Background/Purpose: It is reported that 15-25% patients with GCA present with visual complications. Sight loss (SL) in the elderly is associated with considerable morbidity. There is evidence for reducing this by implementing a fast track pathway nationwide. However, data on the burden of SL due to GCA is lacking. The aim of this study is to estimate the incidence of visual complications in GCA and the factors that contribute to it.

Methods: This is an on-going observational study of new cases of SL attributable to GCA. In order to correctly estimate the incidence of SL, information is collected by participating ophthalmologists and rheumatologists on all patients with new or relapsing GCA with or without SL. Only patients that present with signs and symptoms fulfilling 1990 ACR criteria for classification of GCA or fulfilling 2/5 criteria along with positive imaging (PET-CT or vascular ultrasound) substituting for biopsy are recruited. SL is defined as symptomatic loss of acuity or field of vision, as diagnosed by an ophthalmologist. When a patient with definite visual complications of GCA is identified, an initial reporting “yellow card” will be completed electronically and either posted or emailed to the investigators. The primary statistical analysis is the estimation of the percentage incidence as well analysis risk factors using binary logistic multiple regression methods.

Results: Yellow cards and detailed reports have been sent regarding 105 patients so far from 13 centres. We plan to recruit 250 patients. Patients who developed SL had symptoms for 23.2 days preceding the diagnosis vs. 37.97 days in the non-sight loss group. 27 (25.71%) presented with visual disturbances. Mean age at presentation was 79.96 (57-93) sight loss vs. 72.86 (50-95) non-sight loss group. Interestingly, GCA patients with sight loss had a higher ESR value (60.04 vs. 50.78, p=0.025, 95 %CI 2.47-11.18) and a lower Haemoglobin level (99.98 vs. 118.91, p=0.03, 95% CI -36.087 to -1.767). There was no statistically significant difference between the two groups in terms of symptoms including headaches, jaw claudication or constitutional symptoms or risk factors (p>0.05). 70.47% of the recruited patients had temporal artery biopsy. There was no difference with regards to biopsy results (14 vs 32; OR 0.8750, CI 95%0.2903 to 2.6378, p=0.81) or USS (7 vs 26; OR 3.2308, CI 95% 0.3565 to 29.2791, P=0.29). 18.51% of the SL had a previous diagnosis of GCA or PMR compared to 8.97% (RR 0.66, CI 95% 0.1667 to 2.6657, p=0.56).

Conclusion: Our study shows a major delay associated with the diagnosis of GCA in the UK. This may be related to the high percentage of SL seen in all participating centres. The study confirms that patients with SL have higher inflammatory markers suggesting a more active disease. Our results highlight the need for implementing the fast track GCA pathway to improve outcome and reduce ischemic complication.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-yellow-card-reporting-system-for-sight-loss-in-giant-cell-arteritis/