Background/Purpose: This study aimed to identify the incidence of ophthalmic complication of giant cell arteritis (GCA) among subjects with negative temporal artery biopsy (TAB) and to determine if duration of prednisone exposure prior to GCA diagnosis was associated with the development of ophthalmic complication in TAB-negative subjects.

Methods: The Veterans Health Administration (VHA) national database was queried for subjects between 1999-2017 with 1) ICD-9 or -10 diagnosis code for GCA 2) procedure code for TAB and 3) ICD-9 or -10 diagnosis code for blindness, anterior or posterior ischemic optic neuropathy (AION; PION), or branch or central retinal artery occlusion (BRAO; CRAO) accrued up to 1 year after GCA diagnosis date.  TAB result (positive or negative) was reviewed manually and recorded.  Prescription data regarding prednisone dosage, dispense date relative to GCA diagnosis and date that TAB was performed were collected.  Logistic regression models were run using Stata 11.2.

Results: 11,820 subjects in the database had an ICD-9 or -10 diagnosis code for GCA; incident accrual of an ICD-9 or ICD-10 code for ophthalmic complication within 1 year following GCA diagnosis date was 4.5% (n=528) of the total GCA cohort.  25% (n=2,929) of the total GCA cohort had TAB performed in the VHA system; incident ICD-9 or -10 code for ophthalmic complication was significantly higher in subjects who underwent TAB (6.6%; p< 0.001; Table 1) and significantly higher in those with positive TAB (9.7%; p< 0.05; Table 1).  Age, TAB laterality, and TAB length did not affect the outcome variable of incident ophthalmic complication after GCA diagnosis.  Compared to a reference group of prednisone initiation 0-14 days prior to GCA diagnosis, the likelihood of accruing an ICD-9 or -10 code for ophthalmic complication within 1 year after GCA diagnosis was increased with delayed prednisone dispense dates relative to GCA diagnosis and reached statistical significance when prednisone initiation occurred 14-28 days after GCA diagnosis (OR 2.3, CI 1.01-5.34; Table 2).

Conclusion: In the Veterans Health Administration national database, incident ophthalmic complication within a year following GCA diagnosis occurred in 6.2% of subjects with negative TAB per pathology report despite prednisone exposure.  Among subjects with negative TAB, the odds of developing an ophthalmic complication increased the later prednisone was initiated; this association reached significance in subjects who initiated prednisone 14-28 days after GCA diagnosis.

Table 1 GCA abstract final

Table 2 GCA abstract final

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-veterans-health-administration-vha-national-database-cohort-incident-ophthalmic-complications-in-giant-cell-arteritis-gca-patients-with-a-negative-temporal-artery-biopsy/