Background:Giant cell arteritis (GCA) presents with visual symptoms in approximately 37%1of patients at diagnosis. Patients with visual symptoms present, according to some series, lower levels of C-reactive protein (CRP) at diagnosis and associate less headache, fever, cranial nodules or polymyalgia (PM).Relapses despite glucocorticoid treatment (GC) are frequent (40-60%). Visual symptoms are very rare in relapses (0% in several series). Since most series focus on northern European populations, it is interesting to study the characteristics in our population.Objectives:To describe visual manifestations in both diagnosis and recurrence of stroke, only in patients diagnosed with temporal artery biopsy. To analyze demographic, clinical and analytical features in patients with and without visual symptoms.Methods:We retrospectively reviewed the medical records of patients with positive biopsy for GCA at our center from January 2000 through December 2018. Relapse was defined as the appearance of clinical symptoms in a previously asymptomatic patient requiring a dose increase or restart of GCS. Patients with no response to GCS were not included. Qualitative variables are shown with absolute value and percentage and quantitative variables with mean and standard deviation (SD). Kruskal Wallis, Fisher test and Mann-Whitney U test were used for bivariate analysis.Results:52 patients were found: 39 women (73.6%), with an average age at diagnosis of 77.6 years (SD 6.3). At diagnosis, 28 presented visual symptoms (53.84%): oculomotor paralysis 5 (9.61%), amaurosis fugax 8 (15.38%), blindness 6 (11.54%), decreased visual acuity 8 (28.57%) and other visual symptoms 1 (1.92%). Eleven had monocular symptoms (38%) and 9 binocular (32%), in 10 patients this data was not collected. The symptoms were permanent in 11 (39.2%) despite GC. Type of visual impairment was: Anterior Ischemic Optic Neuropathy (AION) (12, 42.86%), impairment of cranial pairs (5, 17.86%), central retinal artery occlusion (1, 3.57%), cilioretinal artery occlusion (1, 3.57%) and Posterior Ischemic Optic Neuropathy (1, 3.57%).Of the 52 patients, 17 (32.69%) presented a minimum of one recurrence and 3 (5.77%) presented 2 or more. No patient relapsed with visual clinic.There were no differences among patients with and without visual symptoms in the variables studied (table 1). However, patients with visual symptoms at diagnosis had numerically less PM and cranial nodules.Table 1.Demographic, clinical and analytical differences between patients with/without visual symptomsVariablesWith visual symptoms (28)Without visual symptoms (24)ESR >5017 (60.7%)15 (62.5%)ESR <504 (14.3%)2 (8.33%)CRP>1017 (60.7%)13 (54.16%)CRP <103 (10.7%)2 (8.33%)Cephalea24 (85,7%)23 (95,8%)Polymyalgia9 (32,1%)12 (50%)Constitutional syndrome9 (32,1%)7 (29,1%)Jaw claudication17 (60.7%)12 (50%)Cranial nodules4 (14,3%)8 (33,3%)Sex: Man/Woman9/195/19Previous PM diagnosis4 (14,3%)3 (12,5%)Conclusion:In our series, 53% of the patients presented visual symptoms at diagnosis, a number higher than that described in the literature. It is important to remember that only patients with biopsy-confirmed ACG were included. The most frequent manifestations were AION followed by oculomotor paralysis. A numerically lower percentage of PM and cranial nodules was observed at diagnosis in patients with visual symptoms compared to patients without them, as seen in some series. The absence of visual clinic in recurrences coincides with that reported in the available literature.References:[1]Alba M et al. Relapses in Patients With Giant Cell Arteritis Prevalence, Characteristics, and Associated Clinical Findings in a Longitudinally Followed Cohort of 106 Patients. Medicine. 2014;93: 194–201.Disclosure of Interests:None declared
Bilateral Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in Korea
