EULAR 2014 | Daily Highlights

OUTCOME OF LARGE-VESSEL INVOLVEMENT IN GIANT CELL ARTERITIS AFTER 1-YEAR OF GLUCOCORTICOID TREATMENT: PROSPECTIVE STUDY USING COMPUTED TOMPOGRAPHY ANGIOGRAPHY

Abstract: FRI0477
Presenter: S. Prieto-Gonzales
Co-Authors: A. Garcia-Martinez, J.Hernandez-Rodriguez, M.A.Alba et al.

Background:
In a previous study, computed tomography angiography (CTA) disclosed signs of large-vessel vasculitis (LVV) in 67.5% of giant cell arteritis (GCA) patients at the time of diagnosis. Moreover, 15% of patients already had aortic dilation at that assessment.

Objectives:
To prospectively evaluate the outcome of large-vessel involvement in GCA patients by comparing CTA findings at the time of diagnosis and those obtained after 1 year of GC treatment.

Methods:
The 40 GCA-patients evaluated by CTA at diagnosis, were prospectively treated and followed, and scheduled a new CTA after approximately 1 year of treatment GC with homogeneous tapering schedule. Vessel wall thickening, contrast enhancement and vessel diameter at aorta and its tributaries were evaluated. Results were compared to those obtained at the time of GCA diagnosis.

Results:
Follow-up CTA could be performed in 35 patients after a mean of 13.8 months (range from 12,5 to 24 months) of follow-up. Wall thickening suggesting LVV was still present in 17 patients (68% of the patients who initially had LVV). The number of affected segments and mean wall thickening significantly decreased with no patients developing new inflammatory lesions, new aortic dilation or increase in previous dilations. Moreover, contrast enhancement disappeared in almost all the patients (93.75% of 16 patients where this finding could be assessed).

Conclusions:
After 1 year of GC treatment, CTA signs of LVV persisted in two thirds of patients who initially presented abnormal findings. However, wall thickening significantly decreased as well as the number of affected segments. Contrast enhancement practically disappeared and there were no changes in lumen diameters during this period of time. Longer follow-up would be necessary to determine clinical significance of these findings and their relationship with the development of aortic dilatation. Supported by SAF 11/30073.

Disclosure of Interest:
None declared

Comment:
Particularly, if MR-angiography and/or 15-D-PET are not available computed tomography angiography (CTA) is an appropriate imaging technique to detect large-vessel vasculitis (LVV). This is an interesting prospective 1 year study showing that a considerable proportion of patients (15%) already show aortic dilatation at time of diagnostic assessment. This nicely reflects the delay between beginning of vessel inflammation and structural damage and time of diagnosis. This study shows thata 1 year conventional GC-treatment of LVV has vessel-associated anti-inflammatory effect in the vast majority of patients. However, in many patients structural vessel-wall changes do persist despite some treatment-associated attenuations. This gives a hint to the assumption that despite improvement of vessel-wall inflammation structural restoration of affected vessel may remain incomplete over a longer period of treatment and that there might persist ongoing smouldering disease despite treatment putting patients at risk for more long-term vasculitic complications (i.e. aneurysms). Therefore, for such a risk stratification and for treatment adjustment in LVV periodical imaging diagnostics with high resolution techniques as CTA or MRA are mandatory.

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