title: Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review.
abstract: OBJECTIVE
  Non-infectious aortitis often presents with non-specific symptoms leading to inappropriate diagnostic delay. We intend to describe the clinical spectrum and outcome of patients with aortitis diagnosed at a single centre.
  
  
  METHODS
  We reviewed the clinical charts of patients diagnosed with non-infectious aortitis between January 2010 and December 2013 at the Rheumatology Division from a 1.000-bed tertiary teaching hospital from Northern Spain. The diagnosis of aortitis was usually based on FDG-PET-CT scan, and also occasionally on CT or MRI angiography or helical CT-scan.
  
  
  RESULTS
  During the period of assessment 32 patients (22 women and 10 men; mean age 68 years [range, 45-87]) were diagnosed with aortitis. The median interval from the onset of symptoms to the diagnosis was 21 months. FDG-PET CT scan was the most common tool used for the diagnosis of aortitis. The underlying conditions were the following: giant cell arteritis (n=13 cases); isolated polymyalgia rheumatica (PMR) (n=11); Sjögren's syndrome (n=2), Takayasu arteritis (n= 1); sarcoidosis (n=1), ulcerative colitis (n=1), psoriatic arthritis (n=1), and large-vessel vasculitis that also involved the aorta (n=2). The most common clinical manifestations at diagnosis were: PMR features, often with atypical clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory low back pain (n=9 patients, 28%) and fever (n=7 patients, 22%). Acute phase reactants were increased in most cases (median erythrocyte sedimentation rate 46 mm/1st hour, and a median serum C-reactive protein 1.5 mg/dL).
  
  
  CONCLUSIONS
  Aortitis is not an uncommon condition. The diagnosis is often delayed. Atypical PMR features, unexplained low back or limb pain, constitutional symptoms along with increased acute phase reactants should be considered 'red flags' to suspect the presence of aortitis.
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Loricera
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Hernández
authors.affiliation: Department of Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Carril
authors.affiliation: Department of Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Martínez-Rodríguez
authors.affiliation: Department of Radiology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Canga
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Peiró
authors.affiliation: Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Alonso-Gutiérrez
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ortiz-Sanjuán
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Mata
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Pina
authors.affiliation: Department of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: González-Vela
authors.affiliation: Department of Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Martínez-Amador
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain, and University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: M A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology*; D001025:Aortitis / Q000175:diagnosis* / Q000209:etiology; D001027:Aortography; D015535:Arthritis, Psoriatic / Q000150:complications; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications; D057210:Delayed Diagnosis; D005260:Female; D019788:Fluorodeoxyglucose F18; D056973:Four-Dimensional Computed Tomography; D013700:Giant Cell Arteritis / Q000150:complications; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011111:Polymyalgia Rheumatica / Q000150:complications; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications; D012859:Sjogren's Syndrome / Q000150:complications; D013625:Takayasu Arteritis / Q000150:complications; D062606:Tertiary Care Centers
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein