PERMANENT VISION LOSS IN GIANT CELL ARTERITIS: WHY THE INCIDENCE REMAINS HIGH
Authors: Andrea Hemmig et al.
Permanent vision loss (PVL) remains the most feared complication of giant cell arteritis (GCA). In recent years, fast track clinic approaches for early GCA diagnosis have been described, primarily with the goal to reduce the incidence of PVL. This retrospective analysis of a longitudinal cohort of patients with suspected GCA treated at the University Hospital Basel between December 2006 and May 2021 included 740 cases. It aimed at assessing the trend in PVL over time.
311 patients were newly diagnosed, 282 (mean age 72.9years, 64% females) fulfilled inclusion criteria. 47 patients (17%) developed PVL. In 43 (91%) patients, PVL manifested at GCA diagnosis whereas in 4 (9%) patients, PVL developed more than one month after diagnosis. The incidence of PVL over 15 years remained constant.
The majority of patients sought first medical contact because of new-onset visual symptoms (n=40, 85%). However, 27 (57%) patients with PVL reported having other cranial or systemic symptoms before the onset of visual manifestations with a median time from first symptom until first contact with their general practitioners (GP) of 21.0 days (IQR 9.5-31 days.
The data confirm a substantial diagnostic delay in GCA which primarily presents with visual symptoms. Thus, PVL led to the diagnosis but only rarely developed under treatment. The finding of arteriosclerosis as a PVL risk factor supports the hypothesis of a preexisting vascular damage which contributes to the bad response to GC-pulse therapy and the deleterious outcome.