What other catastrophic outcomes may occur in Giant Cell Arteritis patients with aortic involvement?
Aortitis can lead to aortic aneurysms and dissection. GCA patients have a 17x increased relative risk for developing thoracic aortic aneurysms and a 2.4× risk of abdominal aortic aneurysms compared with controls. Aneurysms and dissection may present with midthoracic or low back pain; these symptoms should be urgently evaluated in any GCA patient. Patients with clinical aortic involvement should be followed with magnetic resonance angiography (MRA) or computed tomography angiography (CTA) every 6 to 12 months for the development of new lesions/stenoses or the development of aneurysms. Surgery or endovascular aneurysm repair is considered when the aneurysm enlarges to >5 cm or dissects.
The appropriate monitoring for GCA patients without known clinical aortic involvement is unclear. Bilateral arm BP measurements, listening for a new aortic insufficiency murmur or arterial bruits, and abdominal palpation for an aortic aneurysm during clinic visits seem prudent. A periodic chest radiograph, echocardiogram, and/or abdominal ultrasound have also been recommended.