Aortitis: recent advances, current concepts and future possibilities

Pugh, D., Grayson, P., Basu, N. and Dhaun, N. (2021) Aortitis: recent advances, current concepts and future possibilities. Heart, 107(20), pp. 1620-1629. (doi: 10.1136/heartjnl-2020-318085) (PMID:33593995)

Abstract

Broadly defined, aortitis refers to inflammation of the aorta and incorporates both infectious and non-infectious aetiologies. As advanced imaging modalities are increasingly incorporated into clinical practice, the phenotypic spectrum associated with aortitis has widened. The primary large vessel vasculitides, giant cell arteritis and Takayasu arteritis, are the most common causes of non-infectious aortitis. Aortitis without systemic disease or involvement of other vascular territories is classified as clinically isolated aortitis. Periaortitis, where inflammation spreads beyond the aortic wall, is an important disease subset with a distinct group of aetiologies. Infectious aortitis can involve bacterial, viral or fungal pathogens and, while uncommon, can be devastating. Importantly, optimal management strategies and patient outcomes differ between aortitis subgroups highlighting the need for a thorough diagnostic workup. Monitoring disease activity over time is also challenging as normal inflammatory markers do not exclude significant vascular inflammation, particularly after starting treatment. Additional areas of unmet clinical need include clear disease classifications and improved short-term and long-term management strategies. Some of these calls are now being answered, particularly with regard to large vessel vasculitis where our understanding has advanced significantly in recent years. Work extrapolated from temporal artery histology has paved the way for targeted biological agents and, although glucocorticoids remain central to the management of non-infectious aortitis, these may allow reduced glucocorticoid reliance. Future work should seek to clarify disease definitions, improve diagnostic pathways and ultimately allow a more stratified approach to patient management.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Basu, Professor Neil
• Authors: Pugh, D., Grayson, P., Basu, N., and Dhaun, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 16 February 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Heart 107(20): 1620-1629
• Publisher Policy: Reproduced in accordance with the publisher copyright policy