Title

Rheumatoid aortitis: a rarely recognized but clinically significant entity

UMMS Affiliation

Department of Medicine, Division of Rheumatology

Publication Date

3-1-1989

Document Type

Article

Subjects

Aged; Aged, 80 and over; Aorta, Abdominal; Aorta, Thoracic; Aortitis; Arthritis, Rheumatoid; Female; Humans; Male; Middle Aged; Rheumatoid Nodule; Vasculitis

Disciplines

Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases

Abstract

Aortitis as a feature of rheumatoid arthritis is considered rare. We have, however, identified 10 patients with aortitis from among 188 consecutive autopsy cases of rheumatoid arthritis. There were 5 men and 5 women with a mean duration of rheumatoid arthritis of 9.6 years. Nine were rheumatoid factor positive and had associated nodules. In addition to standard treatment regimens, 9 patients received corticosteroids. Although involvement of the thoracic aorta was most common, involvement of both the thoracic and abdominal aorta was present in 4 cases. Two patients had aneurysmal dilatation of the thoracic aorta and 1 of the abdominal aorta. Microscopic features of aortitis included necrosis of medial smooth muscle and elastica, with an inflammatory infiltrate comprising primarily lymphocytes and plasma cells. A panmural aortitis was seen in 3 cases. Rheumatoid granulomas were noted in the aortic wall in 5. The diagnosis of aortitis was not made until autopsy in any case. Aortitis was hemodynamically significant in 3 patients. Two had congestive heart failure secondary to thoracic aortitis and aortic valvulitis, and 1 had rupture of an abdominal aortic aneurysm at a site involved by aortitis. Seven patients had rheumatoid vasculitis with a mean of 10 organs involved. Six of these died of complications directly related to vasculitis, including 4 patients with coronary arteritis and associated myocardial infarction. Aortitis can be a feature of severe rheumatoid arthritis and is often associated with rheumatoid vasculitis. Hemodynamic compromise does occur and may be fatal.

Source

Medicine (Baltimore). 1989 Mar;68(2):95-106.

Journal/Book/Conference Title

Medicine

Comments

At the time of publication, Ellen Gravallese was not yet affiliated with the University of Massachusetts Medical School

Related Resources

Link to Article in PubMed

PubMed ID

2921941

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