Background/Purpose:

Under reporting of visual impairment attributable to GCA is likely; certificates of visual impairment do not include GCA as a category. Delayed presentation, recognition and treatment are in most cases the reasons that sight loss (SL) is still present in 15-25% of patients at diagnosis. A “Yellow card reporting system” enabled us to characterise the spectrum and severity of visual involvement (VI) attributable to GCA.

Methods:

We recorded patients prospectively, with new or relapsing diagnosis of GCA who presented with or without VI over a period of 2 years. We collected demographic information, symptomatology at presentation, medical history, date/dose of initiation of steroids, response to treatment, laboratory results, confirmatory investigations as ultrasound of temporal arteries, biopsy or /and PET, presence of VI with or without loss of acuity, persistence of visual symptoms and findings from formal ophthalmology assessment. SL was defined as symptomatic loss of acuity, field of vision or diplopia ascribable to ischaemic complications of GCA. Patients with transient visual symptoms were not considered to have SL. Analyses were performed using chi-squared and rank sum tests

Results:

388 patients were enrolled from 19 sites. 135 (35%) presented with VI. Patients with VI had mean age of 75.9 (SD 9.3) years, were predominantly females 95 (70%) and all were Caucasian. Headache (84% vs 92%, p=0.012) and scalp tenderness (61% vs75%, p=0.005) were less common, but jaw (57% vs 46%, p=0.040) and tongue claudication (13% vs 4%, p=0.004) were more common at presentation in patients with VI than in those without. Median duration of symptoms prior to diagnosis was 2.0 (IQR 1.0-4.0) weeks. Information was missing regarding type and severity of VI from 4 patients. 33/131 presented with diplopia, 51 with arteritic ischemic optic neuropathy (AION), 7 with central retinal artery occlusion (CRAO); changes were permanent in 36/58 and 5 patients experienced AION as manifestation of recrudescing disease. Headache (75% vs 92%, p<0.001) and myalgia/stiffness (25% vs 44%, p=0.011) were less common in patients who presented with AION/CRAO than those without. Patients with AION/CRAO were older [mean age 80.9 (SD 6.7) years] compared to those without [73.2 (SD 8.7) years, p<0.001]. History of hypertension was more common (70% vs 46%, p=0.001) and hemoglobin levels were lower (mean 119.9 mg/dl (SD 16.5) vs 124.4 (SD 15.4), p=0.018). Patients with SL presented quicker with median duration of symptoms of 2.0 (IQR 1.0-4.0) vs 3.0 (IQR 1.4-6.0) weeks (p=0.016). 44/92 patients who presented with SL had at least unilaterally reduced visual acuity: counting fingers (3), hand movements (4), no light perception (7), light perception (3), 1 reported as blind and 25 had variable severity of unilateral visual acuity loss (from 6/18 to 6/120 based on Snellen chart).

Conclusion:

Visual symptoms often leading to SL in GCA require urgent management. Patients with VI were older, without ‘typical symptoms’ such as headache and polymyalgia but more likely to have ischaemic symptoms, such as jaw and tongue pain and hypertension. Recognition of VI associated features should be embodied in public and professional awareness programs to prevent permanent SL in GCA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/visual-involvement-in-giant-cell-arteritis-a-prospective-multi-center-study/