LVI, respectively, of whom 21% and 7%, respectively, presented new aortic dilations (p=0.0008). In the patients with LVI, aortic dilation occurred on an aorta segment shown to be inflammatory on previous imaging in 94% of patients. In the multivariate analysis, LVI was the strongest predictor of aortic dilation (hazard ratio: 3.16 [range: 1.34-7.48], p=0.009).

CONCLUSIONS:

LVI represents a distinct disease pattern of GCA with an increased risk of aortic dilation. Control of the aortic morphology during follow-up is required.

KEYWORDS:

Aortic dilation; Aortitis; Giant-cell arteritis; Large-vessel involvement

PMID:
29427822
DOI:
10.1016/j.autrev.2017.11.029
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center