title: [Clinical, laboratory, radiological features, and outcome in 26 patients with aortic involvement amongst a case series of 63 patients with giant cell arteritis].
abstract: OBJECTIVE
  Aortic involvement that occurs in temporal arteritis is probably underestimated because it is usually asymptomatic. The characteristics of giant cell arteritis with aortic involvement are still poorly described and the relationship between aortitis and vascular outcome of the disease has not been clearly delineated. The objective of this retrospective study of 63 patients with giant cell arteritis, including 26 with aortic involvement, was to compare the features of patients with and without aortitis, and to assess the contribution of CT-scan and FDG-PET-scan in screening for vascular disease, monitoring, and therapeutic management of patients.
  
  
  METHODS
  This retrospective study was conducted in the internal medicine department of the university hospital in Marseille, France, from January 1, 2005 to September 30, 2011. Patients had at least three out of the five American College of Rheumatology criteria for temporal arteritis and aortic involvement was investigated in all patients using CT-scan. Aortic wall thickness greater or equal to 3mm was considered to be abnormal.
  
  
  RESULTS
  Of 63 patients diagnosed with giant cell arteritis, 26 (41.3%) had aortic involvement diagnosed by aortic CT-scan. Age at diagnosis was significantly younger (66.8 vs 73.8 years; P=0.002) in the group with aortitis. Inflammatory dorsal and low back pain, signs of vascular disease of the upper limbs (P=0.009), and higher level of acute phase reactants were associated with aortitis. Aneurysmal lesions of the aorta were significantly more frequent in the group with aortitis. Twenty patients had both aortic CT-scan and FDG-PET-scan. For patients in whom aortic involvement was not demonstrated with CT-scan, FDG-PET-scan was always non-contributive. With corticosteroids, aortitis resolved within 6 months in all patients as evaluated by aortic CT-scan. However, aortitis persisted in 80% of cases at 6 months when evaluated with FDG-PET-scan, and in 66% of cases at 12 months, without influencing the treatment.
  
  
  CONCLUSIONS
  This case series shows no specific features of aorta and its main roots involvement in giant cell arteritis, justifying a systematic screening by CT-scan. The high frequency of this arterial involvement could help physicians in the diagnosis of giant cell arteritis. Aortitis seems to be associated with vascular complications as highlighted by the frequency of aortic aneurysm and a case of early aortic dissection. Finally, the role of PET-CT-scan for screening vascular disease and therapeutic monitoring remains to be clarified.
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, post-urgences et thérapeutique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. Electronic address: Aurelie.Daumas@ap-hm.fr.
authors.forename: A
authors.initials: A
authors.lastname: Daumas
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 15, France.
authors.forename: P
authors.initials: P
authors.lastname: Rossi
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 15, France.
authors.forename: F
authors.initials: F
authors.lastname: Bernard-Guervilly
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 15, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Francès
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; EA 3279, laboratoire de santé publique, évaluation des systèmes de soins et santé perçue, UFR médecine, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France.
authors.forename: J
authors.initials: J
authors.lastname: Berbis
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Durand
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France.
authors.forename: G
authors.initials: G
authors.lastname: Kaplanski
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France.
authors.forename: M
authors.initials: M
authors.lastname: Ebbo
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France.
authors.forename: J-R
authors.initials: JR
authors.lastname: Harlé
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Fédération de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: P-J
authors.initials: PJ
authors.lastname: Weiller
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Fédération de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: J
authors.initials: J
authors.lastname: Serratrice
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Fédération de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: P
authors.initials: P
authors.lastname: Disdier
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, post-urgences et thérapeutique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: S
authors.initials: S
authors.lastname: Gayet
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, post-urgences et thérapeutique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: P
authors.initials: P
authors.lastname: Villani
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 15, France.
authors.forename: B
authors.initials: B
authors.lastname: Granel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy; D001011:Aorta; D001025:Aortitis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D014057:Tomography, X-Ray Computed
keywords: (18F)fluorodeoxyglucose positron emission tomography; Angioscanner; Aortite; Aortitis; Artérite à cellules géantes; Computed tomography scan; Giant cell arteritis; Large vessel vasculitis; Maladie de Horton; Tomographie par émission de positons au (18)fluorodéoxyglucose; Vascularite des gros vaisseaux