Friday, 20 Sep 2019

You are here

Noninfectious Proximal Aortitis Needs Serial Follow-ups

A Cleveland Clinic review of patients undergoing thoracic aortic surgery (1996‐2012) identified 196 patients with histopathology‐proven non‐infectious aortitis. The majority of these patients had a recognized systemic disorder, and serial assessments and imaging is crucial to an accurate diagnosis.

In this cohort, diagnoses (giant cell arteritis [GCA], Takayasu's arteritis [Tak], clinically‐isolated aortitis [CIA], or Other), were determined at the time of surgery.

Most patients were older (age 65.6 years), female (67%) and Caucasian (90.3%).  Diagnoses at surgery included:

  • CIA 66%
  • GCA 21%
  • TAK 7%
  • other systemic inflammatory diseases 6%.

During mean follow up of 56.2 months, 19% of CIA patients developed new symptoms, 45% developed new radiographic vascular lesions, 40% underwent additional vascular surgery, and 9 (12%) died.

Eleven of 73 patients (15%) initially classified as CIA developed features of a systemic disease, most often GCA.

The majority of patients (66%) with histopathology‐proven aortitis have CIA at the time of surgery. CIA patients infrequently report new symptoms over time, but new vascular lesions requiring surgery commonly occur.

Long term follow‐up (including large vessel imaging) is strongly advised for all aortitis patients.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Sensitivity of Temporal Artery Biopsy

Metanalysis shows that temporal artery biopsy (TAB) for the diagnosis of giant cell arteritis (GCA) has a sensitivity of 77%, similar to results seen with temporal artery imaging. These data suggest clinicians may be willing to accept a GCA diagnosis without proof by TAB.

FDA Grants Breakthrough Status for Potential Lupus Nephritis Drug

Obinutuzumab (Gazyva) has been granted Breakthrough Therapy Designation (BTD) by the U.S. Food and Drug Administration (FDA) for use in adults with lupus nephritis (LN). The drug made by Genentech, is going forward based on the Phase II NOBILITY study in adult patients with proliferative lupus nephritis (LN). Currently, there are no FDA-approved medicines for lupus nephritis.

Riociguat Fails in Systemic Sclerosis-Associated Digital Ulcers

Riociguat is an oral, selective soluble guanylate cyclase stimulator that has been studied in patients with digital ulcers (DU) due to systemic sclerosis (SSc) but study results show that short term (16 weeks) riociquat therapy does not sufficiently reduce the DU burden in SSc patients.

Nintedanib FDA Approved for Scleroderma Lung Disease

Last Friday, the US Food and Drug Administration approved Ofev (nintedanib) to slow the rate of decline in pulmonary function in adults with interstitial lung disease associated with systemic sclerosis or scleroderma, called SSc-ILD. ILD as a complication of SSc may lead to progressive loss of lung function and may be associated with a significant mortality risk. Prior to the approval of Olev, there were no FDA approved drugs for SSc-ILD.

With Autoimmunity, Checkpoint Inhibitors Can Be Used

Among patients with pre-existing autoimmune diseases who developed cancer and were treated with immune checkpoint inhibitors (ICI), flares of the underlying disease and other immune-related adverse events were common, a retrospective study conducted in France showed.