Vasculitis and vasculopathyThe Erythrocyte Sedimentation Rate Is Associated with the Development of Visual Complications in Biopsy-Proven Giant Cell Arteritis
Section snippets
Patients and Methods
The case records of all patients diagnosed with biopsy-proven GCA at the Department of Medicine of the Hospital Xeral-Calde (Lugo, Northwest Spain) between January 1, 1981 and December 31, 2006 were reviewed. This hospital is the single reference center for a mixed rural and urban population of almost a quarter of a million people. Information about the characteristics of this white population has been described elsewhere (10, 11, 12, 13).
Patients included in this study were diagnosed as having
Results
From 1981 to 2006, 273 Lugo residents were diagnosed with biopsy-proven GCA. All of them fulfilled the 1990 ACR criteria for the classification of GCA (6).
Sixty-one (22%) patients experienced visual ischemic complications. In 6 of them, the ophthalmologic manifestations occurred during admission (after the onset of corticosteroid therapy), while patients were receiving at least 40 mg/prednisone/d.
Thirty-five (13%) experienced irreversible (permanent) visual loss despite corticosteroid therapy.
Discussion
Based on a long series of unselected patients, the present population-based study confirms that the proportion of individuals with biopsy-proven GCA and low ESR, defined as ESR at the time of disease diagnosis of less than 50 mm/h, is small. Patients with low values of ESR exhibited greater hemoglobin values that those with ESR equal to or greater than 50 mm/h.
The present study also shows that the levels of ESR at the time of disease diagnosis may predict the risk of irreversible visual loss.
References (41)
- et al.
Epidemiology of the vasculitides
Rheum Dis Clin North Am
(2001) - et al.
Ocular manifestations of giant cell arteritis
Am J Ophthalmol
(1998) Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions
Semin Arthritis Rheum
(2004)- et al.
Comparative clinical and epidemiological study of hypersensitivity vasculitis versus Henoch-Schönlein purpura in adults
Semin Arthritis Rheum
(1999) - et al.
Visual prognosis in giant cell arteritis
Ophthalmology
(1993) - et al.
Risk factors for visual loss in giant cell (temporal) arteritis: a prospective study of 174 patients
Am J Med
(2001) - et al.
Immunopathways in giant cell arteritis and polymyalgia rheumatica
Autoimmun Rev
(2004) - et al.
Genetic markers of disease susceptibility and severity in giant cell arteritis and polymyalgia rheumatica
Semin Arthritis Rheum
(2003) - et al.
Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy
Semin Arthritis Rheum
(2001) - et al.
Polymyalgia rheumatica and giant-cell arteritis
N Engl J Med
(2002)
Giant cell arteritis
Curr Opin Rheumatol
Temporal arteritis: a cough, toothache, and tongue infarction
JAMA
The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis
Arthritis Rheum
Giant cell arteritis with low erythrocyte sedimentation rate: frequency of occurrence in a population-based study
Arthritis Rheum
Giant cell arteritis: laboratory tests at the time of diagnosis in a series of 240 patients
Medicine (Baltimore)
Risk factors for visual loss in an Italian population-based cohort of patients with giant cell arteritis
Arthritis Rheum
Giant cell arteritis: disease patterns of clinical presentation in a series of 240 patients
Medicine (Baltimore)
The epidemiology of the primary systemic vasculitides in northwest Spain: implications of the Chapel Hill Consensus Conference definitions
Arthritis Rheum
Illustrated histopathologic classification criteria for selected vasculitis syndromes
Arthritis Rheum
Temporal Arteritis in a Northwestern Area of Spain: study of 57 biopsy proven patients
J Rheumatol
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Drs. Gonzalez-Gay and Llorca contributed equally to this study.