P211 Aortitis: clinical experience within a tertiary centre
Authors: Andev Rajinder S , Ahmad Nadia , Luqmani Raashid , Dubey Shirish 
Published: April 2021

Background/Aims 

Giant cell arteritis (GCA) is a common form of vasculitis, but sometimes this condition can manifest as aortitis. Diagnosis of aortitis is trickier than the cranial presentation of GCA. It often leads to prolonged treatment and can cause complications such as aortic dissection. Here we report our centre’s experience of managing patients with aortitis.

Methods 

We retrospectively analysed patients that were diagnosed with aortitis between 2006 and 2019. They were identified by their diagnosis code on a locally developed database. This work was approved within our department and registered with the audit team. Microsoft Excel was used for both data collection and analysis.

Results 

94 patients were included in this analysis. There was a female preponderance at 55.3% (n = 52), with an average age of 70 at the time of diagnosis (range 40-90). The most commonly presenting features were systemic inflammatory response syndrome (51.1%, n = 48), giant cell arteritis-like symptoms (41.2%, n = 39) and polymyalgia rheumatica-like symptoms (38.3%%, n = 36). Importantly, 14.9% (n = 14) of patients presented with claudication and 5.2% (n = 5) were diagnosed after an acute aortic dissection. The median CRP and ESR levels were 63 and 69 respectively at presentation. Most (78.7%, n = 74) had diagnostic changes on CT-PET.

Those with GCA-like symptoms were diagnosed on average 3.5 months before those without them (9.8 months versus 13.4). Most were treated with prednisolone (94.7%, n = 89), with a median duration of 36 months. Only 3 patients did not receive an adjunctive DMARD. The most commonly used DMARD was methotrexate (90.4% n = 85). Leflunomide was used in 23.4% (n = 22) with a median treatment length of 1 year. Azathioprine was used in 19.1% (n = 18) of patients with cyclophosphamide used in 28.7% (n = 27) of the cohort. Tocilizumab (9.6%, n = 9) and rituximab (2.1%, n = 2) were the biologic agents used. Several (39.4% n = 37) were treated with at least 2 DMARDs in addition to prednisolone during their treatment course. Most patients (60.6%, n = 57) were on treatment at the time of analysis, with the most common drug being methotrexate (49.1%, n = 28) and prednisolone (47.3%, n = 27). The most common treatment complication was GI upset, leading to a drug change in 24.5% (n = 23). Relapsing disease was common (47.9%, n = 45) despite being on treatment. Vascular complications were prevalent at 40.4% (n = 38). The majority were related to ischaemic complications such as stroke, although 13.8% (n = 13) developed aneurysms or dissections.

Conclusion 

Systemic inflammatory response syndrome was the commonest presenting feature. Those without GCA-like symptoms received a delayed diagnosis, which increases the risk of preventable vascular events. CT-PET remained the main diagnostic tool. Prednisolone treatment was prolonged with burdensome side-effects. Methotrexate remained the DMARD of choice, but leflunomide also showed good results. Vascular complications are common and need attention.

Disclosure 

R.S. Andev: None. N. Ahmad: None. R. Luqmani: None. S. Dubey: None.