Background Early diagnosis of giant cell arteritis (GCA) and prompt initiation of high-dose glucocorticoid treatment is important to avoid permanent organ damage. One of the most feared outcomes in GCA are ischemic complications, especially visual impairment or irreversible blindness.
Objectives To compare the clinical and laboratory characteristics of patients with biopsy-proven GCA who develop visual complications to patients with GCA with no visual complications.
Methods Data from 840 patients with biopsy-proven GCA in Skåne, the southernmost region in Sweden, diagnosed between 1997 and 2010, were used for this analysis. Patients with GCA were identified in the regional register of the Department of Pathology in Skåne using established methods.The occurrences of acute visual complications after the onset of GCA were identified by linking the GCA cohort to the Skåne Health care Register as previously described using the ICD-10 codes. A nested case-control study was performed within the GCA cohort in which cases with visual complication were compared to age- and sex-matched patients with GCA without visual complications. In a structured review of all medical records, the presence of ophthalmological disease was validated, and we also recorded the use of selected medications at GCA onset, and histopathology findings (Table).
Results 100 of the 840 patients (12%) with GCA had an assigned diagnosis code for at least one visual complication. Upon detailed case record review, eight patients with an ophthalmological complication that pre-dated the diagnosis of GCA, and seven cases with either incomplete records or incorrectly assigned ICD codes were excluded. 85 patients were found to have visual complications (10% of patients); 72 patients had unilateral and 13 had bilateral visual impairment. Compared to patients without visual impairment, patients with GCA with new-onset visual impairment were less likely to have headache, fever, palpable abnormal temporal artery, polymyalgia rheumatica, and lower CRP at diagnosis compared with controls. The use of beta-blockers was associated with visual complication (Table).
Conclusions Patients with GCA with visual complications as a group have lower inflammatory responses compared to patients with GCA and no visual problems, a finding similar to what has been shown in previous studies. Patients with visual complications are more likely to be treated with beta-blockers than patients with GCA without visual changes. The role of beta-blockers in end-organ ischemia related to GCA should be further studied.
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Disclosure of Interest None declared