P1: SBT
0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8
Aortitis 147■Other tests
➣MRI/MRA useful for defining aneurysm or stenosis
➣Biopsy of an involved artery to confirm Giant cell arteritis
differential diagnosis
■broad, consider:
➣thromboembolic disease
➣other causes of systemic inflammatory response
➣dissection
management
What to Do First
■Diagnose and treat underlying condition
■Manage acute problems
General Measures
■Establish working diagnosis by history, physical, tests described
above
■For Takayasu’s,
➣establish type
Type I: primarily involves aortic arch and brachiocephalic
arteries
Type II: primarily involves thoracoabdominal aorta and renal
arteries
Type III: features of both Type I and Type II
Type IV: shows pulmonary artery involvement
➣Treat manifestations
specific therapy
Takayasu’s
■Treatment options (none shown to modify disease progression)
➣Prednisone with gradual taper
➣Methotrexate can be considered if patient’s constitutional symp-
toms not relieved with steroids
➣Cyclophosphamide can also be considered, adjusted for WBC >
3000/mm^3 in refractory cases
➣Aspirin possibly of benefit
Syphilitic Aortitis
■Treatment options
➣Penicillin G for 3 weeks
➣If Penicillin allergic, Doxycycline×21 days
➣If intolerant of Doxycycline confirm Penicillin allergy, consider
erythromycin for 30 days