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Outcomes Among 196 Patients With Noninfectious Proximal Aortitis
Author(s) -
Clifford Alison H.,
Arafat Amr,
Idrees Jay J.,
Roselli Eric E.,
Tan Carmela D.,
Rodriguez E. Rene,
Svensson Lars G.,
Blackstone Eugene,
Johnston Douglas,
Pettersson Gosta,
Soltesz Edward,
Hoffman Gary S.
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40855
Subject(s) - medicine , aortitis , arteritis , context (archaeology) , giant cell arteritis , surgery , medical record , systemic disease , population , takayasu's arteritis , disease , vasculitis , aorta , paleontology , environmental health , biology
Objective Noninfectious aortitis may occur in the context of a recognized systemic disease or as a topographically limited lesion without systemic features, which is called clinically isolated aortitis ( CIA ). This study was undertaken to better define and stress the limitations of this diagnostic category in a large population of patients in a single center dedicated to aortic diseases and to suggest recommendations for care. Methods Records of patients undergoing thoracic aortic surgery (1996–2012) at the Cleveland Clinic were reviewed to identify 196 patients with histopathologically proven aortitis. Clinical diagnoses (giant cell arteritis [ GCA ], Takayasu arteritis [ TAK ], CIA , or Other) were determined at the time of surgery. Clinical features, laboratory findings, and imaging results were recorded throughout the follow‐up period. At least 6 months of follow‐up data were available for 73 CIA patients. Results The mean age of the patients at time of surgery was 65.6 years (range 15–88 years); 67% of patients were female, and 90.3% were white. At the time of surgery, 129 patients (65.8%) met criteria for CIA , 42 (21.4%) for GCA , 14 (7.1%) for TAK , and 11 (5.6%) met criteria for other systemic inflammatory diseases. During a mean follow‐up period of 56.2 months, 19% of CIA patients developed new symptoms, 45% developed new radiographic vascular lesions, 40% underwent additional vascular surgery, and 12% died (n = 9). Eleven of 73 patients (15%) initially classified as having CIA developed features of a systemic disease, most often GCA . Conclusion The majority of patients (66%) with histopathologically 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. Serial follow‐up including large vessel imaging is strongly advised for all aortitis patients.