Vasculitis & polymyalgia rheumatica
Long delay from symptom onset to first consultation contributes to permanent vision loss in patients with giant cell arteritis: a cohort study
Authors' conclusion
The prevalence of GCA-associated PVL remains high. Associated factors were advanced age, jaw claudication and ultrasound findings consistent with vasculitis in all six temporal artery segments. Despite preceding non-ocular GCA symptoms weeks before the onset of PVL, most patients were not seen by a rheumatologist before PVL occurred.
Study context
- Population
- Giant cell arteritis (GCA) patients diagnosed at University Hospital Basel, December 2006 to May 202164% females
- Participants
- 282 patients
- Exposure
- GCA patients with vs without permanent vision loss
- Permanent vision loss (PVL)n = 49
- Outcome
- Permanent vision loss (PVL) and associated factors
Methodological detailssingle-centre, multivariable analysis
- Single-centre
- Multivariable analysis
Main finding
As reported in the abstract
PVL
PVL
17.4%
49
PVL vs No PVLOdds ratio (95% CI)P value
Older age, multivariable analysis
1.17(1.07–1.29)
P = 0.001Jaw claudication, multivariable analysis
3.52(1.02–13.16)
P = 0.051Observational data: associations, not effects.
Further findings
PVL before treatment
- PVL before treatment, of 49
- 43 (87.8%)
- First non-ocular symptoms, sought consultation at PVL
- 24 (55.8%)
- Time from first symptoms to PVL, median (IQR), days
- 21 (14.75-31.0)
- Consulted a physician before PVL but GCA diagnosis missed, of 24
- 5
Time from diagnosis to treatment
- Median (IQR), days
- 1 (0.0-7.0)
PVL on therapy
- Patients
- 6
- Time after treatment start, median (IQR), days
- 40 (20.5-67.3)
- GCs tapered too quickly
- 2
PVL with vasculitic US findings in all six temporal artery segments
- PVL, of 42 patients
- 18 (42.9%)
Incidence of PVL over 15 years
- Did not decline (Spearman rank)
- 0.3, p=0.68
Original publication
Long delay from symptom onset to first consultation contributes to permanent vision loss in patients with giant cell arteritis: a cohort study. RMD Open. Published 12 January 2023. doi:10.
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