Josselin-Mahr Laurence, El Hessen Tony Abi, Toledano Cecile, Fardet Laurence, Kettaneh Adrien, Tiev Kiet, Cabane Jean
Hôpital Saint-Antoine, service de médecine interne, 75012 Paris, France.
Presse Med. 2013 Feb;42(2):151-9. doi: 10.1016/j.lpm.2012.03.003. Epub 2012 Apr 30.
A sub-clinical inflammatory aortitis is very frequent in patients with giant cell arteritis, and can be the only localization of the disease. In most patients, this aortitis is asymptomatic and is of no consequence on the patient's survival. The relative risk of developing an aortic dissection or aneurysm is 17.3. Evolution towards an aneurysm or an aortic dissection is unpredictable and rare; and seems independent of the disease activity and the associated vascular risk factors. Isolated aortitis treatment is not consensual, but often similar to the treatment of giant cell arteritis and adapted to clinical and biological markers of disease activity. Screening for sub-clinical aortitis with FDG-PET should not be prescribed in patients with typical presentation of giant cell arteritis. A systematic screening of aortic complications in giant cell arteritis patients could be done with a chest X-ray and an abdominal ultrasound possibly completed with an aortic CT-scan at time of diagnosis, in order to look for aneurysms with possible surgical indication.
亚临床炎症性主动脉炎在巨细胞动脉炎患者中非常常见，并且可能是该疾病的唯一病变部位。在大多数患者中，这种主动脉炎无症状，对患者生存无影响。发生主动脉夹层或动脉瘤的相对风险为17.3。向动脉瘤或主动脉夹层的演变不可预测且罕见；并且似乎与疾病活动及相关血管危险因素无关。孤立性主动脉炎的治疗尚无共识，但通常与巨细胞动脉炎的治疗相似，并根据疾病活动的临床和生物学指标进行调整。对于有典型巨细胞动脉炎表现的患者，不应进行FDG-PET筛查亚临床主动脉炎。在巨细胞动脉炎患者诊断时，可通过胸部X线和腹部超声进行主动脉并发症的系统筛查，必要时可进行主动脉CT扫描，以寻找可能有手术指征的动脉瘤。
