Last updated date: 29-May-2023
Originally Written in English
Aortitis: Diagnosis & Management
Aortitis is a rare condition that involves inflammation of the aorta, which is the largest artery in the body. Aortitis can be caused by a variety of factors, including infection, autoimmune disorders, and other inflammatory conditions.
Aortitis can be classified based on the part of the aorta that is affected, with the most common types being:
- Thoracic aortitis: Inflammation of the thoracic (chest) portion of the aorta.
- Abdominal aortitis: Inflammation of the abdominal portion of the aorta.
- Aortitis involving both thoracic and abdominal aorta.
Symptoms of aortitis can vary depending on the underlying cause and the extent of inflammation, but may include:
- Pain in the chest, back, or abdomen.
- Fatigue and weakness.
- Fever and night sweats.
- Weight loss.
- Loss of appetite.
- High blood pressure.
Aortitis can be diagnosed through a combination of imaging tests, blood tests, and sometimes a biopsy of the affected tissue. Treatment depends on the underlying cause and severity of the inflammation, but may include corticosteroids or other immunosuppressive medications to reduce inflammation, and antibiotics if the inflammation is caused by an infection.
Complications of aortitis can include aneurysms (weakening and bulging of the aortic wall), dissection (tearing of the aortic wall), and rupture (breakage of the aortic wall), which can be life-threatening. Regular monitoring and follow-up care are important for people with aortitis to detect and manage potential complications.
How Common is Aortitis?
Aortitis is a rare condition, and its exact prevalence is not well-known. However, certain forms of aortitis, such as giant cell arteritis (GCA) and Takayasu's arteritis, are more common in certain populations. GCA is more common in individuals over the age of 50, particularly women, and is estimated to affect up to 1 in 500 people over the age of 50. Takayasu's arteritis is more common in women of Asian descent and is estimated to affect 2.6 to 3.6 per million people in the United States. Other forms of aortitis, such as infectious or idiopathic aortitis, are even more rare.
Is Aortitis An Autoimmune Disease?
Aortitis can be either an autoimmune or an infectious disease. Autoimmune aortitis can occur as a result of an immune response that targets the body's own tissues and causes inflammation in the aorta. Giant cell arteritis (GCA) and Takayasu's arteritis are two examples of autoimmune aortitis. In infectious aortitis, the inflammation of the aorta is caused by an infection, such as a bacterial or fungal infection. It's important to distinguish between the two types, as the treatment for each type can be different.
What Causes Aortitis?
Aortitis can have various causes, depending on the specific type of aortitis. Some of the common causes include:
- Autoimmune disorders: Aortitis can be a result of autoimmune disorders such as giant cell arteritis and Takayasu's arteritis. In these conditions, the body's immune system attacks the aorta and causes inflammation.
- Infections: Infections, such as bacterial or fungal infections, can cause aortitis. These infections can travel through the bloodstream and infect the aorta, causing inflammation.
- Trauma: Trauma to the aorta, such as in cases of blunt chest trauma or surgery, can cause aortitis.
- Other underlying medical conditions: Certain medical conditions, such as syphilis or inflammatory bowel disease, can also cause aortitis.
It's important to determine the cause of aortitis, as the treatment for each type of aortitis can differ.
What Are Systemic Vasculitis & Other Inflammatory Disorders Causing Aortitis?
Aortitis can be caused by a variety of systemic vasculitis and other inflammatory disorders. Some of the common causes of aortitis include:
- Giant cell arteritis (GCA): GCA is a type of systemic vasculitis that mainly affects large and medium-sized arteries, including the aorta. It's more common in people over 50 years of age, and it's associated with headaches, jaw claudication, visual symptoms, and scalp tenderness.
- Takayasu arteritis: Takayasu arteritis is another type of systemic vasculitis that affects the aorta and its branches. It's more common in younger people, and it's associated with symptoms such as fatigue, fever, night sweats, muscle aches, and weight loss.
- Behçet's disease: Behçet's disease is a type of autoimmune disorder that can cause inflammation in the aorta and other blood vessels. It's more common in people of Middle Eastern, Asian, and Mediterranean descent, and it's associated with symptoms such as mouth and genital ulcers, skin rashes, and joint pain.
- Rheumatoid arthritis (RA): RA is an autoimmune disorder that can cause chronic inflammation in the lining of the joints and other tissues. In some cases, it can also cause inflammation in the aorta and other blood vessels.
- Ankylosing spondylitis (AS): AS is a type of inflammatory arthritis that mainly affects the spine and sacroiliac joints. In some cases, it can also cause inflammation in the aorta and other blood vessels.
- Systemic lupus erythematosus (SLE): SLE is a systemic autoimmune disorder that can cause inflammation in various organs and tissues, including the aorta.
- Inflammatory bowel disease (IBD): IBD, including Crohn's disease and ulcerative colitis, can cause chronic inflammation in the intestines and other tissues, including the aorta.
Other less common causes of aortitis include infections (such as syphilis and tuberculosis), atherosclerosis, and trauma.
What are the Symptoms?
The symptoms of aortitis can vary depending on the underlying cause and severity of inflammation. Some of the common symptoms include:
- Pain: Pain in the chest, abdomen, or back is a common symptom of aortitis. The pain can be dull, sharp, or stabbing and may worsen with physical activity.
- Fever: A fever is often present with infectious aortitis.
- Fatigue: Fatigue is a common symptom, which may be due to the body's immune response to inflammation.
- Weight loss: Unexplained weight loss can occur in some cases of aortitis.
- Night sweats: Night sweats can occur in autoimmune aortitis.
- Loss of appetite: Loss of appetite is a common symptom of aortitis.
- Joint pain: Joint pain and stiffness can occur in autoimmune aortitis.
- Weakness: Weakness or numbness in the limbs can occur in some cases of aortitis.
How is Aortitis Diagnosed?
The diagnosis of aortitis often requires a combination of clinical evaluation, imaging studies, and laboratory tests.
Some of the diagnostic tests that may be used to diagnose aortitis include:
- Imaging studies such as ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan can help detect inflammation and structural abnormalities in the aorta.
- Blood tests such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell count can help evaluate the presence of inflammation in the body.
- Biopsy of the affected tissue may be performed in some cases to confirm the diagnosis and identify the underlying cause of aortitis.
the diagnosis of aortitis can be challenging, as the symptoms may be non-specific and can mimic other conditions. Therefore, a team of specialists, including a rheumatologist, cardiologist, and radiologist, may be involved in the diagnosis and management of aortitis.
How is Aortitis Treated?
The treatment of aortitis depends on the underlying cause, the severity of the symptoms, and the extent of the inflammation in the aorta. The goals of treatment are to reduce inflammation, prevent complications, and preserve the function of the aorta.
In general, the treatment of aortitis involves the use of immunosuppressive medications, such as corticosteroids, methotrexate, azathioprine, and mycophenolate mofetil, to reduce inflammation and prevent damage to the aorta.
In some cases, surgery may be necessary to repair or replace a damaged portion of the aorta, particularly if the inflammation has led to aneurysm or dissection.
In addition to medication and surgery, lifestyle changes, such as quitting smoking and controlling high blood pressure and high cholesterol, can help reduce the risk of complications and improve the overall outcome of aortitis.
the treatment of aortitis is often complex and requires ongoing monitoring and management by a team of healthcare professionals, including rheumatologists, cardiologists, and vascular surgeons.
What Medications are Used for Aortitis?
The choice of medication for aortitis depends on the underlying cause and the severity of the inflammation. Corticosteroids are commonly used to reduce inflammation and control symptoms. Immunosuppressive medications, such as methotrexate and azathioprine, may be used in combination with corticosteroids for more severe cases or when corticosteroids alone are not effective. Biologic agents, such as rituximab and tocilizumab, may be used in some cases. Antibiotics are used to treat aortitis caused by an infection, such as syphilis. In addition to medication, lifestyle modifications, such as quitting smoking, may also be recommended to reduce the risk of complications. Surgery may be necessary in some cases, such as when there is a large aneurysm or aortic dissection that could potentially rupture.
Side Effects of These Treatments
Yes, some of the medications used to treat aortitis can have side effects. For example, corticosteroids such as prednisone may cause weight gain, mood changes, high blood pressure, and increased risk of infection. Immunosuppressive drugs such as azathioprine and cyclophosphamide may cause an increased risk of infection, hair loss, and gastrointestinal problems. Biologic agents such as tocilizumab and rituximab may cause allergic reactions, an increased risk of infection, and liver damage. It is important to discuss the potential side effects of these medications with a healthcare provider.
Complications of Aortitis
Aortitis can lead to several complications, depending on the extent and severity of the inflammation. Some of the possible complications include:
- Aortic aneurysm or dissection: Aortitis can weaken the wall of the aorta, which may lead to the formation of an aneurysm or a tear (dissection) in the aortic wall. These conditions can be life-threatening if left untreated.
- Heart problems: Aortitis can cause inflammation of the heart valves, leading to valve damage or malfunction. This may cause symptoms such as chest pain, shortness of breath, and palpitations.
- Stroke: Aortitis can lead to the formation of blood clots in the aorta, which can break off and travel to other parts of the body, including the brain, leading to a stroke.
- Reduced blood flow to other organs: Aortitis can cause narrowing or blockage of the blood vessels that supply blood to other organs, leading to reduced blood flow and potential organ damage.
- Aortic regurgitation: Aortitis can cause the aortic valve to leak, leading to blood flowing back into the heart instead of forward. This can put extra strain on the heart and lead to heart failure.
- Aortoenteric fistula: Aortitis can cause a connection (fistula) between the aorta and the intestines, leading to bleeding and infection in the digestive system.
When Do I Need Surgery for Aortitis?
Surgery may be necessary in some cases of aortitis to repair or replace the affected part of the aorta. The decision to perform surgery depends on various factors such as the severity and extent of the inflammation, the location of the affected area, the age and overall health of the patient, and the presence of other medical conditions.
If the aortitis has caused significant damage to the aorta, such as an aneurysm (a bulge in the wall of the aorta) or aortic dissection (a tear in the inner layer of the aorta), surgery may be required. Aortic aneurysms and dissections are potentially life-threatening complications of aortitis, and prompt surgical intervention may be necessary to prevent rupture or other serious complications.
In some cases, surgery may also be recommended for patients with severe aortic regurgitation (leakage of blood back into the heart) or stenosis (narrowing of the aortic valve) caused by aortitis. Surgery can help to relieve symptoms and improve overall heart function.
How Can I Reduce My Risk?
It may not be possible to prevent aortitis since its underlying causes are not yet well-understood. However, some general lifestyle measures may help to reduce the risk of developing some forms of vasculitis and other inflammatory disorders that can cause aortitis. These measures include:
- Maintaining a healthy diet and weight
- Regular exercise
- Avoiding smoking and exposure to secondhand smoke
- Practicing good hygiene to reduce the risk of infections
- Managing other medical conditions, such as diabetes or high blood pressure, that can increase the risk of vasculitis.
It is also important to be aware of the signs and symptoms of aortitis and seek prompt medical attention if they occur. Early diagnosis and treatment can help prevent complications and improve outcomes.
Who should be on my healthcare team if I have Aortitis?
If you are diagnosed with aortitis, your healthcare team may involve several specialists to manage your condition effectively. Your primary care physician will likely coordinate your care with the following healthcare providers:
- Rheumatologist: A specialist in the diagnosis and treatment of autoimmune diseases, including aortitis.
- Cardiologist: A specialist in the diagnosis and treatment of heart conditions and diseases that may result from aortitis.
- Vascular surgeon: A specialist who may be involved in managing complications of aortitis that involve blood vessels, such as aneurysms or dissections.
- Infectious disease specialist: A specialist who may be involved in the diagnosis and treatment of infectious causes of aortitis.
- Ophthalmologist: A specialist who may be involved in managing ocular complications of aortitis.
- Other healthcare providers: Depending on the specific symptoms and complications of your aortitis, you may also see other healthcare providers, such as a pulmonologist, neurologist, or nephrologist.
It is important to have a multidisciplinary team of healthcare providers to ensure that your aortitis is effectively managed, and your overall health is taken care of.
The outlook for aortitis depends on the underlying cause and the severity of the inflammation. With early and appropriate treatment, the prognosis can be good. However, if left untreated, aortitis can lead to serious complications such as aneurysm, dissection, or rupture of the aorta, which can be life-threatening. It is important to follow the recommended treatment plan and have regular follow-up appointments with a healthcare provider to monitor the condition and adjust the treatment as needed.
When Should I Go to the ER?
You should go to the emergency room immediately if you experience severe chest, back or abdominal pain, shortness of breath, fainting, dizziness or lightheadedness, or if you suspect an aortic aneurysm or dissection. These symptoms can be life-threatening and require urgent medical attention.
Aortitis is a rare but serious condition that involves inflammation of the aorta, the largest artery in the body. It can be caused by a variety of factors, including infections, autoimmune disorders, and other inflammatory conditions. The symptoms of aortitis can vary depending on the cause and location of the inflammation, and can range from mild to severe. Aortitis is diagnosed through a combination of medical history, physical exam, imaging tests, and blood tests. Treatment typically involves addressing the underlying cause of the inflammation and managing symptoms with medications, such as corticosteroids or immunosuppressants. In some cases, surgery may be necessary. It is important to work closely with a healthcare team, which may include a rheumatologist, cardiologist, and other specialists, to manage the condition and prevent complications.