Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
Department of Angiology, University Hospital Basel, Basel, Switzerland.
RMD Open. 2023 Jan;9(1). doi: 10.1136/rmdopen-2022-002866.
To characterise factors associated with permanent vision loss (PVL) and potential reasons for the therapeutic delay contributing to PVL in giant cell arteritis (GCA).
Retrospective analysis of GCA patients diagnosed at the University Hospital Basel between December 2006 and May 2021.
Of 282 patients with GCA (64% females), 49 (17.4%) experienced PVL. In 43/49 (87.8%) PVL occurred before treatment. Of these, 24 (55.8%) patients had first non-ocular symptoms and eventually sought consultation when PVL occurred in a median of 21 (IQR 14.75-31.0) days after the first symptoms. Only five of the 24 patients had consulted a physician before PVL, but GCA diagnosis was missed. Treatment was initiated rapidly after diagnosis (median 1 day (IQR 0.0-7.0)). PVL on therapy occurred in six patients in a median of 40 (IQR 20.5-67.3) days after treatment started. In two of those, glucocorticoids were tapered too quickly.In multivariable analysis, patients with PVL were older (OR 1.17, 95% CI 1.07 to 1.29, p=0.001) and reported more frequently jaw claudication (OR 3.52, 95% CI 1.02 to 13.16, p=0.051). PVL was present in 18 (42.9%) of the 42 patients with vasculitic ultrasound findings in all six temporal artery segments. The incidence of PVL over 15 years did not decline (Spearman rank=0.3, p=0.68).
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.
描述与巨细胞动脉炎（GCA）患者永久性视力丧失（PVL）相关的因素，以及导致 GCA 患者治疗延迟的潜在原因。
对 2006 年 12 月至 2021 年 5 月期间在巴塞尔大学医院诊断为 GCA 的患者进行回顾性分析。
282 例 GCA 患者中（64%为女性），49 例（17.4%）出现了 PVL。在 43/49 例（87.8%）PVL 发生在治疗之前。其中，24 例（55.8%）患者在出现 PVL 之前有非眼部症状，在中位 21 天（IQR 14.75-31.0）后最终就诊，首次出现症状。24 例患者中只有 5 例在 PVL 之前咨询过医生，但未确诊 GCA。诊断后迅速开始治疗（中位时间 1 天（IQR 0.0-7.0））。6 例患者在治疗开始后中位 40 天（IQR 20.5-67.3）时发生了治疗相关的 PVL，其中 2 例患者糖皮质激素减量过快。多变量分析显示，发生 PVL 的患者年龄更大（OR 1.17，95%CI 1.07 至 1.29，p=0.001），更常报告咀嚼困难（OR 3.52，95%CI 1.02 至 13.16，p=0.051）。42 例患者的所有 6 条颞动脉节段均有血管炎超声表现，其中 18 例（42.9%）出现了 PVL。15 年内 PVL 的发生率并未下降（Spearman 秩=0.3，p=0.68）。
GCA 相关的 PVL 患病率仍然很高。相关因素包括年龄较大、咀嚼困难和所有 6 条颞动脉节段均有超声检查符合血管炎的表现。尽管在 PVL 发生之前，几周前就出现了非眼部 GCA 症状，但大多数患者在 PVL 发生之前并未就诊于风湿病医生。
