TY - JOUR
T1 - Persistent aortic inflammation in patients with giant cell arteritis
AU - Kaymakci, Mahmut S.
AU - Boire, Nicholas A.
AU - Bois, Melanie C.
AU - Elfishawi, Mohanad M.
AU - Langenfeld, Hannah E.
AU - Hanson, Andrew C.
AU - Crowson, Cynthia S.
AU - Koster, Matthew J.
AU - Sato, Yuki
AU - Weyand, Cornelia M.
AU - Warrington, Kenneth J.
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/9
Y1 - 2023/9
N2 - Objectives: To investigate the clinicopathologic features of patients with giant cell arteritis (GCA) who had thoracic aorta aneurysm or dissection surgery. Methods: Patients who had thoracic aorta surgery between January 1, 2000, and December 31, 2021, at the Mayo Clinic, Rochester, Minnesota, were identified with current procedural terminology (CPT) codes. The identified patients were screened for a prior diagnosis of GCA with diagnostic codes and electronic text search. The available medical records of all the patients of interest were manually reviewed. Thoracic aorta tissues obtained during surgery were re-evaluated in detail by pathologists. The clinicopathologic features of these patients were analyzed. Overall observed survival was compared with lifetable rates from the United States population. Results: Of the 4621 patients with a CPT code for thoracic aorta surgery, 49 had a previous diagnosis of GCA. Histopathologic evaluation of the aortic tissue revealed active aortitis in most patients with GCA (40/49, 82%) after a median (IQR) of 6.0 (2.6–10.3) years from GCA diagnosis. All patients were considered in clinical remission at the time of aortic surgery. The overall mortality compared to age and sex-matched general population was significantly increased with a standardized mortality ratio of 1.55 (95% CI, 1.05–2.19). Conclusion: Histopathologic evaluation of the thoracic aorta obtained during surgery revealed active aortitis in most patients with GCA despite being considered in clinical remission several years after GCA diagnosis. Chronic, smoldering aortic inflammation likely contributes to the development of aortic aneurysm and dissection in GCA.
AB - Objectives: To investigate the clinicopathologic features of patients with giant cell arteritis (GCA) who had thoracic aorta aneurysm or dissection surgery. Methods: Patients who had thoracic aorta surgery between January 1, 2000, and December 31, 2021, at the Mayo Clinic, Rochester, Minnesota, were identified with current procedural terminology (CPT) codes. The identified patients were screened for a prior diagnosis of GCA with diagnostic codes and electronic text search. The available medical records of all the patients of interest were manually reviewed. Thoracic aorta tissues obtained during surgery were re-evaluated in detail by pathologists. The clinicopathologic features of these patients were analyzed. Overall observed survival was compared with lifetable rates from the United States population. Results: Of the 4621 patients with a CPT code for thoracic aorta surgery, 49 had a previous diagnosis of GCA. Histopathologic evaluation of the aortic tissue revealed active aortitis in most patients with GCA (40/49, 82%) after a median (IQR) of 6.0 (2.6–10.3) years from GCA diagnosis. All patients were considered in clinical remission at the time of aortic surgery. The overall mortality compared to age and sex-matched general population was significantly increased with a standardized mortality ratio of 1.55 (95% CI, 1.05–2.19). Conclusion: Histopathologic evaluation of the thoracic aorta obtained during surgery revealed active aortitis in most patients with GCA despite being considered in clinical remission several years after GCA diagnosis. Chronic, smoldering aortic inflammation likely contributes to the development of aortic aneurysm and dissection in GCA.
KW - Aortitis
KW - Chronic disease
KW - Giant cell arteritis
KW - Histopathology
KW - Large vessel vasculitis
UR - http://www.scopus.com/inward/record.url?scp=85169502921&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85169502921&partnerID=8YFLogxK
U2 - 10.1016/j.autrev.2023.103411
DO - 10.1016/j.autrev.2023.103411
M3 - Review article
C2 - 37597603
AN - SCOPUS:85169502921
SN - 1568-9972
VL - 22
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
IS - 9
M1 - 103411
ER -