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Ocular ischaemic complications in giant cell arteritis: CHADS2-score predicts risk of permanent visual impairment

Michael Czihal1, Janina Tschaidse2, Christoph Bernau2

  • 1Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany. michael.czihal@med.uni-muenchen.de.

Clinical and Experimental Rheumatology
|June 5, 2019
PubMed

Insights

Giant cell arteritis (GCA) patients over 70 are at higher risk for permanent visual loss (PVL). However, constitutional symptoms and axillary artery vasculitis may lower PVL risk. The CHADS2 score helps predict PVL risk in GCA.

Area of Science:

  • Rheumatology
  • Ophthalmology
  • Vascular Medicine

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis often affecting large arteries.
  • Permanent visual loss (PVL) is a serious complication of GCA, necessitating identification of risk factors.
  • Established scoring systems for ischemic risk assessment are crucial for managing GCA patients.

Purpose of the Study:

  • To identify independent risk factors for permanent visual loss (PVL) in patients with giant cell arteritis (GCA).
  • To evaluate the role of sonographic findings in temporal, carotid, and axillary arteries in predicting PVL.
  • To assess the utility of established ischemia risk scoring systems, like CHADS2 and CHA2DS2-VASc, in GCA-related PVL.

Main Methods:

  • Retrospective analysis of 152 consecutive GCA patients diagnosed between 2002 and 2013.
  • Data collection included clinical, ophthalmological, laboratory, and arterial ultrasound findings.
  • Multivariate logistic regression was used to identify independent risk factors for PVL, with CHADS2 and CHA2DS2-VASc scores calculated.

Main Results:

  • PVL occurred in 30.2% of patients, primarily due to anterior ischemic optic neuropathy (91.3%).
  • PVL risk significantly increased after age 70.
  • Axillary artery vasculitis (OR 0.3) and constitutional symptoms (OR 0.1) were negatively associated with PVL, while a CHADS2 score ≥1 (OR 10.7-25) significantly increased PVL risk.

Conclusions:

  • Age is a significant risk factor for PVL in GCA, with risk escalating post-70.
  • Presence of constitutional symptoms and axillary artery involvement may indicate a lower risk of PVL.
  • The CHADS2 score is a valuable tool for stratifying GCA patients into low and high risk categories for PVL.
Abstract

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