BackgroundAortitis is a several and potentially lethal clinical condition. It is usually oligosymptomatic or may present with non-specific symptoms that complicate and delay the diagnosis. On the other hand, treatment of aortitis is not established.ObjectivesThe objetive of this study is to describe clinical manifestations, laboratory studies and treatment of patients with aortitis in a single center.MethodsWe have reviewed the medical records of patients who had positive Positron Emission Tomography (PET) for aortitis fron January 2013 to December 2015 in the Rheumatology Department of a University Hospital. We included 13 cases and we recorded epidemiological, clinical data, laboratory results, treatment and evolution.Quantitative variable results were expressed as mean±standard deviation (SD) or median (interquatile range-IQR). Qualitative variable results were expressed as percentage. The analysis was performed with the SAS System for Windows V 9.2.ResultsIn the last 3 years 13 cases of aortitis were diagnosed (3 in 2013, 3 in 2014 and 7 in 2015). The male to female ratio was 3/10. Mean age±SD was 72.23±12.36 years [range, 51–83]. The underlying conditions were: giant cell arteritis (GCA) (n=7), polymyalgia rheumatica (PmR) (n=2), idiopathic (n=2), relapsing polychondritis (n=1) and Sjögren syndrome (n=1). The median interval between the diagnosis of the underline disease and the aortitis was 7 months [1–20].The most common manifestations were constitutional syndrome (n=5), inflammatory back pain (n=4), pain irradiated to lower limbs (n=4), atypical polymyalgia (n=1) and fever (n=1).All patients exhibited increased acute phase reactants except for the two patients with idiopathic aortitis. Erythrocyte sedimentation rate (ESR) mean was 62±33.84 mm/1st hour and C Reactive Protein (CRP) median level mas 3.3 [2.91–5.13] mg/dl. Five patients presented anaemia.At the time of diagnosis, 9 patients were receiving prednisone (mean dose, 18.89±19.3 mg/day), 4 were with methotrexate (MTX) (mean dose, 15±5.77 mg/week) and the remaining 3 were not receiving any drug.Treatment of aortitis was based on the onset or increase in prednisone dose (mean dose, 34.17±9.73 mg/day) in all cases except for one patient who needed surgery for aortic aneurysm. MTX was initiated in 5 patients and its dose was increased in 4 more (mean maximum dose, 14.72±6.43 mg/week). Three patients were treated with methilprednisolone i.v. (0.5 g/day, 3 consecutive days). Tocilizumab (TCZ) was added to therapy in 2 cases due to refractory disease.In the first visit, two to four months later, the ESR mean was 25.92±24.88mm/1st hour and CRP median was 0.32 [0.16–1.11] mg/dl. In successive clinical controls, after a mean follow-up of 10±4.32 months, clinical and laboratory improvement was maintained.Four patients had a new PET-TAC control 6–16 months later, 3 of them presented complete remission and another one partial remission.ConclusionsAccording to our data, clinical and laboratory data are often nonspecific in aortitis. The increase in the diagnosis c...
BackgroundEarly diagnosis and treatment of aortitis are important to prevent possible serious complications such us aneurysm, aneurismal ruptured or aortic dissection. Aortitis may present with non-specific symptoms. Positron emission tomography (PET) is useful in diagnosing aortitis. However, PET is an expensive technique.ObjectivesOur aim was to evaluate those PET performed by suspected aortitis in order to find some predictive factors for positive PET for aortitis.MethodsStudy of PET performed by suspected aortitis in a University Hospital (from January 2013 to December 2015). The main epidemiological, clinical and laboratory data of these patients were extracted from clinical records according to a specifically designed protocol, reviewed for confirmation of the diagnosis, and stored in a computerized file. To minimize entry error all data were double checked.A comparative study was made between positive and negative PET to identify red flags of an underlaying aortitis.Quantitative variable results were expressed as mean±standard deviation (SD) or median [IQR] and were analyzed by Mann-Whitney U test. Qualitative variable results were expressed as percentages and frequency and were analyzed by Fisher's exact test. Statistic analysis was performed with the SAS System for Windows V 9.2.ResultsIn last 3 year period 33 PET were requested to confirm aortitis (5 of them in 2013, 7 in 2014 and 21 in 2015). We had 3 positive results of 5 (60%) in 2013, 3 of 7 (42.85%) in 2014 and 7 of 21 (33.33%) in 2015. The mean age of the 33 (22 female/11 male) patients was 70.30±14.16 years (range, 31–89).The underlying diseases associated to these patients were: giant cell arteritis (GCA) (n=12), polymyalgia rheumatic (PmR) (n=8), connective tissue diseases (Sjögren syndrome, dermatomyositis, undifferentiated connective pathology) (n=5), seronegative polyarthritis (n=3), relapsing polychondritis (n=2), idiophatic (n=2), hiper-IgG syndrome (n=1).Comparative study between positive and negative PET is summarized in TABLE. Inflammatory back pain and irradiated lower limb pain conditions were more common among patients with positive PET. They were the unique variables with statistically significant difference. The rest of both epidemiologic, clinical, laboratory or the possible influence of treatment with steroids and/or immunosuppressants at the time of conducting PET did not differ between groups.ConclusionsIn this estudy we observed an increasing in demand for PET for suspected aortitis every year and more cases were diagnosed in recent years. However, positive test percentage progressively decreased. The presence of inflammatory back pain and pain radiating to the lower extremities may have clinical relevance to suspect aortitis and a positive PET result. Prospective studies are needed with larger numbers of patients to establish a predictive model for aortitis.Disclosure of InterestNone declared
BackgroundLow back pain of mechanical origin is a major cause of disability and surgical intervention. The lumbar computed tomography (CT)-guided steroid infiltration can accelerate the recovery process and sometimes avoid the surgery.ObjectivesOur aim was to review the indications, efficacy and complications of this technique in a wide series of unselected patients. In addition a comparative study of efficacy was performed according to the lumbar underlying pathology, type of steroid and approach of injection.MethodsStudy of lumbar CT-guided steroid injections performed in a University Hospital between January 2012 and June 2015. The minimum follow-up was 3 months.The procedure was performed in patients with low back pain refractory to standard medical therapy and Lumbar Spine Rehabilitation.Efficacy was assessed at 1 and 3 months according to a semiquantitative scale as the pain response as a) total response, b) partially c) no or d) worsening pain.A comparative study of the efficacy and safety was performed, regarding: a) underlying pathology, b) approach of injection and c) the different types of steroids used.Fisher's test and χ2 and the SAS System for Windows V program 9.2.were used for statistical analysis.ResultsDuring the study period 258 procedures were performed in 171 patients (132 men/126 women) with a mean age ± SD of 58.24±13.45 years (range, 18–88).The indications for the injection were: a) disc herniation (44.57%), b) lumbar stenosis (34.11%), c) postoperative fibrosis and spondylolisthesis (20.15%) and d) facet joint synovial cysts syndrome (1.17%).Approaches used were: a) posterior epidural (24.42%), b) lateral recess (58.91%), and c) foraminal (16.67%).The chosen steroid was triamcinolone (74.81%), dexamethasone (23.64%) and methylprednisolone (1.55%).In a significant proportion of the procedures improvement in the patient's sintomatology was reported at the first month, regardless of the indication, route of corticosteroid injection and steroid used (TABLE).Regarding the overall outcome, at 3 months 72.48% of the patients experienced clinical improvement. And only 21.71% of patients required a subsequent surgery.The clinical efficacy showed no statistically significant differences according to the indication of the procedure or the route used for the injection. However, the improvement of pain was significantly greater in patients treated with triamcinolone than those treated with dexamethasone (p=0.01).Regarding safety there were 6 (2.3%) local complications (puncture of the thecal sac) and 3 (1.16%) systemic complications (allergic reaction). None of these complicationes were of clinical relevance and they were not associated with the corticosteroid used.ConclusionsCT-guided corticosteroid injection is an effective and safe treatment in low back pain refractory to standard medical therapy in patients with spinal stenosis, disc herniation and postoperative fibrosis.Triamcinolone infiltration seems to be more effective than dexamethasone.Disclosure of InterestNone declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.