Characteristics and outcomes of patients with ophthalmologic involvement in giant-cell arteritis: A case-control study

Dumont, Anaël; Lecannuet, Anaïs; Boutémy, Jonathan; Maigné, G.; Silva, Nicolas Martin; Deshayes, Samuel; Audemard-Verger, Alexandra; Sultan, Audrey; Planchard, G.; Aouba, Achille; Boysson, Hubert de

doi:10.1016/j.semarthrit.2019.09.008

Cited by 40 publications

(36 citation statements)

References 29 publications

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“…The incidence of permanent visual loss in GCA ranges from 8.2% to 40% 39,40 . Bilateral visual loss occurs in 20% to 62% of patients and up to 10% of patients with visual involvement are bilaterally blind 40‐43 .…”

Section: Clinical Featuresmentioning

confidence: 99%

“…The most common visual symptoms in GCA patients are blurry vision (7%‐60%), 40,42 amaurosis fugax (7%‐18%) 42,44 and loss of vision (7%‐91.1%) 42,45 . Amaurosis fugax is an important predictor of permanent visual loss 40,46 . Postural change‐associated visual loss 47 and bright light‐induced amaurosis in the absence of carotid occlusive disease have also been described 48 .…”

Section: Clinical Featuresmentioning

confidence: 99%

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Diagnosis and management of giant cell arteritis: Major review

Simon

Ninan

Hissaria

2021

Clinical Exper Ophthalmology

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Giant cell arteritis is a medical emergency because of the high risk of irreversible blindness and cerebrovascular accidents. While elevated inflammatory markers, temporal artery biopsy and modern imaging modalities are useful diagnostic aids, thorough history taking and clinical acumen still remain key elements in establishing a timely diagnosis. Glucocorticoids are the cornerstone of treatment but are associated with high relapse rates and side effects. Targeted biologic agents may open up new treatment approaches in the future.

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Diagnosis and management of giant cell arteritis: Major review

Simon

Ninan

Hissaria

2021

Clinical Exper Ophthalmology

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“…Regarding GC, most studies showed a higher percentage of vision loss during treatment. One recent casecontrol study with 104 GCA-patients showed new ischemic events (AION) in 4% after initiation of treatment with GC (21). An abstract of the ACR 2019 presented a cohort of 11'820 veterans in the United States with ophthalmologic complications of 6.2% within 1 year after diagnosis despite prednisone exposure (22).…”

Section: Discussionmentioning

confidence: 99%

Vision Loss in Patients with Giant Cell Arteritis Treated with Tocilizumab

Amsler

Kysela

Tappeiner

et al. 2020

Preprint

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Objectives: Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ.Methods: In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical and laboratory data were analyzed. Results: A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed in magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6-17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0-8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p=0.032), had a lower C-reactive protein (p=0.002), more often cranial symptoms (p<0.001) or jaw claudication (p=0.031) and showed a negative association with MRA of the aorta (p=0.006). Two patients (1.1%) developed vision loss, both at initiation of TCZ treatment.Conclusion: Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.

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“…Diplopia, resulting from microvascular ischemia to cranial nerves III, IV or VI, occurs in up to 6% of patients [30]. In one retrospective study of patients diagnosed with vision loss from GCA, amaurosis fugax was the initial presenting sign in 18% of cases and, of the patients with vision loss or blurred vision at the time of diagnosis, 44% experienced transient visual symptoms prior to treatment [1]. A work up for GCA, beginning with stat CBC, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), should therefore be part of the work up for any patient with amaurosis fugax over age 50, even if they do not have systemic symptoms.…”

Section: Manifestationsmentioning

confidence: 99%

“…Its chief vascular targets are extracranial branches of the external and internal carotid arteries, the former resulting in headache, scalp tenderness and jaw claudication, and the latter resulting in potentially blinding ischemic injury to the optic nerve or retina. In fact, at least 9% of patients experience severe, irreversible vision loss from the disease [1], a complication that is more likely if high dose corticosteroids are not started in a timely fashion. Less common but life-threatening complications include myocardial infarction, cerebral infarction and aortic aneurysms.…”

Section: Introductionmentioning

confidence: 99%