Michael Czihal1, Janina Tschaidse2, Christoph Bernau2, Christian Lottspeich2, Anton Köhler2, Claudia Dechant3, Hendrik Schulze-Koops3, Ulrich Hoffmann2, Marc J Mackert4, Stephan Thurau4. 1. Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany. michael.czihal@med.uni-muenchen.de. 2. Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany. 3. Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany. 4. Department of Ophthalmology, University Hospital, Ludwig- Maximilians-University, Munich, Germany.
Abstract
OBJECTIVES: To identify independent risk factors for permanent visual loss (PVL) in patients with giant cell arteritis (GCA), with a special focus on sonographic findings of the temporal, carotid and subclavian/axillary arteries, and on established scoring systems of ischaemia risk assessment. METHODS: Consecutive patients with a diagnosis of GCA between 2002 and 2013 were retrospectively identified from a prospectively maintained database. Data on clinical characteristics including ophthalmological findings, laboratory values, and sonographic findings of the temporal, carotid an axillary arteries were extracted. CHADS2- and CHA2DS2-VASc-score were calculated. Clinical, laboratory and sonographic characteristics of patients with and without PVL were compared. Multiple logistic regression models were calculated to identify variables independently associated with PVL. RESULTS: One-hundred-fifty-two patients were included in the analysis. PVL occurred in 30.2% of patients, with anterior ischaemic optic neuropathy as predominant underlying cause (91.3%). The frequency of PVL was strongly dependent on the age at diagnosis, with a significant increase after the age of 70 years. In multivariate analysis, axillary artery vasculitis with an odds ratio (OR) of 0.3 and constitutional symptoms with an OR of 0.1 were negatively associated with PVL. A CHADS2-score of 1 (OR 10.7) or ≥2 (OR 25) was associated with a significantly increased risk of PVL. CONCLUSIONS: The risk of PVL secondary to GCA increases with age but is lower in patients presenting with constitutional symptoms and/or exhibiting axillary artery involvement. The CHADS2-score may help to discriminate patients with low vs. high risk of PVL.
OBJECTIVES: To identify independent risk factors for permanent visual loss (PVL) in patients with giant cell arteritis (GCA), with a special focus on sonographic findings of the temporal, carotid and subclavian/axillary arteries, and on established scoring systems of ischaemia risk assessment. METHODS: Consecutive patients with a diagnosis of GCA between 2002 and 2013 were retrospectively identified from a prospectively maintained database. Data on clinical characteristics including ophthalmological findings, laboratory values, and sonographic findings of the temporal, carotid an axillary arteries were extracted. CHADS2- and CHA2DS2-VASc-score were calculated. Clinical, laboratory and sonographic characteristics of patients with and without PVL were compared. Multiple logistic regression models were calculated to identify variables independently associated with PVL. RESULTS: One-hundred-fifty-two patients were included in the analysis. PVL occurred in 30.2% of patients, with anterior ischaemic optic neuropathy as predominant underlying cause (91.3%). The frequency of PVL was strongly dependent on the age at diagnosis, with a significant increase after the age of 70 years. In multivariate analysis, axillary artery vasculitis with an odds ratio (OR) of 0.3 and constitutional symptoms with an OR of 0.1 were negatively associated with PVL. A CHADS2-score of 1 (OR 10.7) or ≥2 (OR 25) was associated with a significantly increased risk of PVL. CONCLUSIONS: The risk of PVL secondary to GCA increases with age but is lower in patients presenting with constitutional symptoms and/or exhibiting axillary artery involvement. The CHADS2-score may help to discriminate patients with low vs. high risk of PVL.
Authors: Javier Loricera; Santos Castañeda; Clara Moriano; Javier Narváez; Vicente Aldasoro; Olga Maiz; Rafael Melero; Ignacio Villa; Paloma Vela; Susana Romero-Yuste; José L Callejas; Eugenio de Miguel; Eva Galíndez-Agirregoikoa; Francisca Sivera; Jesús C Fernández-López; Carles Galisteo; Iván Ferraz-Amaro; Julio Sánchez-Martín; Lara Sánchez-Bilbao; Mónica Calderón-Goercke; Alfonso Casado; José L Hernández; Miguel A González-Gay; Ricardo Blanco Journal: Ther Adv Musculoskelet Dis Date: 2022-07-22 Impact factor: 3.625