番茄社区

GLASGOW -- The development of blindness remains an important clinical problem among patients with giant cell arteritis (GCA), according to a multinational study reported here.

Six months after the diagnosis of GCA, the incidence of complete blindness in at least one eye was 7.9%, according to , of the University of East Anglia in England.

Giant cell arteritis is a vasculitis of the medium and large arteries afflicting the elderly, and is associated with complications including vision loss. Standard treatment involves prompt administration of steroids.

"Anterior ischemic optic neuropathy is the greatest fear in giant cell arteritis. Unfortunately this complication occurs early in the disease course, and it's often not responsive to treatment," Yates said at the here.

The rate of sight loss, however, is uncertain and varies widely in the published literature. In addition, risk factors have been reported inconsistently, with some studies suggesting a role for previous cardiovascular disease.

Therefore, to address these questions, Yates analyzed data from the , which enrolled 715 patients from 23 countries by 2014.

"This study was intended to come up with new diagnostic criteria for GCA, but because it covers a wide range of the globe, it also gives us the opportunity to establish a more precise and robust estimate of blindness," he said.

Patients enrolled in DCVAS were diagnosed clinically, and visual impairment was evaluated on the Vasculitis Damage Index. Of the 433 patients classified as having GCA, 404 fulfilled the disease criteria of the American College of Rheumatology and 54% had positive temporal artery biopsies.

The majority of patients were women, and mean age at diagnosis was 73. Jaw claudication, a known risk factor for blindness, was present in 40%, fever in 16%, and weight loss in 34%.

Baseline median erythrocyte sedimentation rate was 70 mm/h and C-reactive protein was 62 mg/L, but none of the laboratory abnormalities, including thrombocytopenia and anemia, which had been linked with blindness in some other reports, were associated with vision loss. Rather, on logistic regression analysis, a history of cerebrovascular accident had a significant association, with an odds ratio of 4.47 (95% CI 1.30-15.41), as did peripheral vascular disease, with an odds ratio of 10.44 (95% CI 2.94-37.03).

Prevalent diabetes also showed an association, but had only borderline statistical significance (OR 2.48, 95% CI0.98-6.25).

"The study highlights the need for urgent referral and treatment in GCA. It's interesting that there was this association with vascular disease, and perhaps we need greater vigilance in those patients who already have vascular disease to closely watch and monitor them," he concluded.

Limitations of the study included the possibility of referral bias and a lack of information on treatment. In addition, patients with partial vision loss were not included. A study looking at those patients is recruiting now, Yates noted.