From the Guidelines
Aortitis, an inflammation of the aorta, should be diagnosed and treated promptly to prevent life-threatening complications, with treatment typically involving corticosteroids like prednisone and potentially immunosuppressants or antibiotics, depending on the underlying cause, as recommended by the 2021 American College of Rheumatology/Vasculitis Foundation guideline 1. The diagnosis of aortitis can be challenging, but it is essential to identify the underlying cause, which can be infections, autoimmune disorders like giant cell arteritis or Takayasu arteritis, or conditions such as ankylosing spondylitis.
- Key considerations in the diagnosis of aortitis include:
- Clinical presentation, such as headaches, scalp tenderness, vision loss, and jaw claudication in giant cell arteritis
- Pathologic abnormalities on temporal artery biopsy
- Evidence of large vessel involvement on vascular imaging, such as MRI or CT angiography
- Laboratory tests, including inflammatory markers and blood cultures According to the 2018 EULAR recommendations for the use of imaging in large vessel vasculitis, MRI is recommended as the first imaging test to make a diagnosis of Takayasu arteritis, assuming high expertise and prompt availability of the technique 1. Treatment of aortitis should be individualized based on the underlying cause, but typically involves corticosteroids like prednisone starting at 40-60mg daily, gradually tapered over months, and potentially immunosuppressants such as methotrexate or azathioprine for autoimmune aortitis, or antibiotics for infectious aortitis 1. Regular imaging with CT or MRI angiography is essential to monitor disease progression and response to treatment, as well as to detect potential complications such as aortic aneurysm or dissection, which may require surgical intervention 1.
- Important considerations in the treatment of aortitis include:
- Monitoring for potential complications, such as aortic aneurysm or dissection
- Adjusting treatment based on disease progression and response to therapy
- Considering surgical intervention for complications or refractory disease Prompt diagnosis and treatment are crucial, as mortality rates can be high in untreated cases, particularly with infectious aortitis, highlighting the importance of a comprehensive and multidisciplinary approach to managing aortitis 1.
From the Research
Diagnosis of Aortitis
- Aortitis can be diagnosed using various imaging techniques such as PET/CT, angio-CT, and angio-MRI 2
- The diagnosis of aortitis is often made in patients with giant cell arteritis (GCA), with aortic parietal thickening noted in about 50% of patients with GCA 2
- Infectious aortitis can be difficult to diagnose, especially in the absence of aneurysm or pseudoaneurysm, and requires a high index of suspicion 3
Treatment of Aortitis
- The treatment of GCA-related aortitis is based on high-dose glucosteroids, with an initial prednisone dose at 0.7 mg/kg/d 2
- Tocilizumab (TCZ) has been shown to be effective in treating aortitis and aneurysms associated with GCA, with a rapid and maintained clinical and analytical improvement observed in patients treated with TCZ 4
- Aortic ectasia and aneurisms require monitoring, and aortic surgery may be proposed in the best conditions possible 2
Complications of Aortitis
- Aortitis can lead to serious complications such as aneurysm rupture or aortic dissection, which can be potentially reduced with early diagnosis and regular monitoring 2
- Infectious aortitis can cause sudden unexpected death due to aortic tears, especially in patients with risk factors for atherosclerosis 5
- The prognosis of aortitis and its complications remains poorly known, but mortality due to serious events can be potentially reduced with early diagnosis and treatment 2