Steroids Reduce Signs of Aortic Aneurysm Risk in GCA

In a before-and-after study with CT imaging, signs of large vessel vasculitis and aortic wall thickening improved for some but not all patients treated with steroids for giant-cell arteritis

Prieto-GonzÃ¡lez S; GarcÃa-MartÃnez A, Tavera-Bahillo I, et al.Effect of Glucocorticoid Treatment on Computed Tomography Angiography Detected Large-Vessel Inflammation in Giant-Cell Arteritis. A Prospective, Longitudinal Study. Medicine. 2015; 94(5):e486doi: 10.1097/MD.0000000000000486

This report extends recent imaging studies on the newly identified inflammation of the aorta and its branches in giant-cell arteritis (GCA).

GCA has an increased risk of thoracic aortic aneurysm, but it is not known whether the inflammation directly causes the aneurysm or whether treating the inflammation will reduce the risk.

This study evaluated signs of large-vessel inflammation and remodeling of the aorta after a year of treatment with glucocorticoids.

Forty biopsy-proven GCA patients were prospectively evaluated by computed tomography angiography (CTA) for vessel wall thickening, diameter, and contrast enhancement of the aorta and its tributaries at diagnosis. CTA was repeated one year later on 35 patients.

Signs of large vessel vasculitis improved with treatment. Wall thickness along the aorta, measured at the ascending arch and the descending and abdominal aorta, was reduced in some patients, but persisted in two-thirds. Contrast enhancement resolved in most patients.

The number of affected segments and wall thickness significantly deceased, and no patients developed new lesions.

Notably, there were no significant differences in aortic diameters.