A nationwide study of ocular manifestations leading to hospital contacts among patients with giant cell arteritis

Philip Therkildsen; Annette de Thurah; Mikkel Faurschou; Bo Baslund; Ib Tønder Hansen; Mette Nørgaard; Berit Dalsgaard Nielsen; Ellen-Margrethe Hauge

doi:10.1016/j.semarthrit.2022.152071

A nationwide study of ocular manifestations leading to hospital contacts among patients with giant cell arteritis

Semin Arthritis Rheum. 2022 Oct:56:152071. doi: 10.1016/j.semarthrit.2022.152071. Epub 2022 Jul 16.

Authors

Philip Therkildsen¹, Annette de Thurah², Mikkel Faurschou³, Bo Baslund³, Ib Tønder Hansen², Mette Nørgaard⁴, Berit Dalsgaard Nielsen⁵, Ellen-Margrethe Hauge²

Affiliations

¹ Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: au336945@uni.au.dk.
² Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
³ Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
⁵ Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark.

PMID: 35878473
DOI: 10.1016/j.semarthrit.2022.152071

Abstract

Objectives: To investigate the risk of ocular manifestations leading to hospital contacts among patients with giant cell arteritis (GCA).

Methods: A Danish, nationwide, register-based cohort study including 14,574 GCA patients diagnosed 1996-2018 and 145,740 general population referents, matched on sex and date of birth. Cumulative incidence proportions (CIPs) and relative risks (RRs) of ocular manifestations with 95% confidence intervals (CIs) were calculated using a pseudo-observation approach.

Results: A total of 1026/14,574 (7.0%) GCA patients were registered with ocular manifestations within ±1 year of the diagnosis; 392/1026 (38%) being before and 634/1026 (62%) after the GCA diagnosis, and 744/1026 (73%) were registered within ±1 month of the diagnosis. The diagnoses were 336/1026 (33%) retinal vascular occlusions, 300/1026 (29%) disorders of the optic nerve, 177/1026 (17%) visual impairment, 90/1026 (9%) diplopia, and 123/1026 (12%) amaurosis fugax. The CIP for ocular manifestations among GCA patients after 3, 6, and 12 months following the diagnosis were 4.0% (95% CI: 3.6-4.3), 4.2% (95% CI: 3.9-4.6), and 4.6% (95% CI: 4.2-4.9). The 1-year RR of ocular manifestations among GCA patients was 28.0 (95% CI: 24.0-32.7), with age above 70 years, male sex, and a positive temporal artery biopsy being risk factors. Treatment with low-dose aspirin was not associated with a reduced 1-year RR of incident ocular manifestations.

Conclusions: In GCA, most cases of ocular manifestations leading to hospital contacts occur close to the time of diagnosis, with over one-third of cases occurring before the diagnosis, emphasizing the need for early recognition and treatment.

Keywords: Epidemiology; Giant cell arteritis; Large-vessel vasculitis; Temporal artery biopsy; Vision loss.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biopsy
Cohort Studies
Giant Cell Arteritis* / complications
Giant Cell Arteritis* / diagnosis
Giant Cell Arteritis* / epidemiology
Hospitals
Humans
Incidence
Male
Retrospective Studies