Vasculitis Clinic, Canadian Network for Research on Vasculitides (CanVasc), Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada.
Department of Medicine, University of Montreal, Montreal, QC, Canada.
Clin Rheumatol. 2021 Aug;40(8):3207-3217. doi: 10.1007/s10067-021-05643-5. Epub 2021 Feb 12.
BACKGROUND/PURPOSE: Permanent vision loss (PVL) is a feared complication and a leading cause of morbidity in giant cell arteritis (GCA). The objective of this study is to describe visual manifestations and identify risk factors of ocular involvement in GCA.
A retrospective database from a single vasculitis referral center was used. Descriptive statistics comparing patients with and without ocular involvement were performed.
One hundred patients with GCA were included. Visual symptoms were present in 53% of patients at diagnosis and included blurred vision (30%), diplopia (16%), amaurosis fugax (14%), and blindness (19%). Out of 19 patients with blindness, 16 did not recover and had PVL. Patients with PVL were older (79.2 ± 6.7 vs 74.2 ± 7.6 years; p = 0.008) and more likely to have coronary artery disease (31% vs 10%; p = 0.018). However, they were less likely to have other cranial symptoms (81% vs 96%; p = 0.019), mainly headaches (64% vs 92%; p = 0.003). Risk factors associated with an abnormal ophthalmologic examination were the same as for PVL, but patients were also more likely to have diabetes (29% vs 7%; p = 0.040) and less likely to have constitutional symptoms (53% vs 80%; p = 0.033).
Patients with GCA and ocular involvement were more likely to have baseline diabetes and atherosclerosis. A predisposing vascular vulnerability might therefore increase the risk of ocular involvement. Key points • Most patients with GCA and complete vision loss at presentation will not recover and evolve to have permanent vision loss. • A GCA patient with visual manifestations at presentation has more baseline vascular risk factors (diabetes, atherosclerosis) than patients without ocular involvement. • Patients with GCA and visual manifestations have fewer constitutional symptoms and lower inflammatory markers than patients without ocular involvement.
背景/目的：永久性视力丧失（PVL）是巨细胞动脉炎（GCA）的一种可怕并发症和主要致残原因。本研究旨在描述 GCA 的眼部表现并确定眼部受累的危险因素。
使用单一大血管炎转诊中心的回顾性数据库。对有和无眼部受累的患者进行描述性统计比较。
共纳入 100 例 GCA 患者。53%的患者在诊断时存在视觉症状，包括视力模糊（30%）、复视（16%）、一过性黑矇（14%）和失明（19%）。19 例失明患者中，16 例未恢复并发生 PVL。PVL 患者年龄更大（79.2 ± 6.7 岁 vs 74.2 ± 7.6 岁；p = 0.008），更可能患有冠心病（31% vs 10%；p = 0.018）。然而，他们更不可能有其他颅神经症状（81% vs 96%；p = 0.019），主要是头痛（64% vs 92%；p = 0.003）。与异常眼科检查相关的危险因素与 PVL 相同，但患者也更可能患有糖尿病（29% vs 7%；p = 0.040），且更不可能有全身症状（53% vs 80%；p = 0.033）。
GCA 患者伴眼部受累更可能存在基线糖尿病和动脉粥样硬化。因此，血管易损性的潜在倾向可能会增加眼部受累的风险。
关键点
• 大多数 GCA 患者在就诊时完全失明且无法恢复，最终会发展为永久性视力丧失。
• 就诊时存在视觉表现的 GCA 患者比无眼部受累的患者基线血管危险因素更多（糖尿病、动脉粥样硬化）。
• 与无眼部受累的患者相比，GCA 患者伴视觉表现的患者全身症状更少，炎症标志物水平更低。
