title: Giant cell arteritis with or without aortitis at diagnosis. A retrospective study of 22 patients with longterm followup.
abstract: 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 events such as aortic aneurysm, mortality, relapses of GCA, and requirement for steroids, was assessed in 2011 by chart review and patient/physician interviews.
  
  
  RESULTS
  At disease onset, 10/22 patients had aortitis on CT scan. Patients with and without aortitis had similar baseline characteristics, including cardiovascular risk profile. At the time of the study, 12/22 (57%) patients had died. Vascular causes of death were more frequent in patients with aortitis (5/7 vs 0/5; p = 0.02). A higher number of vascular events was noted in patients with aortitis (mean events per patient 1.33 vs 0.25; p = 0.009). Stroke was more frequent in patients with aortitis. These patients seemed to exhibit a more chronic or relapsing disease course, and they were less likely to completely discontinue steroid therapy (p = 0.009, log-rank test).
  
  
  CONCLUSIONS
  Our study suggests for the first time that inflammatory aortic involvement present at onset of GCA could predict a more chronic/relapsing course of GCA, with higher steroid requirements and an increased risk for vascular events in the long term.
authors.affiliation: Department of Internal Medicine, Department of Epidemiology and Biostatistics, and Department of Radiology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Espitia
authors.forename: Antoine
authors.initials: A
authors.lastname: Néel
authors.forename: Christophe
authors.initials: C
authors.lastname: Leux
authors.forename: Jérome
authors.initials: J
authors.lastname: Connault
authors.forename: Alexandra
authors.initials: A
authors.lastname: Espitia-Thibault
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponge
authors.forename: Benoit
authors.initials: B
authors.lastname: Dupas
authors.forename: Jacques H
authors.initials: JH
authors.lastname: Barrier
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Hamidou
authors.forename: Christian
authors.initials: C
authors.lastname: Agard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000453:epidemiology; D001025:Aortitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate