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Espitia O, Toquet C, Jamet B, Serfaty JM, Agard C. [Aortitis]. Rev Med Interne 2024:S0248-8663(24)00674-X. [PMID: 39034261 DOI: 10.1016/j.revmed.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
Aortitis is a rare disease entity of unknown prevalence. Primary aortitis mainly affects the thoracic aorta. They are most often diagnosed on imaging by grade III 18-FDG uptake of the aortic wall on PET, or by circumferential thickening>2.2mm on CT or MRI with late-stage contrast. More rarely, aortitis is histologically proven, as in some cases of clinically isolated aortitis discovered after planned aortic aneurysm surgery or during aortic dissection surgery. The most common histological types are granulomatous/giant cell or lymphoplasmacytic. Clinical signs associated with aortitis are often non-specific: asthenia, fever, dry cough, chest, back, lumbar or abdominal pain. Aortitis can be divided into different etiological categories: primary aortitis, which includes vasculitis with a preferential or exclusive tropism for the aortic wall, aortitis secondary to systemic or iatrogenic diseases, and infectious aortitis. The main etiologies of primary aortitis are giant cell arteritis (GCA), Takayasu arteritis (TA) or clinically isolated aortitis. Aortitis secondary to systemic diseases is seen in atrophying polychondritis, systemic lupus and inflammatory rheumatic diseases such as spondyloarthropathy and rheumatoid arthritis. In both ACG and AT, aortitis is a negative factor, characterized by a higher risk of relapse, cardiovascular complications and increased mortality. The management of aortitis is insufficiently codified, and relies on the control of cardiovascular risk factors, with particular monitoring of blood pressure and LDL cholesterol, and on corticosteroid therapy and immunosuppressive drugs, the use of which will depend on the disease associated with the aortitis, the initial severity and comorbidities.
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Affiliation(s)
- Olivier Espitia
- Inserm UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Service de Médecine Interne et Vasculaire, Institut du Thorax, Nantes Université, CHU de Nantes, 44000 Nantes, France.
| | - Claire Toquet
- Inserm UMR1087/CNRS UMR 6291, service d'anatomopathologie, institut du thorax, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - Bastien Jamet
- CNRS, Inserm, CRCINA, service de médecine nucléaire, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - Jean-Michel Serfaty
- Inserm UMR1087/CNRS UMR 6291, service de radiologie cardiaque et vasculaire, institut du thorax, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - Christian Agard
- Service de médecine interne, Nantes université, CHU de Nantes, 44000 Nantes, France
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Manzo C, Castagna A, Veronese N, Isetta M. Presence of subclinical giant cell arteritis in patients with morning stiffness of duration less than 45 minutes at the time of diagnosis of polymyalgia rheumatica. Reumatologia 2024; 61:432-438. [PMID: 38322103 PMCID: PMC10839912 DOI: 10.5114/reum/176860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/12/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction In some patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) is subclinical as underlying inflammation of large vessels (LV) is present without evidence of related clinical manifestations. Different factors have been proposed as predictive of subclinical GCA in PMR patients. To date, the literature reports scant data about the association between subclinical GCA and long-lasting morning stiffness (MS) in patients at the time of diagnosis of PMR. Given this background, the aim of this study was to assess the association between subclinical GCA and MS < 45 min in patients with newly diagnosed PMR. Material and methods We performed an observational, retrospective, single-centre cohort study of patients consecutively referred to our public out-of-hospital rheumatologic clinic between January 2015 and December 2020, who could be classified as having PMR according to the 2012 EULAR/ACR criteria. Subclinical GCA was investigated through ultrasound examination of a core set of arteries (temporal, axillary, common carotid, and subclavian arteries), in accordance with the EULAR recommendations for the use of imaging in LV vasculitis. Patients who did not have GCA symptoms but showed halo sign in at least one of these arteries were described as having subclinical GCA. Results We included a total of 143 patients (35 men and 108 women). Their median age was of 71.5 years. Thirty-five had MS duration < 45 min at the time of PMR diagnosis. Subclinical GCA was found in 23 PMR patients (16.1%); 18 had a cranial and 5 an extracranial GCA. A univariate analysis highlighted that MS < 45 min was associated with a lower prevalence of GCA (OR = 0.11, 95% CI: 0.04-0.29; p < 0.0001). This association was retained in a multivariable analysis that accounted for 6 different potential covariates (OR = 0.06, 95% CI: 0.01-0.26; p < 0.0001. Conclusions In our study MS < 45 min at the time of PMR diagnosis was associated with a significantly lower risk of subclinical GCA, when patients were screened by ultrasound, of approximately 90%. Identification of a more accurate MS cut-off value could improve the accuracy for subclinical GCA in patients with newly diagnosed PMR.
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Affiliation(s)
- Ciro Manzo
- Rheumatologic Outpatient Clinic, Azienda Sanitaria Napoli 3 sud, Sant' Agnello, Italy
| | - Alberto Castagna
- Department of Primary Care, Health District of Soverato, Azienda Sanitaria Provinciale Catanzaro, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Medicine, University of Palermo, Italy
| | - Marco Isetta
- Central and North West London NHS Trust, England
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Espitia O, Bruneval P, Assaraf M, Pouchot J, Liozon E, de Boysson H, Gaudric J, Chiche L, Achouh P, Roussel JC, Miranda S, Mirault T, Boussouar S, Redheuil A, Serfaty JM, Bénichou A, Agard C, Guédon AF, Cacoub P, Paraf F, Fouret PJ, Toquet C, Biard L, Saadoun D. Long-Term Outcome and Prognosis of Noninfectious Thoracic Aortitis. J Am Coll Cardiol 2023; 82:1053-1064. [PMID: 37673506 DOI: 10.1016/j.jacc.2023.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known. OBJECTIVES The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis. METHODS This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis. RESULTS Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died. CONCLUSIONS This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France.
| | - Patrick Bruneval
- Department of cardiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Morgane Assaraf
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jacques Pouchot
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Liozon
- Department of Internal Medicine, CHU Limoges, France
| | | | - Julien Gaudric
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Paul Achouh
- Department of Cardiothoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Christian Roussel
- Department of Cardiothoracic Surgery, Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | | | - Tristan Mirault
- Université Paris Cité, Department of Vascular Medicine, Hôpital Européen Georges Pompidou, APHP, INSERM U970 PARCC, Paris, France
| | - Samia Boussouar
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Alban Redheuil
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Jean-Michel Serfaty
- Nantes Université, CHU Nantes, Department of Cardiovascular Imaging, Nantes, France
| | - Antoine Bénichou
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Alexis F Guédon
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Patrice Cacoub
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Pierre-Jean Fouret
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Service d'anatomopathologie, UPMC-Paris VI, Paris, France
| | - Claire Toquet
- Nantes Université, CHU Nantes, Department of Pathology, Nantes, France
| | - Lucie Biard
- APHP Department of Biostatistics and Medical Information, Saint-Louis Hospital, Paris, France; ECSTRRA Team, CRESS UMR 1153, INSERM, Paris Cité University, Paris, France
| | - David Saadoun
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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Abstract
Vasculitis is a diverse group of disorders involving inflammation of the blood vessels. Approaching the diagnosis of vasculitis can be challenging, given the differing clinical presentation and organ manifestations. Often vasculitis is a diagnosis that is considered too late, given the heterogeneous presentation and various mimics. This article aims to provide physicians with a diagnostic approach to vasculitis.
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Affiliation(s)
- Kunal Mishra
- Division of Cardiovascular Medicine, University of Virginia, 1215 Lee Street, PO BOX- 100058, Charlottesville, VA 22902, USA
| | - Randy K Ramcharitar
- Division of Cardiovascular Medicine, University of Virginia, 1215 Lee Street, PO BOX- 100058, Charlottesville, VA 22902, USA
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, 1215 Lee Street, PO BOX- 100058, Charlottesville, VA 22902, USA.
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Kermani TA, Byram K. Isolated Aortitis: Workup and Management. Rheum Dis Clin North Am 2023; 49:523-543. [PMID: 37331731 DOI: 10.1016/j.rdc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The finding of aortitis, often incidentally noted on surgical resection, should prompt evaluation for secondary causes including large-vessel vasculitis. In a large proportion of cases, no other inflammatory cause is identified and the diagnosis of clinically isolated aortitis is made. It is unknown whether this entity represents a more localized form of large-vessel vasculitis. The need for immunosuppressive therapy in patients with clinically isolated aortitis remains unclear. Patients with clinically isolated aortitis warrant imaging of the entire aorta at baseline and regular intervals because a significant proportion of patients have or develop abnormalities in other vascular beds.
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Affiliation(s)
- Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA 90404, USA.
| | - Kevin Byram
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, T3113, MCN, Nashville, TN 37232, USA
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Seitz L, Seitz P, Pop R, Lötscher F. Spectrum of Large and Medium Vessel Vasculitis in Adults: Primary Vasculitides, Arthritides, Connective Tissue, and Fibroinflammatory Diseases. Curr Rheumatol Rep 2022; 24:352-370. [PMID: 36166150 PMCID: PMC9513304 DOI: 10.1007/s11926-022-01086-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review To provide a comprehensive overview of the spectrum of large and medium vessel vasculitis in adults with primary vasculitides, arthritides, connective tissue, and fibroinflammatory diseases as well as vasculitis mimics, for an efficient differential diagnosis and initial diagnostic approach. Recent Findings Imaging has had a tremendous impact on the diagnosis of medium to large vessel vasculitis, now often replacing histopathologic confirmation and identifying new disease manifestations (e.g., intracranial disease in giant cell arteritis; vascular manifestations of IgG4-related disease). Novel diseases or syndromes involving blood vessels have been described (e.g., VEXAS-Syndrome with polychondritis). The use of the terms “medium” or “large” vessel varies considerably between medical specialties. Summary The differential diagnosis of large and medium vessel vasculitis is becoming increasingly complex as new entities or disease manifestations of known inflammatory rheumatic diseases are regularly identified. A more precise and widely recognized definition of the vessel sizes would make future research more comparable.
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Affiliation(s)
- Luca Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. .,Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland.
| | - Pascal Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Roxana Pop
- Department of Infectious Diseases and Hospital Hygiene, University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
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Martins-Martinho J, Dourado E, Khmelinskii N, Espinosa P, Ponte C. Localized Forms of Vasculitis. Curr Rheumatol Rep 2021; 23:49. [PMID: 34196889 PMCID: PMC8247627 DOI: 10.1007/s11926-021-01012-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/26/2022]
Abstract
Purpose of Review To provide an updated review on epidemiology, clinical manifestations, diagnostic assessment, treatment, and prognosis of localized vasculitis, following the 2012 Revised International Chapel Hill Consensus Conference Nomenclature on single-organ vasculitis. Recent Findings Localized, single-organ vasculitides encompass a group of rare conditions in which there is no evidence of concomitant systemic vasculitis. Most data on this topic derives from case reports and small case series. Although some aspects of these diseases, such as clinical manifestations and histologic findings, have already been extensively investigated, there is still a lack of robust data concerning the pathogenesis, epidemiology, and treatment. Summary Localized vasculitides may have a wide range of clinical features depending on the organ affected. The inflammatory process may have a multifocal/diffuse or unifocal distribution. Diagnosis is usually based on histopathology findings and exclusion of systemic vasculitis, which may frequently pose a challenge. Further research on treatment is warranted.
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Affiliation(s)
- Joana Martins-Martinho
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal. .,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Eduardo Dourado
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Pablo Espinosa
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal.,Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal
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