Eric Liozon1, François Dalmay2, Fabrice Lalloue2, Guillaume Gondran2, Holy Bezanahary2, Anne-Laure Fauchais2, Kim-Heang Ly2. 1. From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges. liozone@yahoo.fr. 2. From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges.
Abstract
OBJECTIVE: To determine the risk factors for permanent visual loss (PVL) in patients with biopsy-proven giant cell arteritis (GCA) and the usefulness of the factors in clinical practice. METHODS: From 1976 through 2015, the clinical charts and laboratory results of 339 patients with biopsy-proven GCA were recorded prospectively at the time of diagnosis. We used multivariable logistic regression analysis to determine which of 24 pretreatment characteristics were associated with PVL. RESULTS: Visual ischemic manifestations occurred in 108 patients, including PVL in 53 (16%), bilaterally in 15 patients (28%). The independent predictors associated with an increased risk of PVL were age (OR 1.06, 95% CI 1.01-1.12, p = 0.01), a history of transient visual ischemic symptoms (OR 2.62, 95% CI 1.29-5.29, p < 0.01), and jaw claudication (OR 2.11, 95% CI 1.09-4.10, p = 0.03). The presence of fever (OR 0.30, 95% CI 0.14-0.64, p < 0.01) and rheumatic symptoms (OR 0.23, 95% CI 0.10-0.57, p = 0.001) were associated with a markedly reduced risk of developing visual loss (3.7% if features were both present). No laboratory variables were independently associated with PVL. CONCLUSION: The visual ischemic risk of untreated GCA can be readily estimated upon simple clinical findings, but not laboratory variables. However, we did not identify a subgroup of patients carrying no risk of developing visual loss. Glucocorticoid treatment remains, therefore, urgent for any patient with a high clinical suspicion index.
OBJECTIVE: To determine the risk factors for permanent visual loss (PVL) in patients with biopsy-proven giant cell arteritis (GCA) and the usefulness of the factors in clinical practice. METHODS: From 1976 through 2015, the clinical charts and laboratory results of 339 patients with biopsy-proven GCA were recorded prospectively at the time of diagnosis. We used multivariable logistic regression analysis to determine which of 24 pretreatment characteristics were associated with PVL. RESULTS:Visual ischemic manifestations occurred in 108 patients, including PVL in 53 (16%), bilaterally in 15 patients (28%). The independent predictors associated with an increased risk of PVL were age (OR 1.06, 95% CI 1.01-1.12, p = 0.01), a history of transient visual ischemic symptoms (OR 2.62, 95% CI 1.29-5.29, p < 0.01), and jaw claudication (OR 2.11, 95% CI 1.09-4.10, p = 0.03). The presence of fever (OR 0.30, 95% CI 0.14-0.64, p < 0.01) and rheumatic symptoms (OR 0.23, 95% CI 0.10-0.57, p = 0.001) were associated with a markedly reduced risk of developing visual loss (3.7% if features were both present). No laboratory variables were independently associated with PVL. CONCLUSION: The visual ischemic risk of untreated GCA can be readily estimated upon simple clinical findings, but not laboratory variables. However, we did not identify a subgroup of patients carrying no risk of developing visual loss. Glucocorticoid treatment remains, therefore, urgent for any patient with a high clinical suspicion index.
Entities:
Keywords:
GIANT CELL ARTERITIS; POLYMYALGIA RHEUMATICA; RISK FACTORS; VISUAL LOSS
Authors: Kornelis S M van der Geest; Maria Sandovici; Yannick van Sleen; Jan-Stephan Sanders; Nicolaas A Bos; Wayel H Abdulahad; Coen A Stegeman; Peter Heeringa; Abraham Rutgers; Cees G M Kallenberg; Annemieke M H Boots; Elisabeth Brouwer Journal: Arthritis Rheumatol Date: 2018-07-30 Impact factor: 10.995
Authors: Sara Monti; Ana F Águeda; Raashid Ahmed Luqmani; Frank Buttgereit; Maria Cid; Christian Dejaco; Alfred Mahr; Cristina Ponte; Carlo Salvarani; Wolfgang Schmidt; Bernhard Hellmich Journal: RMD Open Date: 2019-09-16