Risk of Aortic Aneurism

[Annodomini]

My father died when an undiagnosed aortic aneurism ruptured about a year after he was diagnosed with PMR and started on prednisolone. Now my sister, who doesn't have PMR, has been found to have a very small (so far) aneurism and she has warned me and our other sister that this may be an hereditary condition - she is a doctor. I think I have heard that steroids put one at greater risk of aneurism and I intend to take this up with my GP and request a scan to set my mind at rest. I've now been on varying dosage of pred for four years, and am currently on 8mg, recently reduced from 10. Does anyone have any experience of aneurism related to steroids?

[Celtic PMRGCAuk volunteer]

Annodomini, it isn't the steroids that carry a risk of aortic aneurism but the inflammation of Giant Cell Arteritis does carry that risk. Could your father perhaps have had undiagnosed GCA along with the PMR that made him susceptible? There are other causes for aneurism, including high blood pressure, smoking etc or, as in your sister's case, a possible hereditary factor. No doubt she will now be well monitored via an annual chest X-ray or ultrasound and I'm sure once you discuss your fears with your GP s/he will be happy to refer you for the necessary check. Lots of good luck wishes to you both.

[Annodomini in reply to Celtic]

Thanks Celtic. I don't have GCA, so that's one possible cause out of the way. My dad had been a smoker most of his life though on the whole he was pretty fit. As my sister is a retired doctor, in New Zealand, she has the right contacts to have herself monitored, but thought it best to warn us that there might be an hereditary factor. Hoping for the best!

Anno

[Hidden]

Annodomini,

There are two types of aortic aneurism, abdominal and thoracic.

Abdominal aortic aneurism ( AAA ) are by far the commonest and more prevalent amongst males. In Scotland there is a screening programme for all males over 60 ( I think ).

Thoracic aortic aneurism are much less common generally but more common in inflamatory conditions like GCA, ankylosing spondylitis, TAK, GPA etc. they are screened for with a chest X ray although they only show if an aneurism is present, they won't show if there is inflamation in the thoracic ascending aorta ( you need an MRA or CT/ PET for that).

I hope your GP can put your mind at rest.

[jinasc]

I had GCA (now in remission) After two years on pred, I had a pulmonary artery and aorta scan done with an echocardiogram. This is recommended in the treatment and diagnosis of GCA. You can read these papers on the NHS and BSR websites. PMR&GCA uk North East, PMR GCAuk, PMR GCA Scotland websites.

[PMRpro Ambassador]

It is the unmanaged inflammation of GCA and PMR that increases the risk of aortic aneurysm and the recommendations include annual chest x-rays as a monitoring means. Far better would be an echocardiogram - that uses ultrasound to visualise the heart and aorta inside the ribs. There is a screening programme for men over 65 for abdominal aortic aneurysm and women at risk can be added by contacting the screening people.

It's known about - or it would be if the other doctors read the guidelines instead of saying "guidelines are guidelines, and always trumped by clinical judgement". Said by a doctor whose clinical judgement about GCA/PMR was rather poor when measured against his peers.

[Annodomini]

Thanks Pro - that makes things much clearer. I am speaking to my GP tomorrow - telephone appointment! - so I will be able to raise all concerns with him then. I must make some notes so that I don't forget anything!

[Annodomini]

I've now spoken to my GP who is always very amenable to my requests! And he is going to refer me for a scan for AAA. Tomorrow I'm going for a Vit D blood test and if the result is favourable, the rheumy will refer me for bisphosphnate infusion.