Visual manifestations in giant cell arteritis: identification of risk factors from the ARTESER Registry
Authors: Molina-Collada Juan , Domínguez-Álvaro Marta , Melero-González Rafael B , Fernández-Fernández Elisa , Silva-Díaz Maite , Valero Jesús Alejandro , González Ismael , Sánchez Martín Julio , Narváez Javier , Calvo Itziar , Mendizábal Javier , Abasolo Alcázar Lydia , Loricera Javier , Ruíz-Román Alberto , Moya Patricia , Tortosa-Cabañas Marina , Estrada Paula , Prado-Galbarro Francisco-Javier , Castañeda Santos , Blanco Ricardo ,   ARTESER Project Collaborative Group, Morales Clara Moriano , Álvarez Elvira Díez , Sandoval Trinidad Pérez , Cáceres Vicente Aldasoro , Manteca María Concepción Fito , del Val del Amo Natividad , Rubio Loreto Horcada , Zudaire Inmaculada Paniagua , Courel Laura Garrido , Polo Ricardo Gutiérrez , Vélez Juliana Restrepo , Cortina Eduardo Loza , Carreira Patricia , Almorza Tomás , Mateos Leticia Léon , Rodríguez Luis Rodríguez , Urgelles Judit Font , Bermejo Pia Mercedes Lois , Monte Tarek Salman , Arrabal Selene Labrada , Frutos Anne Riveros , Casafont Ivette , Pérez Susana Holgado , Camins Jordi , Almela Clara Molina , Fernández Cristina Campos , Cid Amalia Rueda , Catalá Javier Calvo , Rodríguez Iñigo Hernández , Maceiras Francisco , Pérez Nair , Barbazán Ceferino , Pego Jose María , Altabás Irena , Guzman John , Angeles Vanessa Andrea Navarro , Corominas Hector , Castellví Iván , Magallares Berta , Millán Ana Milena , Villar María Alcalde , Valenciano Ana F Cruz , del Pozo Félix Cabero , Cambrón Ana Belén Rodríguez , Villa Cristina Macia , de Andrés Eva Álvarez , Mas Antonio Juan , Vilamajó Inmaculada Ros , Barcelo Monica Ibáñez , Toniolo Elide , Cacheda Ana Paula , Reyes María Sagrario Bustabad , González María García , Dorta Alicia García , Hernández Vanesa Hernández , Rocha Margarida Vasques , Allen Jaime Calvo , de Miguel Mendieta Eugenio , Henri Irene Monjo , Uriarte-Ecenarro Miren , Martínez Cristina Valero , Rabaneda Esther F Vicente , Porrúa Carlos García , Ubiaga Carlota Laura Iñiguez , Rivas Noelia Álvarez , Rodríguez Tomás Ramón Vázquez , Filloy Jose Alberto Miranda , Fernández Amalia Sánchez-Andrade , González-Gay Miguel Ángel , Da Veiga Carlos Galisteo Lencastre , Fontova Joan Calvet , Villanueva María Jesús García , Grijalba Carmen Larena , Álvarez Patricia Morán , Warleta Marta Serrano , Vargas Aliuska Palomeque , Garrido Noemí , Cros Clara Aguilera , Jimenez Alejandro Muñoz , Sanjuán Francisco Ortiz , Ivorra Jose A Román , Bárcena Carmen Riesco , Huaylla Anderson , Agirregoikoa Eva Galíndez , Lluch Judit , Belzunegui Joaquín María , Domínguez Luis López , Dubuc Cesar Antonio Egues , Fernández Lucia Silva 
Published: January 2024

Abstract

Objective
To determine the prevalence and predictive factors of visual manifestations in a large registry of patients with GCA.

Methods
ARTESER is a large Spanish multicentre registry supported by the Spanish Society of Rheumatology. It includes patients with GCA from across the entire country diagnosed between June 2013 and March 2019. The variables collected at diagnosis were demographics, clinical manifestations (including all visual manifestations), laboratory, temporal artery biopsy, and imaging findings (ultrasound, FDG-PET/CT, MRI angiography, CT angiography). Patients with and without visual involvement were compared in a bivariate analysis. Multivariate logistic regression was performed to determine potential predictive factors of visual manifestations.

Results
The study population comprised 1636 GCA patients, of whom 599 (36.6%) presented visual manifestations. Anterior ischemic optic neuropathy was the most frequent (n = 274 of 599; 45.7%) ocular complication. The independent predictors that increased the risk (OR; 95% confidence interval) of visual involvement were older age (1.027; 1.009–1.045) and jaw claudication (1.724; 1.325–2.243). The variables associated with a reduced risk were polymyalgia rheumatica (0.541; 0.414–0.708), fever (0.373; 0.264–0.527), longer symptom duration (0.946; 0.909–0.985) and higher erythrocyte sedimentation rate (ESR) (0.992; 0.988–0.997), common features of patients with large vessel GCA.

Conclusion
One-third of GCA patients present visual manifestations at diagnosis. Older age and jaw claudication are independent predictors of visual manifestations, whereas polymyalgia rheumatica, fever, longer symptom duration and high ESR reduce the risk of visual involvement.