Daumas A, Rossi P, Bernard-Guervilly F, Francès Y, Berbis J, Durand J-M, Kaplanski G, Ebbo M, Harlé J-R, Weiller P-J, Serratrice J, Disdier P, Gayet S, Villani P, Granel B
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.
Aix-Marseille université, 13284 Marseille, France; Service de médecine interne, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 15, France.
Rev Med Interne. 2014 Jan;35(1):4-15. doi: 10.1016/j.revmed.2013.06.007. Epub 2013 Jul 29.
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.
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.
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.
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.
颞动脉炎中出现的主动脉受累情况可能被低估了，因为它通常无症状。巨细胞动脉炎合并主动脉受累的特征仍描述不足，且主动脉炎与该疾病血管结局之间的关系尚未明确界定。这项对63例巨细胞动脉炎患者（包括26例有主动脉受累者）的回顾性研究的目的是比较有和无主动脉炎患者的特征，并评估CT扫描和FDG - PET扫描在血管疾病筛查、患者监测及治疗管理中的作用。
这项回顾性研究于2005年1月1日至2011年9月30日在法国马赛大学医院内科进行。患者符合美国风湿病学会颞动脉炎五项标准中的至少三项，所有患者均使用CT扫描来研究主动脉受累情况。主动脉壁厚度大于或等于3mm被认为异常。
在63例诊断为巨细胞动脉炎的患者中，26例（41.3%）经主动脉CT扫描诊断有主动脉受累。主动脉炎组的诊断年龄显著更年轻（66.8岁对73.8岁；P = 0.002）。炎性背痛和腰背痛、上肢血管疾病体征（P = 0.009）以及更高水平的急性期反应物与主动脉炎相关。主动脉瘤样病变在主动脉炎组中明显更常见。20例患者同时进行了主动脉CT扫描和FDG - PET扫描。对于CT扫描未显示主动脉受累的患者，FDG - PET扫描总是无帮助的。使用皮质类固醇治疗后，经主动脉CT扫描评估，所有患者的主动脉炎在6个月内消退。然而，经FDG - PET扫描评估，80%的病例在6个月时主动脉炎持续存在，12个月时66%的病例仍持续存在，且这并未影响治疗。
该病例系列显示巨细胞动脉炎中主动脉及其主要根部受累无特异性特征，证明需通过CT扫描进行系统筛查。这种动脉受累的高频率有助于医生诊断巨细胞动脉炎。如主动脉瘤的频率和一例早期主动脉夹层病例所突出显示，主动脉炎似乎与血管并发症相关。最后，PET - CT扫描在血管疾病筛查和治疗监测中的作用仍有待阐明。
