Background Permanent visual loss is one of the most serious complications in giant cell arteritis (GCA). Visual manifestations have been reported in 26% and permanent visual loss in up to 15% of the GCA patients (1).
Objectives The aim of this retrospective study was to examine if the implementation of the “fast track” principle in an outpatient clinic for GCA patients could reduce the rate of transient and permanent visual loss.
Methods Patients suspected to have GCA were consecutively evaluated between March 2010 and December 2012 by color Doppler ultrasound (CDUS). The “Fast- track” principle (quick evaluation by CDUS during 24 hours, and immediate initiation of treatment if appropriate) was implemented in our outpatient clinic from March 2012. All the patients fulfilled the American College of Rheumatology Classification Criteria for GCA (2) and had a positive CDUS of the temporal artery. Chi-square test was used for group comparison and p values < 0.05 were considered significant.
Results During the evaluation period 46 patients were diagnosed to have GCA. Among the 46 patients, 28 patients were traditionally evaluated between March 2010 and February 2012. Vision disturbances were observed in 7 patients, 6 of them suffered from permanent (21.5 %) vision loss in one (5 patients) or both eyes (1 patient). Among the 18 patients evaluated by the “fast track” principle (from March to December 2012), 2 (11.1%) had transient visual manifestations and none suffered from permanent visual loss. The difference between the two groups with regard to permanent visual loss was statistically significant (p=0.035).
Conclusions Our data indicate that a “Fast-track” approach including a rapid assessment with ultrasonography may significantly reduce the permanent vision loss in GCA patients. These encouraging observations need to be confirmed in larger groups of patients.
Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Hajeer AH, Branas F, Dababneh A, et al. Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients. Medicine (Baltimore). 2000;79(5):283-92. Epub 2000/10/20.
Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33(8):1122-8. Epub 1990/08/01.
Disclosure of Interest None Declared