Vasculitis and vasculopathy
The Erythrocyte Sedimentation Rate Is Associated with the Development of Visual Complications in Biopsy-Proven Giant Cell Arteritis

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Objectives

To investigate the potential association between levels of the erythrocyte sedimentation rate (ESR) and specific clinical features of giant cell arteritis (GCA), in particular, visual loss, in a series of consecutive patients diagnosed with GCA at the reference hospital for a well-defined population.

Methods

The case records of all biopsy-proven GCA patients diagnosed at the Department of Medicine of Hospital Xeral-Calde (Lugo, Northwest Spain) between 1981 and 2006 were reviewed. Clinical information and laboratory data including ESR at the time of disease diagnosis were assessed.

Results

Only 10 (3.6%) of the 273 patients had ESR <50 mm/h. Significant differences in the frequency of visual ischemic complications according to different levels of ESR were observed (P = 0.01), mainly due to an increased frequency of visual ischemic events in patients with ESR between 70 and 100/h at the time of disease diagnosis. Twenty-five (21%) of 120 individuals with ESR values ranging between 70 and 100 mm/h experienced permanent visual loss compared with only 10 (7%) of the remaining 153 patients (P = 0.0005; OR: 3.76 [95% CI: 1.73-8.19]). An ESR between 70 and 100 mm/h was the best predictor of visual ischemic complications (OR = 2.29 [95% CI: 1.16-4.55]; P = 0.03) and irreversible visual loss (OR = 3.58 [95% CI: 1.51-8.49]; P = 0.004).

Conclusions

The results from this study show an increased risk of severe ocular complications in biopsy-proven GCA patients presenting with an ESR between 70 and 100 mm/h. Prompt initiation of corticosteroid therapy and close follow-up of these patients is recommended to minimize the risk of irreversible visual loss.

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.

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  • Cited by (0)

    Drs. Gonzalez-Gay and Llorca contributed equally to this study.

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