Prognosis in giant-cell arteritis.

Abstract

In a study to assess the natural history of giant-cell arteritis, 90 patients with proved disease were followed up from the time of diagnosis. Early mortality was low and most commonly due to vertebral arteritis, but cerebral infarction did not appear to be a late complication. High maintenance dose steroids and visual loss were associated significantly with a shortened life span (p =00003 and p=0-0024). One-third of the patients developed chronic relapsing disease, but serious late complications were not encountered.After the initial attack has been controlled steroid dosage should be reduced to the minimum needed to alleviate symptoms.

Visual improvement with corticosteroid therapy in giant cell arteritis. Report of a large study and review of literature

“…The data suggested only poor reversibility of lost visual function. This is in sharp contrast to a number of reports in the literature claiming improvement in every eye (Parsons-Smith 1959;Graham et al 1981) or in about half of treated eyes (Whitfield et al 1953;Parsons-Smith 1959;Cohen 1973;Kupersmith et al 1999). Every case of visual improvement with steroid therapy for GCA reported in the English literature was reviewed (by SSH) in order to find an explanation for the reported differences in visual improvement.…”

“…Some studies report this as occurring in every eye treated on the same day as the onset of blindness (Parsons-Smith 1959;Graham et al 1981), while others report it as occurring in almost half of eyes (Whitfield et al 1953;Parsons-Smith 1959;Cohen 1973;Kupersmith et al 1999). But can these claims of marked visual improvement with steroid therapy be reconciled with the very rare visual improvement seen by ourselves and others?…”

“…Kearns (1973), in discussing this paper, questioned the claims of visual improvement in this study and stated that 'one should not expect real improvement in vision' in these cases. Graham et al (1981) retrospectively reviewed 43 GCA patients with visual loss due to unilateral AION (33), bilateral AION (5), CRAO (4) and branch retinal artery occlusion (1), treated with 250 mg intravenous hydrocortisone followed by 80 mg oral prednisone. They reported some visual recovery in three AION eyes with VA of 20/200 and an altitudinal field defect; in all three cases treatment was started within 24 hours of the visual loss and vision improved within 48 hours.…”

“…A review of the literature reveals many reports claiming variable degrees of visual improvement with systemic corticosteroid therapy. Some of these are based on retrospective reviews of varying numbers of patients seen in the authors' clinics (Whitfield et al 1953;Meadows 1954;Bennett 1956;Parsons-Smith 1959;Russell 1959;Norn 1966;Cohen 1973;Graham et al 1981;Bengtsson & Malmvall 1982;Aiello et al 1993;Liu et al 1994;Kupersmith et al 1999). Others are derived from observation of only one or two cases (Caccamise 1956;Cullen 1963;Friedman 1965;Schneider et al 1971;McLeod et al 1978;Model 1978;Lipton et al 1985;Rosenfeld et al 1986;Diamond 1991;Clearkin & Caballero 1992;Matzkin et al 1992;Postel & Pollock 1993;Thystrup et al 1994;Kattah et al 1999).…”

Low‐dose aspirin and prevention of cranial ischemic complications in giant cell arteritis

“…Acute visual loss, attributable mostly to anterior ischemic optic neuropathy and less commonly to central retinal artery occlusion, and cerebrovascular accidents (CVAs) are among the leading causes of giant cell arteritis (GCA)-related morbidity (1)(2)(3)(4). Other cranial ischemic complications such as tongue necrosis, scalp necrosis, and hearing loss are less common (5).…”