GCA Aortic Aneurysm Risk — SCE Rheumatology MCQ

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EasyVasculitisGCA Aortic Aneurysm RiskSCE Rheumatology

A 65-year-old woman with treated giant cell arteritis is being counselled about serious vascular complications that may develop years after diagnosis, including during apparent clinical remission. Which complication is most characteristically associated with this delayed risk?

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Correct answer: D — Thoracic aortic aneurysm, with possible dissection or rupture

GCA is a large-vessel vasculitis that can cause aortitis followed by progressive aortic dilatation, particularly thoracic aortic aneurysm. This may become apparent years after diagnosis or during apparent clinical remission and can lead to dissection, rupture and death. Cohort estimates of the relative risk vary, so a single figure such as “17 times higher” should not be treated as universal. The optimal imaging-surveillance schedule is also not established and should be individualised, especially where large-vessel involvement is known or suspected. DVT and varicose veins are venous disorders rather than characteristic consequences of GCA. Atherosclerotic carotid stenosis and peripheral arterial disease may coexist because of age and cardiovascular risk factors, but neither is the characteristic feared delayed vascular complication.

Reference: Therkildsen P et al. Increased risk of thoracic aortic complications among patients with giant cell arteritis: a nationwide, population-based cohort study. Rheumatology, 2022. https://pubmed.ncbi.nlm.nih.gov/34918058/