Background/Purpose: Giant cell arteritis (GCA) involves both the cranial and large vessels. Permanent visual loss is a feared complication reported in up to 19% of GCA patients. The extension of vascular inflammation (halo count) was associated with visual disturbances and loss (1).

This study aimed to investigate: 1. The rates of visual loss in patients with GCA in a prospective cohort of GCA patients 2. Whether halo count is associated with visual disturbances and loss. In addition, the rates of visual loss before, during, and after COVID lockdown were explored.

Methods: Patients with new-onset GCA referred to the Department of Rheumatology, Martina Hansens Hospital, Norway, were prospectively included and followed up from September 2017 till July 2021. All patients fulfilled the ACR 1990 criteria modified by Dejaco et al. Visual loss was defined as a permanent visual impairment in one or both eyes, and visual disturbances as diplopia, amaurosis fugax, or blurred vision. Halo count was further extended by including the carotid, vertebral and subclavian arteries. The patients were divided into three groups (before, during, and after) according to lockdown in Norway from 15^th March 2020 to 1^st June 2020 and were compared for visual loss and delays in diagnosis.

Results: One hundred thirty-three patients, 88 (66,2%) females, were diagnosed with GCA during the study period. The mean age was 72,7 years. Forty patients had only involvement in the cranial vessels only, 21 had involvement in the large supraaortic vessels (LV), and 72 in both cranial and large supraaortic vessels (mixed-GCA). Twenty-eight patients (21,0%) suffered from new-onset visual disturbances, and 5 of these patients had permanent visual loss (3,8%). Twenty-seven (96,4%) of the patients with visual disturbances had involvement of cranial vessels, p < 0,05. All patients with visual loss had cranial vessel involvement (2 patients with isolated cranial GCA and three patients with mixed GCA). The relative risk for visual loss was 1,2 (95% CI (1,1-1,3)) for cranial vessel involvement, p=1. The mean halo count for patients with visual disturbances was 4,8 (95% CI 4,3-5,3) compared to 4,3 (95 % CI 3,4-5,2) for patients without. Of the patients with visual loss, the mean halo count was 4,2 (95% CI 0,2-8,1) compared to a mean of 4,7 (95% CI 4,2-5,1) in patients without visual loss. No patients developed visual loss after the diagnosis and for the whole follow-up period.

No GCA patients presented with visual loss during or after COVID lockdown. The mean number of days from symptoms start to diagnosis was 8,8 days (95% CI 6,5-11,1) for before, 8,9 days (95% CI 3,1-14,6), during, and 8,5 days (95% CI 5,9-11,1) after the lockdown period.

Conclusion: In a prospective cohort of GCA patients, the cranial disease appears to be a risk factor for visual loss. However, the extended halo count was not associated with visual disturbances or loss. Interestingly during COVID lockdown, no new GCA patients appeared to suffer from visual loss, and no delays were observed in the diagnosis.

1. van der Geest KSM, Borg F, et al. Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia. Ann Rheum Dis. 2020;79(3):393-9.

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