title: Prospective long term follow-up of a cohort of patients with giant cell arteritis screened for aortic structural damage (aneurysm or dilatation).
abstract: BACKGROUND
  Aortic structural damage (ASD) may complicate the course of patients with giant cell arteritis (GCA). However the frequency and outcome of ASD has not been assessed in long term prospective studies.
  
  
  METHODS
  In a previous screening of 54 biopsy proven GCA patients, significant ASD was detected in 12 (22.2%) after a median follow-up of 5.4 years. These patients were periodically evaluated (every 4 years) over a median of 10.3 years (range 4-16.6 years) in order to investigate the development of new ASD and the outcome of previously detected abnormalities.
  
  
  RESULTS
  18 of the 54 patients abandoned the study due to death or other reasons. The remaining 36 patients were subjected to a second screening and 14 to a third screening. 12 (33.3%) of the 36 patients re-screened and 16 (29.6%) of the initial cohort developed ASD, all but one in the thoracic aorta. Aortic diameters at the ascending and descending aorta significantly increased over time. One patient (1.9% of the initial cohort) died from aortic dissection. Surgery was advised in eight (50%) patients with ASD but could only be performed in three patients (37.7%). The development of ASD was not associated with persistence of detectable disease activity.
  
  
  CONCLUSIONS
  The incidence of ASD is maximal within the first 5 years after diagnosis but continues developing over time, affecting up to 33.3% of individuals after long term follow-up. Once ASD occurs, dilatation increases over time, underlining the need for periodic evaluation. Surgical repair is feasible in about one-third of candidates.
authors.affiliation: Vasculitis Research Unit, Department of Emergency Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García-Martínez
authors.affiliation: Centre for Diagnostic Imaging, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Arguis
authors.affiliation: Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Prieto-González
authors.affiliation: Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Georgina
authors.initials: G
authors.lastname: Espígol-Frigolé
authors.affiliation: Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Alba
authors.affiliation: Vasculitis Research Unit, Department of Emergency Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Butjosa
authors.affiliation: Vasculitis Research Unit, Department of Emergency Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Itziar
authors.initials: I
authors.lastname: Tavera-Bahillo
authors.affiliation: Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Hernández-Rodríguez
authors.affiliation: Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Cid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D013700:Giant Cell Arteritis / Q000150:complications*; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
keywords: Cardiovascular Disease; Corticosteroids; Giant Cell Arteritis; Outcomes research; Systemic vasculitis