Risk Factors for Cranial Ischemic Complications in Giant Cell Arteritis

Abstract

Cranial ischemic complications (CICs) are among the presenting manifestations of giant cell arteritis (GCA). Yet patients with GCA may develop CICs at a later stage, despite steroid therapy. In the current report we delineate risk factors for CICs, both at presentation and during follow-up, and review the relevant literature. We reviewed charts of 175 patients with GCA. Follow-up data were available for 166 patients. CICs at presentation or developing within 2 weeks of GCA diagnosis were considered GCA related. CICs developing later were considered GCA related only when associated with other GCA-related manifestations or acute-phase reactions. Associations between CICs and other variables were tested by multivariate analysis. At presentation, 43 patients (24.6%) had CICs. Risk factors were transient cerebro-ophthalmic ischemic episodes (COIEs) (odds ratio [OR] 4.3) and male sex (OR 2.5), while the presence of systemic symptoms was "protective" (OR 0.3). During follow-up 8.4% of patients with GCA developed new CICs. Risk factors in these cases were previous CICs at presentation (OR 5.6) and transient COIEs developing during follow-up (OR 14.8). The use of low-dose aspirin was protective (OR 0.2). These data, together with data from the literature review, suggest that GCA patients with transient COIEs and without fever or other systemic symptoms are at increased risk of presenting with CICs. Risk factors for late-developing CICs were CICs at presentation and late-developing transient COIEs.

Risk factors for visual loss in an Italian population‐based cohort of patients with giant cell arteritis

“…In our series, the proportion of patients who developed permanent visual loss (19.1%) was similar to that reported by Gonzalez-Gay et al (2,12) and by Cid et al (9) (2,3,9,11). Although geographic and ethnic factors may be implicated in the differences in the incidence of GCA at different latitudes, they do not seem to influence the expression of visual manifestations.…”

“…Subsequently, other studies have reported an association between the presence of systemic manifestations, in particular fever, and a lower incidence of visual manifestations or cranial ischemic complications (3,10 -12). However in most studies, laboratory parameters of inflammation did not differ significantly between those with visual loss and those without it (3,12).…”

“…These authors also observed a negative association between anemia (Hgb Ͻ12 gm/dl) and the development of severe ischemic manifestations (2). Nesher et al (3) showed that major risk factors of cranial ischemic complications (most of them were constituted by acute loss of vision) were transient cerebro-ophthalmic ischemic episodes and male sex, while the presence of systemic symptoms was protective.…”

“…Two recent studies from Spain and Israel have reported the presence of irreversible visual loss in 14.9% and 18.3%, respectively, of patients with GCA (2,3). By contrast, less recent studies have reported visual disturbances in 30 -60% of patients (4 -7).…”

PlA1/A2 polymorphism of the platelet glycoprotein receptor IIIA and risk of cranial ischemic complications in giant cell arteritis

“…Acute visual loss, attributable mostly to anterior ischemic optic neuritis, and cerebrovascular accidents (CVAs) are among the leading causes of giant cell arteritis (GCA)-related morbidity (1)(2)(3)(4)(5)(6). Permanent partial or complete loss of vision in one or both eyes occurs in up to 20% of patients with GCA and is often an early manifestation of the disease (2)(3)(4).…”