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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis

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Persistent aortic inflammation in patients with giant cell arteritis

Mahmut S Kaymakci1, Nicholas A Boire2, Melanie C Bois3

  • 1Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Autoimmunity Reviews
|August 19, 2023
PubMed

Insights

Giant cell arteritis (GCA) patients undergoing thoracic aorta surgery often show active inflammation, even years after diagnosis. This chronic aortitis may lead to aortic aneurysm and dissection, increasing mortality risk.

Area of Science:

  • Vascular Surgery
  • Rheumatology
  • Pathology

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis that can affect large arteries, including the aorta.
  • Thoracic aorta aneurysm and dissection are serious complications that can occur in patients with GCA.

Purpose of the Study:

  • To investigate the clinicopathologic features of patients with GCA who underwent thoracic aorta surgery.
  • To determine the prevalence of active aortitis in GCA patients with thoracic aorta pathology.
  • To assess the long-term survival outcomes in GCA patients after thoracic aorta surgery.

Main Methods:

  • Retrospective review of patients who underwent thoracic aorta surgery between 2000 and 2021 at Mayo Clinic.
  • Screening for prior GCA diagnosis using diagnostic codes and electronic text search.
  • Pathologic re-evaluation of thoracic aorta tissues and analysis of clinicopathologic features.

Main Results:

  • Of 4621 thoracic aorta surgery patients, 49 had a GCA diagnosis.
  • Active aortitis was found in 82% of GCA patients (40/49) during surgery, a median of 6 years post-GCA diagnosis.
  • GCA patients had a significantly increased standardized mortality ratio (1.55) compared to the general population.

Conclusions:

  • Active aortitis persists in the thoracic aorta of most GCA patients, even when in clinical remission.
  • Chronic, smoldering inflammation of the aorta is a likely contributor to aneurysm and dissection development in GCA.
  • These findings highlight the importance of long-term surveillance for aortic complications in GCA patients.
Abstract

Keywords:
AortitisChronic diseaseGiant cell arteritisHistopathologyLarge vessel vasculitis

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