Aortitis
| Aortitis | |
|---|---|
| Specialty | Cardiology |
| Diagnostic method | ANA, ANCA |
Aortitisis theinflammationof the aortic wall. The disorder is potentially life-threatening and rare. It is reported that there are only 1–3 new cases of aortitis per year per million people in the United States and Europe.[1]Aortitis is most common in people 10 to 40 years of age.[1]
Causes
[edit]Thisinflammationhas a number of possible causes, includingtrauma,viralorbacterialinfections (notably,syphilis), and certainimmune disordersandconnective tissue diseases.[1]
Aortitis is most commonly seen in patients withsyphilis,autoimmune vasculitis (giant cell arteritis,Takayasu's arteritis),polymyalgia rheumatica,andrheumatoid arthritis.[2]IgG4-related diseasehas more recently been identified as a cause of aortitis, and also as a cause of periaortitis (inflammationsurroundingthe aorta).[3]
There is a wide range of symptoms that are dependent on the location of the aortic inflammation or associated disorder. A few symptoms recognized in patients arefever,chills,muscle pains,and malaise (general discomfort).[2]In addition,hypertension(high blood pressure) may occur. Hypertension happens when therenal arterynarrows and elasticity of the aorta and branches decrease.[4]Aortitis can also be caused bySalmonellainfection.[5]
Diagnosis
[edit]Diagnosis of aortitis starts withphysical examinationand recording patient's medical history. Imaging tests such asmagnetic resonance angiography,doppler ultrasonography,andpositron emission tomography(PET) can be used to look at the blood vessels and blood flow, and highlight areas of inflammation. Condition is generally diagnosed based on the symptoms the patient is experiencing and the aortic images.[5]
Treatment
[edit]Treatment of aortitis depends on the underlying cause. The initial treatment of suspected infectious aortitis is intravenous antibiotics with broad antimicrobial coverage of the most likely pathologic organisms, In contrast,immunosuppressivetherapy is the primary treatment of non-infectious aortitis due to large-vessel vasculitis, and patients are ideally managed by a multi-disciplinary team that includes a rheumatologist and medical and surgical cardiovascular specialists. Once the diagnosis of non-infectious aortitis due to GCA or Takayasu arteritis has been established, oral glucocorticoid therapy should be initiated.[6]Frequently, adjunctive immunosuppressants, includingmethotrexateandazathioprine,are paired with steroids to treat refractory disease or to minimize steroid-induced adverse effects.[7]
Management includes the following treatment priorities: stop theinflammation,treat complications, prevent and monitor for re-occurrence.[8]
Prognosis
[edit]If untreated, has three distinct phases.[1]The first is a prepulseless inflammatory stage with nonspecific symptoms such as fatigue, arthralgias, and low-grade fevers. Phase two includes vascular inflammation with pain secondary to the condition, along with tenderness to palpation over the site. The last phase includes symptoms ofischemiaand pain associated with the use of limbs. Limbs are also cool and clammy in this stage.[9]
References
[edit]- ^abcd"eMedicine - Aortitis: Article by Masato Okada, MD, FACP, FACR, FAAAAI".Archivedfrom the original on 14 July 2007.Retrieved2007-07-28.
- ^ab[Taber's Cyclopedic Medical Dictionary. 19th ed. Philadelphia: F.A. Davis, 2001.]
- ^John H. Stone; Arezou Khosroshahi; Vikram Deshpande; et al. (October 2012)."Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations".Arthritis & Rheumatism.64(10): 3061–3067.doi:10.1002/art.34593.PMC5963880.PMID22736240.
- ^Link text,American Heart Association.
- ^ab"Articles".Cedars-Sinai.Archived fromthe originalon 2020-11-20.Retrieved2022-05-14.
- ^Gornik, H. L.; Creager, M. A. (2008)."Aortitis".Circulation.117(23): 3039–51.doi:10.1161/CIRCULATIONAHA.107.760686.PMC2759760.PMID18541754.
- ^Skeik, Nedaa; Ostertag-Hill, Claire A.; Garberich, Ross F.; Alden, Peter B.; Alexander, Jason Q.; Cragg, Andrew H.; Manunga, Jesse M.; Stephenson, Elliot J.; Titus, Jessica M.; Sullivan, Timothy M. (October 2017)."Diagnosis, Management, and Outcome of Aortitis at a Single Center".Vascular and Endovascular Surgery.51(7): 470–479.doi:10.1177/1538574417704296.ISSN1538-5744.PMID28859604.S2CID206757069.
- ^Noble, Barnes &.Inflamed Aorta, (Aortitis) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions.NOOK Book.Retrieved2022-05-14.
- ^Blackwood, A. L. (2021-05-11).Diseases of the Heart.B. Jain Publishers. p. 222.ISBN978-81-7021-213-3.