Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

148 Aortitis

Giant Cell Aortitis

■Treatment options

➣Prednisone, when ESR and symptoms resolve, taper gradually for

1–2 y

➣Methotrexate can be considered for a steroid sparing effect

Other Rheumatologic Aortitis

■Treatment underlying disease as usual

Side Effects & Contraindications

■Prednisone

➣Side effects: many including glucose intolerance, Cushingoid

changes, adrenocortical insufficiency, increased susceptibility

to infection, muscle wasting, skin atrophy, peptic ulcer, depen-

dence

➣Contraindications

Absolute: abrupt discontinuation in a steroid dependent patient

Relative: tntc

■Methotrexate and Cyclophosphamide are both antineoplastic agents

and should only be prescribed by physicians specifically trained in

their use.

■Aspirin

➣Side effects: GI upset, bleeding

➣Contraindications

Absolute: significant aspirin allergy

follow-up

■Aggressive respond to vascular crises with arterial bypass or angio-

plasty is felt to increase longevity in Takayasu’s. Aortic valve replace-

ment or aneurysm repair occasionally indicated.

complications and prognosis

Complications

■aortic valve regurgitation, aneurysm formation, sequelae of branch

vessel occlusion depend on areas of involvement (stroke, limb

ischemia, renovascular hypertension, gut ischemia, coronary

ischemia), blindness (Giant Cell),

Prognosis

■Takayasu’s: unpredictable course, generally slowly progressive: In

older series, 97% 5 year survival if no major complications, 59% after

development of major complications. Aggressive management of

vascular crises likely improves survival

■Relevant survival data for other etiologies is scarce