Characteristics of patients with giant cell arteritis who experience visual symptoms

Abstract

Permanent vision loss is one of the most serious complications of giant cell arteritis (GCA) and therefore prompt diagnosis is paramount. However, diagnosis of GCA remains challenging due to its frequently non-specific presentation. Our aim was to identify differences in the characteristics of GCA patients with, and without, current visual symptoms. A cross-sectional survey was mailed to patients with a GCA Read code entered in their GP electronic medical record. Responders were categorised as those currently reporting a visual symptom or not. We compared general and GCA-specific characteristics in these two groups. The association of diagnostic delay with subsequent experience of visual symptoms was examined using unadjusted and adjusted linear regression analysis. 318 GCA patients responded to the survey (59.6%). Responders were predominantly female (69.8%), with a mean age of 73.7 years (SD 8.2). 28% reported current visual symptoms. There was no statistically significant difference in the general characteristics between those with and without visual symptoms. Of GCAspecific characteristics, pre-GCA diagnosis of diplopia (p = 0.018), temporary (p ≤ 0.001) or permanent visual problems (p = 0.001) and hoarseness (p = 0.004) were more common among those reporting current visual symptoms. There was no association between the extent of diagnostic delay and reporting of current visual symptoms. Though we found few characteristics to distinguish between GCA patients with or without current visual symptoms, diagnostic delay was not associated with current visual symptoms. Our findings highlighted the continued difficulty for clinicians to identify GCA patients at the highest risk of visual complications.

Dysregulated Expression of Arterial MicroRNAs and Their Target Gene Networks in Temporal Arteries of Treatment-Naïve Patients with Giant Cell Arteritis

“…Combining clinical, imaging and molecular disease characteristic can significantly advance stratification of patients in prognostic and therapeutic groups. In GCA, irreversible vision damage remains the most feared acute complication and identifying GCA patients at risk for vision damage represents a major clinical need [ 42 , 43 ]. Several clinical, laboratory, histological and ultrasound imaging parameters have been associated with increased risk of vision disturbances in GCA.…”

Maxillary Artery Involvement in Giant Cell Arteritis Demonstrated by Ultrasonography

“…Chewing diffi culties and jaw claudication are present in up to 45% of individuals with GCA. 9 The muscles of mastication are supplied directly by the maxillary artery. The maxillary artery is the larger of the two terminal branches of the external carotid artery, the other one is the superfi cial temporal artery.…”

Extended in Scotland

“…1 Those with an increased Body Mass Index (BMI) often suffer from a range of comorbidities including heart disease, hypertension, diabetes and more recently have been shown to have poorer outcomes following COVID-19. 2,3 Dentists are knowledgeable regarding the oral consequences of these conditions, alongside the effects upon general health.…”

“…Assessment also identifies other parameters of significance: hypertension or reduced oxygen saturations, alongside anatomical complicating factors, such as airway management. 3…”

“…This may mean that potentially half of those with GCA may seek the attention of their GDP. 3 Although commonly presenting with symptoms that may be confused with local oral or dental issues, GCA is a rare condition with an annual incidence of 2.2/10,000 in the UK, which may add to the problem of early recognition. 4 In addition, dental practices may have established referral pathways with the maxillofacial surgery department, but not with the ophthalmology or rheumatology departments, further complicating the process of referral to secondary care.…”