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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAortic complications are an important cause of death in patients with giant-cell arteritis (GCA). Extracranial involvement of large vessels in patients with GCA probably is underdiagnosed. 18-fluoro-deoxyglucose (FDG) positron emission tomography (PET) offers good sensitivity for the detection of large vessel involvement in patients with GCA [Blockmans D et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2006; Besson FL et al. \u003Cem\u003EEur J Nucl Med Mol Imaging\u003C\/em\u003E 2011]. The objectives of this study were to characterize large vessel involvement using PET in a cohort of patients with GCA, describe the patients who had aortic complications, and identify factors associated with aortic complications.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ETomography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVasculitis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ETomography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVasculitis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAortic complications are an important cause of death in patients with giant-cell arteritis (GCA). According to Hubert de Boysson, MD, Centre Hospitalier et Universitaire Cote de Nacre, Caen, France, extracranial involvement of large vessels in patients with GCA probably is underdiagnosed.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003E18-fluoro-deoxyglucose (FDG) positron emission tomography (PET) offers good sensitivity for the detection of large vessel involvement in patients with GCA [Blockmans D et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2006; Besson FL et al. \u003Cem\u003EEur J Nucl Med Mol Imaging\u003C\/em\u003E 2011]. The objectives of this study were to characterize large vessel involvement using PET in a cohort of patients with GCA, describe the patients who had aortic complications, and identify factors associated with aortic complications.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPatients included in this retrospective observational study met at least three American College of Rheumatology (ACR) criteria for GCA (or two criteria plus extra-temporal biopsy-proven giant-cell vasculitis), had at least one PET at diagnosis or during follow-up, and had an aortic morphology assessment at diagnosis and during follow-up. Patients with aortic complications at diagnosis were excluded. A positive PET was defined as FDG vascular uptake superior to the liver in at least one of the following vascular segments: thoracic or abdominal aorta, or subclavian, axillary, carotid, upper limb, ilio-femoral, or lower limb arteries.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn total, 129 patients met the criteria and were followed for 35 months. Baseline characteristics, clinical characteristics and cardiovascular risk factors were similar in the entire cohort between patients with aortic complications and those without complication. Among the 129 patients, 65 (50%) had PET at diagnosis (ie, before or in the 10 first days of the treatment) and 64 (50%) had PET during follow-up. Aortic complications occurred in a total of 10 patients: 6 patients (60%) who had PET at diagnosis and 4 patients (40%) who had PET during follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ESixty-four (50%) patients had a positive PET (55% at diagnosis, 44% during follow-up). The three most-involved vascular areas were thoracic aorta (81%), subclavian arteries (73%), and abdominal aorta (58%). Nine of the 10 patients with aortic complications had a positive PET compared with 55 of 119 patients without complications (90% vs. 46%, p=0,008). Complications occurred at a median time of 19.5 (range, 3 to 43) months after PET and 27.5 (3 to 180) months after diagnosis. In the univariable analysis, patients with a positive PET had a significantly higher risk of developing aortic complications as compared with those with a negative PET (HR, 9.2; 95% CI, 1.2 to 72.7; p=0.01; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Risk of Aortic Complications in Patients With a Positive Versus Negative PET\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-788398800\u0022 data-figure-caption=\u0022Risk of Aortic Complications in Patients With a Positive Versus Negative PET\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14587\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ERisk of Aortic Complications in Patients With a Positive Versus Negative PET\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EPET=positron emission tomography.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from H de Boysson, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EAmong the 10 patients with aortic complications, the thoracic section was of a concern for 9 patients (8 had thoracic aorta dilatation or aneurysm, and 1 had aortic dissection), whereas 1 patient had an abdominal aorta aneurysm. Patients with a positive PET versus those with a negative PET had more extra-cephalic manifestations (64% vs 37%; p=0.002) and fewer cephalic symptoms (72% vs 89%; p=0.01). There were 7 deaths, including 2 from strokes, 2 from myocardial infarctions, 1 from colitis, 1 from pneumonia, and 1 from limb ischemia. Three of 5 patients with a cardiovascular event had a positive PET.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThis study suggested that patients with GCA who had a positive PET at diagnosis or during follow-up had a higher risk of developing aortic complications. These patients had an atypical presentation with more extra-cephalic symptoms and fewer cephalic manifestations than is typically observed in GCA. Prospective studies are needed to confirm these results.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/17\/14.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp3e1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp3e1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}