Hospital General Universitario Gregorio Marañón Madrid, Spain
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Juan Molina-Collada1, Marta Domínguez2, Rafael Benito Melero-Gonzalez3, Elisa Fernandez-Fernandez4, Maria. T Silva-Diaz5, Joaquín M. Belzunegui6, Ismael González7, Julio Sanchez Martin8, Javier Narvaez9, Eva Galíndez10, javier Mendizábal11, Leticia Leon Mateos12, Javier Loricera8, Alejandro Muñoz13, Santos Castañeda14, Iván Castellvi15, Marina Tortosa-Cabañas16, Vanesa Navarro17, Carlos Galisteo18, Ivette Casafont-Solé19, Jose Andres Roman Ivorra20, TAREK CARLOS SALMAN MONTE21, Margarida Rocha22, Carlota Laura Iñiguez23, Maria Vanesa Hernandez Hernandez24, Cristina Campos25, María Alcalde26, Antonio Juan Mas27, Francisco Javier Prado28 and Ricardo Blanco29, 1Hospital General Universitario Gregorio Marañón, Madrid, Spain, 2Sociedad Española de Reumatología, Madrid, Spain, 3CHU Vigo, O Carballino, Spain, 4La Paz University Hospital, Madrid, Spain, 5Complexo Hospitalario Universitario A Coruña, A Coruña, Spain, 6Hospital Universitario Donostia, Donostia, Spain, 7Hospital Universitario de León, León, Spain, 8Hospital Universitario Marqués de Valdecilla, Santander, Spain, 9Hospital Universitario de Bellvitge, Barcelona, Spain, 10Hospital Universitario de Basurto, Bilbao, Spain, 11Complejo Hospitalario de Navarra, Pamplona, Spain, 12IDISSC Hospital Clinico San Carlos, Madrid, Spain, 13Hospital universitario Virgen del Rocío, El Viso de Alcor, Spain, 14Hospital Universitario de la Princesa, Madrid, Spain, 15Hospital de Santa Creu i Sant Pau, Barcelona, Spain, 16Ramon y Cajal University Hospital, Madrid, Spain, 17H Moisès Broggi, Sant Joan Despí, Barcelona, Spain, 18Hospital Universitario Parc Taulí, Barcelona, Spain, 19Hospital Germans Trias i Pujol, Badalona, Spain, 20Hospital Universitari i Politècnic la Fe, Valencia, Spain, 21Hospital del Mar/Parc de Salut Mar-IMIM, Barcelona, Spain, 22Osakidetza, Bilbo, Spain, 23Hospital Universitario Lucus Augusti, Lugo, Spain, 24Hospital Universitario de Canarias, La Laguna, Spain, 25Rheumatology Unit, Hospital General Universitario de Valencia, Valencia, Spain, 26Hospital Severo Ochoa, Madrid, Spain, 27Hospital Universitario Son Llàtzer, Mallorca, Spain, 28Research department Hospital Infantil de México Federico Gómez, Mexico City, Mexico, 29Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Background/Purpose: Visual loss is one of the most feared complications in giant cell arteritis (GCA). Some factors have been previously associated with visual loss, as lower levels of inflammatory markers, jaw claudication or thrombocytosis, although some of these studies showed contradictory results. Our objective was to identify predictive factors of visual involvement in a large cohort of patients with GCA.
Methods: ARTESER is a large Spanish multicenter registry promoted by the Spanish Society of Rheumatology, including patients with GCA diagnosis from June 2013 to March 2019. The following variables were collected at diagnosis per protocol: demographics, symptoms (including all visual manifestations reported by clinicians), laboratory test results, temporal artery biopsy and imaging techniques (ultrasound, PET, MRI, CT).Patients with and without visual involvement were compared in a bivariate analysis. Multivariate logistic regression model was performed to determine potential predictive factors of visual manifestations.
Results: A total of 1636 GCA patients were included for analysis, of whom 599 (36.6%) presented visual involvement. The most frequent visual manifestation was anterior ischemic optic neuropathy (45.7%), followed by transient monocular vision loss (45.1%). Clinical, laboratory and imaging variables of patients with and without visual symptoms are shownin Table 1. Older age (OR 1.029; 95% CI 1.011-1.048), jaw claudication (OR 1.747; 95% CI 1.343-2.271) and diabetes mellitus (OR 1.358; 95% CI 0.994-1.854) were the only independent predictors of visual symptoms in our cohort. The presence of polymyalgia rheumatica (OR 0.498; 95% CI 0.383-0.648), fever (OR 0.393; 95% CI 0.274-0.563) and higher erythrocyte sedimentation rate (ESR) (OR 0.993; 95% CI 0.989-0.998) were associated with a reduced risk of developing visual involvement (Table 2).
Conclusion: One out of every three GCA patients present visual manifestations at diagnosis. Older age, jaw claudication and diabetes mellitus are independent predictors of visual manifestations, whereas polymyalgia rheumatica, fever and high ESR reduces the risk of visual involvement.
Table 1. Clinical, laboratory and imaging variables of patients with GCA according to presence of visual manifestations.
Table 2. Logistic regression analysis of factors associated with visual manifestations.
J. Molina-Collada: None; M. Domínguez: None; R. Melero-Gonzalez: None; E. Fernandez-Fernandez: None; M. Silva-Diaz: None; J. Belzunegui: None; I. González: None; J. Sanchez Martin: None; J. Narvaez: None; E. Galíndez: None; j. Mendizábal: None; L. Leon Mateos: None; J. Loricera: None; A. Muñoz: None; S. Castañeda: None; I. Castellvi: None; M. Tortosa-Cabañas: None; V. Navarro: None; C. Galisteo: None; I. Casafont-Solé: None; J. Roman Ivorra: None; T. SALMAN MONTE: None; M. Rocha: None; C. Iñiguez: None; M. Hernandez Hernandez: None; C. Campos: None; M. Alcalde: None; A. Mas: None; F. Prado: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6.
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