Do Early Diagnosis and Glucocorticoid Treatment Decrease the Risk of Permanent Visual Loss and Early Relapses in...

Area of Science:

• Rheumatology
• Ophthalmology
• Internal Medicine

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis that can lead to severe complications like permanent visual loss (PVL).
• Glucocorticoids (GCs) are the cornerstone of GCA treatment, but their long-term use is associated with significant side effects, and relapses can occur during dose tapering.

Purpose of the Study:

• To determine the incidence of permanent visual loss (PVL) in patients with giant cell arteritis (GCA).
• To assess the GCA relapse rate during glucocorticoid (GC) tapering.
• To identify factors associated with PVL and GCA relapse.

Main Methods:

• A prospective, longitudinal study conducted at a single rheumatology center in Slovenia from September 2011 to September 2014.
• Sixty-eight GCA patients were followed for a median of 104 weeks, with clinical and laboratory assessments at predetermined intervals.
• Patients were categorized into 'early GCA' (symptoms <31 days) and 'late GCA' (symptoms ≥31 days) groups.

Main Results:

• The incidence of PVL was 5.9% (4 out of 68 patients), with only one case in the early GCA group.
• GCA relapse rates were high in both early (43.6%) and late (48.3%) GCA groups.
• Relapses were predicted by significantly higher baseline levels of inflammatory markers (ESR, CRP, serum amyloid A, haptoglobin, fibrinogen).

Conclusions:

• Early GCA diagnosis and prompt GC treatment appear to decrease the PVL rate compared to historical data.
• The frequency of GCA relapses during GC tapering was not significantly impacted by early diagnosis or prompt treatment.
• High baseline inflammatory biomarker levels are predictive of GCA relapses, suggesting a need for closer monitoring in such patients.