Increased number of cases of giant cell arteritis and higher rates of ophthalmic involvement during the era of COVID-19

Abstract

Objectives Our centre offers a fast-track assessment service for patients with suspected giant cell arteritis (GCA) and this service continued to operate during the Covid-19 pandemic. During and immediately following the peak of the Covid-19 pandemic in the UK we observed an increase the number of patients diagnosed with GCA plus an increased number of patients with visual complications. Our aim was to investigate this further. Methods The electronic medical records of all patients referred for GCA fast-track assessment from January 2019 were reviewed. A complete list of patients undergoing temporal artery ultrasound and temporal artery biopsy for investigation of GCA, dating back to 2015, was also available. Results In the 12-week period between April and June 2020 24 patients were diagnosed with GCA. Six (25%) had associated visual impairment. In contrast during 2019, 28 new diagnoses of GCA were made in total, and just 10% of patients suffered visual involvement. The number of patients diagnosed with GCA in April-June 2020 was nearly 5-fold that of the same time period the previous year. GCA diagnoses between April and June 2020 were supported by imaging (temporal artery ultrasound or CT-PET) in 72% of cases. We noted a higher proportion of male patients and a lower median age but no clear difference in duration of symptom onset prior to assessment. Conclusions The reasons behind our observations remain unclear however our findings support the viral aetiopathogenesis hypothesis for GCA and demonstrate the importance of maintaining access to urgent rheumatology services during periods of healthcare disruption.

Arteritic Anterior Ischemic Optic Neuropathy in the Course of Giant Cell Arteritis After COVID-19

“…Luther et al stated that while 28 patients were diagnosed with GCA in 2019, between April 2020 and June 2020, the number of new GCA cases was 24, suggesting that viral etiopathogenesis of GCA might exist. Higher rates of ocular manifestations of GCA were also observed during the pandemic; however, none of the patients diagnosed with GCA had any symptoms suggesting COVID-19 [ 5 ]. Mulhearn et al observed the excess of 33 cases of GCA in 2020 in comparison with 2019, which they reported might have been caused by the damage to the endothelium and activation of T-helper cell type 1 cellular immunity and the monocyte-macrophage system [ 6 ].…”

Correspondence on: ‘What comes after the lockdown? Clustering of ANCA-associated vasculitis: single-centre observation of a spatiotemporal pattern‘

“…Our experience with GCA is in fact quite the opposite to that reported by Luther et al, who recently identified an increase of GCA cases as well as of cases with visual impairment during the COVID-19 pandemic. 3 In conclusion, our experience shows that patients with systemic vasculitis sought help and did not suffer from significant delays in receiving healthcare even during the pandemic.…”

A Case Report of Post COVID19 Giant Cell Arteritis and Polymyalgia Rheumatica With Visual Loss

“… 14 Interestingly, presentation with otalgia and visual loss were reported with normal ESR in cases that showed positive COVID-19. 15 Literature from several parts of the world observed the association of COVID-19 and giant-cell arteritis. 16 - 18 …”

“…14 Interestingly, presentation with otalgia and visual loss were reported with normal ESR in cases that showed positive COVID-19. 15 Literature from several parts of the world observed the association of COVID-19 and giant-cell arteritis. [16][17][18] Therefore, it is wise to suspect GCA in those over 50 years of age presenting with symptoms in one or both eyes, or persistent frontal or parietal headache (Table 1).…”