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.

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主动脉炎：最新进展、当前概念和未来可能性

从广义上讲，主动脉炎是指主动脉的炎症，包括感染性和非感染性病因。随着先进的成像方式越来越多地融入临床实践，与主动脉炎相关的表型谱已经扩大。原发性大血管炎、巨细胞动脉炎和大动脉炎是非感染性主动脉炎的最常见原因。没有全身性疾病或其他血管区域受累的主动脉炎被归类为临床孤立性主动脉炎。炎症扩散到主动脉壁之外的主动脉周围炎是具有不同病因的重要疾病亚群。传染性主动脉炎可能涉及细菌、病毒或真菌病原体，虽然不常见，但可能是毁灭性的。重要的，主动脉炎亚组之间的最佳管理策略和患者结果不同，突出了全面诊断检查的必要性。随着时间的推移监测疾病活动也具有挑战性，因为正常的炎症标志物不能排除明显的血管炎症，特别是在开始治疗后。未满足临床需求的其他领域包括明确的疾病分类和改进的短期和长期管理策略。其中一些呼吁现在正在得到回应，特别是关于大血管炎，近年来我们的理解有了显着进步。从颞动脉组织学推断的工作为靶向生物制剂铺平了道路，尽管糖皮质激素仍然是非感染性主动脉炎治疗的核心，但这些药物可能会减少对糖皮质激素的依赖。